ANTANANARIVO, Madagascar, 14 May 2007 - Dr. Ranto Andriantsara hurried to his office when told a team from UNICEF had just driven into the dusty compound that houses the Amboasary hospital. He looked startled, not quite expecting his visitors that early in the morning. Graciously, he ushered them into his office.
They were a team of four, comprising a local film crew and a Reuters journalist, exploring a phenomenon UNICEF Madagascar calls the 'silent emergency' - a chronic, underreported nutrition crisis afflicting large areas of this vast Indian Ocean island.
As the chief of a regional hospital, Dr. Ranto was well placed to help explain the silent emergency and its causes.
"The three regions of southern Madagascar [Anosy, Androy and South-West] suffer from recurrent droughts and food insecurity," he said. "Malnutrition is therefore a chronic problem. Nearly half of all under-five children are undernourished. In times of a severe drought, as happened in the last quarter of 2006, we see an upsurge in the number of severely malnourished children. In this hospital, 140 children have been treated since October 2006."
Warning signs in 2006
As Dr. Ranto noted, southern Madagascar endured a drought towards the end of last year. Early signs of trouble were detected as early as June 2006, when aid agencies warned of declining maize, sorghum and cassava harvests.
Nutritional surveys conducted in the three regions in December 2006 revealed rates of acute malnutrition among under-five children that reached 13 per cent and higher in some areas. About 6,000 under-five children were wasted, indicating a recent and severe weight loss often associated with acute starvation or severe disease.
The surveys estimated that a further 85,000 young children and 25,000 pregnant or lactating women were at risk of malnutrition.
The government issued an appeal for help in January 2007. The World Food Programme and non-governmental organizations stepped up food distribution, and UNICEF and the Ministry of Health set up nutrition rehabilitation centres to treat malnourished children. By the end of March, more than 5,000 children had been treated, 500 of these for severe malnutrition.
Rains allow planting of crops
Ms. Dauphine, a 26 year-old farmer in Ambovombe, blames lack of rain for the poor harvests last year. In a twist of irony, the arrival of cyclones at the beginning of this year brought much-needed rains to the south, enabling farmers to plant their maize, sorghum, and cassava crop.
The rains, however, were too short to yield a handsome harvest.
"It is thanks to this cyclone that we can begin to farm. Of course, the harvest will not be enough," said Ms. Dauphine.
Underlying causes of the crisis
Apart from droughts and lack of food, malnutrition is caused by several factors. Project Director Antoine Deligne of GRET, a European Union-funded NGO, explained that chronic child malnutrition is a symptom of deeper structural problems in society. Poor transport and communication, lack of irrigation infrastructure and inadequate access to safe drinking water and sanitation are among the underlying causes.
"The south is a semi-arid area and the rainfall is unpredictable," said Mr. Deligne. "It is also a very isolated place, with little or no communication. People live from what they produce."
Many Malagasies eat rice three times a day. Though rich in carbohydrates, this staple food is short on minerals, proteins and vitamins - a deficiency that weakens the ability of children in particular to fight off illnesses such as measles, malaria, and diarrhoea.
Long term solutions
According to UNICEF Madagascar Nutrition Officer Paola Valenti, the answer lies in longer-term solutions that address the chronic nature of the crises. These solutions include the bi-annual mother and child health weeks, through which mothers and under-five children receive vitamin A and de-worming tablets.
Providing pregnant women with iron, preventing and treating malaria, increasing exclusive breastfeeding of infants, and vaccinating all young children will ensure that children are better able to cope with nutritional crises the next time they occur, Ms. Valenti added.
"We are also working to strengthen the ability of communities to monitor the growth and nutritional status of children," she said. "In this way, communities will be able to identify vulnerable children and seek help before these children plunge into severe malnutrition and, quite possibly, death."
A grandmother and grandchild outside a therapeutic feeding centre in Ambovombe; the child was left in the care of his grandmother when his young mother went to seek a livelihood in another town.