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Missing Out
Landlocked Niger on the southern edge of the Sahara Desert is one of the poorest countries in the world, and less than a third of its population have access to any health care. Malnutrition remains the main cause of maternal and infant mortality: there's a hidden hunger among almost all the women and young children, caused by iron-deficiency anaemia. It's an unseen problem, that slowly steals away the body's strength and immunity to disease.
Zalika was so severely anaemic she collapsed after she gave birth - she had to spend two weeks in hospital. She's just one of the two billion people around the world who lack iron - an essential micronutrient. People who get enough red meat in their diets don't usually become anaemic - but red meat is expensive in countries like Niger, and when it's available the men tend to get the lion's share. Malaria and intestinal parasites both make anaemia worse.
In Niger's rural areas, pregnant women rely on the knowledge of village birth attendants like Zeinaba to help them through childbirth. In Tourikoukey, in the west of the country, three-quarters of the women are anaemic. It's so common there's a word for it in the local language - it's 'lack of blood'. Women know they should really go to hospital to be treated, but that costs money - which would mean even less food for their families.
Dr Amadou Boukari, Head of Nutrition at the Ministry of Health, describes the problem of anaemia: "Iron deficiency needs a particular strategy because the dose isn't weekly, monthly or quarterly - we have to give it every day." He admits the health service just cannot cope with the problems of distribution, even if they had enough iron tablets.
Helen Keller International trains midwives to distribute iron folate tablets to pregnant women - and the results are encouraging. But treating pregnant women is just scratching at the surface of the problem, says Helen Keller's Regional Director Shawn Baker. "During the adolescent growth spurt, the levels of need for iron are extremely high - they go up dramatically - and girls marry very young here - often 15 or younger. So you're starting this vicious cycle that girls are anaemic - they go into their first pregnancy anaemic - and they never recover between pregnancies."
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Despite the involvement of the Head of State in promoting micronutrients, the situation in Niger is desperate. There are only 10 qualified nutritionists in the whole country, and drought and uncertain harvests mean that food supplies are precarious. Most people survive on a staple diet of millet, which actually inhibits the absorption of iron, and rural families only manage to eat meat a few times a month.
And malaria makes anaemia worse, because the parasite destroys red blood cells. Fati spent a lot of money on hospital tests, and they told here she was anaemic. "Look at my hands and my eyes! I'm dizzy and I can't stand for long when I'm dizzy it always makes me vomit. I find it difficult to stand up on my own. When I went to the maternity hospital I met many women with the same problem -they all complained about malaria."
Malaria is even more of a problem in the coastal zone of Tanzania, on the other side of the continent, and is causing an increase in anaemia, which, in some areas, affects 93 per cent of children under five. Often, intestinal parasites make matters worse. This affects children's schooling as well as their health.
Schoolteacher Fatuma explains: "They become very weak and, even in class, they can't concentrate because they are tired all the time. And in class their brain becomes slower and slower and they get worse every day. They can attend for three days and then they're absent for two. Sometimes they attend in the morning but then not in the afternoon because they are so weak Because of the malaria they become anaemic and then they get malaria again."
The Tanzanian Food and Nutrition Centre is working with four health centres in Bagamoyo to try and replace the iron lost in children due to malaria. Children under five are given deworming pills and iron syrup. But the state of the primary health care network means that many do not complete the course.
Preventing the spread of malaria is important, but difficult. Mitamaa bought a mosquito net when her first child was born 19 years ago, but she's unusual - and she couldn't afford to buy another one now. "To buy one now - it's 3,300 Tanzanian Shillings. I don't have that money because I can't afford it - I live by farming - I dig cassava and I use this to feed my children. If I sell the cassava what will I feed my children with?" Four children sleep under the net, but the rest of the family is unprotected.
Dr Sabas Kimboka, of the Tanzanian Food and Nutrition Centre, says that poverty is at the root of the health problems: "So long as poverty reigns in this part of world all these problems will continue to be afflicting us." Meera Shekar of Unicef agrees: people's diet is unlikely to improve as long as they are so poor: "Supplementation is something that would probably need to be continued on a medium term if not long term basis."
And she says that adolescent girls need much greater attention. "Adolescent girls are a very, very critical group as far as anaemia, malaria and iron supplementation, all three of those, are concerned." As in Niger, they have early pregnancies - 16 per cent of pregnancies are to women under the age of 18. But often, the iron pills are not well tolerated, and the girls stop taking them.
It's going to take a big education push to promote good nutrition and the importance of eating iron rich foods before the rates of anaemia go down, as Dr Kimboka recognises. "We have a problem of sustainability in our country... You find a project like this is supported from outside, and it's short lived. So when the supporters are ready to pull out you find the country is not ready to take over."
Dr Kimboka also complains that the IMF Structural Adjustment Programme has affected social services in Tanzania for the past 15 years. "Before that the funding for social services in this country was a bit better but from that time, things have become worse and worse. Social services are not funded and we are servicing external debts, that's the problem." But he's hopeful that debt cancellation will now provide the country with a new start. "With cancellation of debts, we think that we'll be able to put more funds into health services - including nutrition - and we should be able to sustain some of these projects which we are initiating."
TRANSCRIPT
Read the full transcript of Missing Out
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