About half of Madagascar's children under the age of five are stunted - the irreversible effect of undernourishment during the first 1,000 days of life. Children who suffer from stunting are at greater risk of illness, impaired cognitive development and death.
Madagascar has the sixth highest incidence of stunting in the world, according to the UN Children's Fund (UNICEF). Poverty is a key contributor to the country's malnutrition rates. According to the February 2012 Southern Africa Regional Food Security Update, 80 percent of Madagascar's 20 million people live on US$1 a day or less, and poor households spend nearly three-quarters of their income on food.
High rates of infection during pregnancy and childhood also contribute to stunting in Madagascar. Poor nutrition means that girls often do not reach their full growth potential until they are 21, by which time many are already mothers. About 39 percent of Malagasy women measure under 150cm in height and are more likely to have low-birth-weight babies.
In the capital of Antananarivo, residents' preference for the staple rice - resulting in the exclusion of other food items - also affects child nutrition. A National Community Nutrition Programme (PNNC), which receives technical and financial assistance from UNICEF, has been implemented across 6,000 centres nationally, with the aim of diversifying diets for better nutritional health.
The centres provide nutritional advice and cooking lessons to encourage the consumption of a variety of cheap, nutritious, locally available foods. The centres also monitor the nutritional health of children under age five.