Malnutrition - basic facts

Provinces in northern Burundi have observed a dramatic increase in malnutrition rates in recent months due to consecutive weather-affected poor harvests (late or insufficient rains) and aggravated by a recent malaria epidemic.

An MSF weight for height nutrition survey conducted in Karuzi Province in November 2000 indicated a global malnutrition rate for children-under-five years of 23.8% (these children should theoretically be included in Supplementary Feeding Programs.) A new nutritional survey with retrospective mortality rates will be conducted by MSF in the coming weeks. In the province of Karuzi (centre-north of Burundi) where MSF runs nutritional programmes, the capacity of therapeutic and supplementary feeding centres (TFC/SFC) are having to be constantly increased to cope with new arrivals of severely malnourished children. Figures are alarming: As of January 2001, the TFCs (total four) take care of 1,100 severely malnourished children (In January 2000, the figure was 232.) Everyday, approximately 100-200 new children are admitted in the TFCs, following the international criteria for malnutrition. With the foreseen opening of two additional TFCs within the next two weeks, total capacity will increase to 2,300 children.

SFC - January 2001 - 19,000 children in the program (ten times more than in January 2000 when the figure was 1,900.) Total capacity of the SFCs is reaching its limits - The total capacity is 20.000. MSF activities currently require more than 1,000 national staff and 43 expatriates. The malaria epidemic in Burundi is still not under control. MSF conducts more than 35,000 consultations per week. Malaria hampers the capacity of Burundians to work in their fields and also increases the numbers of people with severe anaemia.

Evolution

As the next harvest will take place in May/June, no immediate improvement in the situation is foreseen. MSF cannot say there will be a famine, but the situation in the province of Karuzi may clearly deteriorate beyond control in the next few months. This is traditionally the period known as the 'hunger gap', where there is a shortage of food while awaiting the next harvest. In order to combat this, a General Food Distribution (GFD) must be organised by the World Food Program (WFP) whereby a full food ration is distributed to the whole population. If no GFD is organised, the consequences for the population, both children and adults, will be dramatic. In order to address the basic needs of the population, and to prevent the worst case scenario for the future, MSF urges the responsible agencies such as WFP, with the support of the community of donors - in conjunction with relevant NGOs to:

• ensure a general food distribution in the affected provinces
• assure the care of malnourished adults
• distribute seeds and tools (by FAO) in conjunction with a distribution of a seed protection ration (by WFP)

Explanations/Developments

General Food Distribution for all populations in the affected provinces, with full ration for all family members until the next harvest. The children are the most vulnerable group. They are the first ones to be affected in a nutrition crisis and give an indicator of what may occur later to adults. Many families already do not have enough food and the situation will only deteriorate in the coming months. The population needs food to fill the gap until the next harvest (May-June). The SFCs are already already overloaded. Without a GFD, the SFCs will not be able to cope with the number of new admissions.

Malnourished adults

As MSF programs principally target children, the organization does not currently have a clear assessment of the situation of the adults. In view of the number of beneficiaries already in the programs, MSF is calling on other agencies to take in charge adults affected by malnutrition. Nevertheless, MSF is already confronted with and is admitting malnourished mothers (many of who are no longer able to breast feed), with malnourished babies to the feeding centres. In the SFCs, MSF staff have also observed that food provided to malnourished children is often shared between all members of the family, thus not having the desired effect on the beneficiary. 

Distribution of seeds and tools

In prevision for the next harvest (May-June), farmers can sow until mid-February. Problems: people don'­t have any/enough seeds, and they lack the energy to work in the fields (due to effects of malaria and malnutrition.) The small harvest due now in January will be approximately 30% down compared to a normal year. Confronted by hunger, many people ate a part of the seeds they received during the last distribution (2000.) Conclusion: the next seed distribution by FAO - foreseen for February - must be distributed with a food protection ration by WFP, which is separate from the need for a GFD. 

Karuzi Province and MSF

Population: /- 350.000 people Today: 4 TFCs (2 further to be opened within two weeks) and 10 SFCs TFC/SFC programmes based in the north of the province. In the South, only 3 SFCs due to security constraints. Consequently: a less thorough overview of the situation in the south.

Other sources

OCHA press release (extract), 24.01.01 'Dramatic increase in malnutrition rates in Northern Burundi'

'Provinces in northern Burundi have observed a dramatic increase in malnutrition rates in recent months due to consecutive drought-induced poor harvests and a malaria epidemic. UNICEF reports that admissions to nutritional centres have increased up to 68% countrywide since September 2000. While 46,700 individuals suffering from malnutrition were admitted to supplementary feeding centres in September 2000, three months later, in December, the number had risen to 80.000. Developments in Therapeutic Feeding Centres are similarly worrying. 2,800 severely malnourished patients were newly admitted in September 2000, 4.000 in December, UNICEF says. The province of Karuzi is of particular concern. Other provinces affected are Kayanza, Muyinga and Ngozi. The health NGO MSF says the situation in Karusi province may deteriorate beyond control, if general food distributions are not commenced immediately.'

World Vision Rapid Appraisal of Food Security in Karuzi Province November 2000 (extract):

'World Vision had conducted a rapid appraisal of the food security situation in Karusi in March 2000 in conjunction with the MSF-Belgium nutritional survey and a smaller scale appraisal in July with FAO seed program. Because of the drought conditions (late arrival and early cessations of rains), there has not been a harvest since that time except for a few beans and some manioc and sweet potatoes in June. Essentially, many farmers lost the season 2000B harvest (usually May-June) to drought. For those who had land in the marsh areas, the season 2000C harvest was also lost (usually August - October) because the marsh areas had dried up and the water table lowered considerably. 'By November, the World Vision team had already concluded and the farmers themselves reaffirmed that this is a very hungry time bordering on famine (MSF-Belgium conducted a weight for height malnutrition survey in Karusi Province in November 2000. The results indicated a global malnutrition rate for children under five years old of 23,8%).'