The fight against child malnutrition in Burkina Faso is gaining ground but chronic malnutrition remains above emergency threshold levels, particularly in rural areas, a situation that will be resolved only if the government and its partners step up prevention efforts.
Country-wide, the severe acute malnutrition (SAM) rate was 8.2 percent in 2013, down from 10.9 percent in 2012, while chronic malnutrition rate lowered fractionally, to 31.5 percent from 32.9 percent over the same period, according to government health statistics.
These rates have shown a downward trend over the past 20 years, though with fluctuations year-on-year. In 1993, some 41 percent of children in Burkina Faso were stunted as a result of being chronically malnourished. This rose to 43 percent in 2003, and dropped to 35 percent in 2010, and then to 31.5 percent in 2013.
Moderate acute malnutrition was at 16 percent in 1993. It reached a high of 21 percent in 2003, and dropped to 8.2 percent in 2013. This is partly because treatment of acute malnutrition has significantly improved, as has the provision of supplementary foods, said Bertile Ouaro, head of nutrition at the health ministry. Still, prevention efforts for both acute and chronic malnutrition are lagging, he said.
This is particularly the case in rural areas, said Monica Rinaldi, who works with the NGO HELP in the Dori and Shebba districts of the northern Sahel Region.
One in five children under age five is stunted in Burkina Faso's urban areas, while in rural areas the number jumps to one in three, according to the 2010 Demographic Health Survey. Access to health services is far more limited in rural areas, than urban, and awareness of children's nutritional needs is lower, said experts.
Stunting rates are particularly high - 46 and 43 percent - in the Sahel and East regions, respectively.
More needs to be done to improve exclusive breastfeeding for infants in these regions, and to improve household hygiene practices and access to clean water and sanitation, said Sylvestre Tapsoba, a nutrition expert at the UN Children's Fund (UNICEF).
The government's nutrition strategy stressed improving access to nutrition-led healthcare programmes in rural areas. It planned to build 1,688 health clinics across 13 districts, placing emphasis on malnutrition prevention and treatment.
But Rinaldi says outreach is needed among rural populations as without a major push to change behaviour, the malnutrition cycle will just continue.
HELP raised awareness among communities in Dorri and Shebba, spreading the word that pregnant women and infants could access free healthcare and be screened for malnutrition. Attendance rates at nutrition treatment centres in these districts shot up by 600 percent over the course of 2013. Acute malnutrition is often linked to an illness that has not been treated, so making healthcare free for children under age five encourages families to seek care, said Rinaldi.
But stunting is often less noticeable than acute malnutrition, and thus more likely to go overlooked, admitted the health ministry's Ouaro.
Micronutrient deficiencies contribute to stunting, so the government has recommended that families introduce more varied diets for their children after weaning. It is also pushing fortified foods. In 2009, the government made it mandatory to fortify some oils with vitamin A, salt with iodine, and flour with iron and folic acid.
The problem is that it is difficult to roll these messages out country-wide, particularly in remote rural areas, said Ouaro.
Malnutrition funding - which grew significantly between 2006 and 2013 - usually favours acute malnutrition treatment, to the detriment of chronic malnutrition prevention, said Tapsoba.
At UNICEF's 2013 international conference against child undernutrition in Paris, the Burkina Faso government called for US$35 million to combat malnutrition from 2013-2015, stressing the importance of prevention. Donors funded $19.2 million's worth of nutrition projects in 2013 through the appeal but this has not been enough to make a major different in malnutrition prevention efforts, said Tapsoba.
Even $35 million would be too modest, he said.
"This budget estimate is well below the actual requirements to scale up the prevention interventions that are currently in place," he told IRIN.
If more is not done to prevent stunting, the one million chronically malnourished children in Burkina Faso "risk never reaching their physical, intellectual or developmental potential, or risk dying of diarrhoea or other infectious diseases," he warned.
Globally, malnutrition directly or indirectly causes more than 45 percent of deaths among children under five, according to UNICEF. Chronically malnourished children lose on average 10-15cm of height, will have IQ rates 10-15 points lower than the average, and are more likely to drop out of school, according to Tapsoba.