The staccato cries of young children pierce the hot, humid air as babies and toddlers are weighed at a monthly health session in rural Mahatsara village in Madagascar. In a hut fashioned from local palm trees and corrugated tin, a scale hangs from a large hook balanced on a beam. Its black needle moves sharply, registering each child's weight. "Eight kilos [17 pounds]," a health worker calls out as a 2½-year-old girl's bare feet dangle over the wood floor.
The worker logs the child's weight into her health record. Next, is measurement of the child's arm circumference. A white paper band is circled and tightened around her thin arm until it reveals her nutritional status—whether she has fallen into the red/danger or yellow/warning zone.
Mothers fan away the heat with their children's record booklets while their children cling to mothers' wrap skirts in fearful anticipation of their turn at the scale. One by one, more than 100 children under age 5 are weighed and measured. Health workers record each result on a large handwritten chart hanging on the wall. During this particular weighing session, 15 children were in the red zone and two, in the yellow zone.
Critical First 5 Years
Angeline Lalao's son Jonica registered in the red zone during a recent weighing session. The 2-year-old's belly was distended, and he had developed a persistent cough. "He used to sit on my lap listless," says Angeline. "He had no energy to play."
Nutrition Training for Expectant Moms and Dads
Expectant mothers are a key component in safeguarding the health of children. SALOHI caters to this group by promoting prenatal care, organizing monthly weigh-ins and arranging informational sessions on the care and nutrition of pregnant women and children.
Topics include malaria and diarrhea prevention, breastfeeding, hygiene, the importance of vaccinations and the nutritional needs of a pregnant woman and young children.
Men are considered crucial to a healthy pregnancy and nutrition. Expectant fathers are invited to attend prenatal visits, where they learn their role in helping mothers receive adequate nourishment throughout their pregnancy.
Like most Malagasy, Angeline thought feeding her son more rice was the solution. The cherished grain makes bellies feel full but lacks the nutritional wallop necessary to help young bodies grow. On an average day, Angeline was feeding Jonica 1½ cups of white rice supplemented, on occasion, with more rice or a banana as a snack.
"It gives my mind a workout when he's hungry," says Angeline. "I'm constantly trying to find ways to help him."
A solution finally came in the form of Strengthening and Accessing Livelihood Opportunities for Household Impact (SALOHI), a program that works to provide safe, nutritious food. Catholic Relief Services and our local partners are implementing this project, which is funded generously by the American people through the U.S. Agency for International Development. The first 5 years of life are critical to a child's growth and development, and monthly weighing sessions are part of a comprehensive package to safeguard the health of expectant mothers and children under 5.
Low weight prompts health care workers to pair mothers who have healthy children with those who have malnourished children. The mothers of healthy children share tips, answer questions and lead cooking lessons on how to keep their children healthy. In addition, the program brings pregnant and nursing mothers together to exchange best practices and prevent malnutrition before it starts.
Countering Nutrition Misconceptions
The scent of roasting peanuts fills the open-air kitchen as a woman leans over a stove to see if they're ready. Smoke billows around her and the toddler strapped to her back with a fuchsia wrap. Mothers like Angeline and their young children chatter excitedly as they slice bananas, sift through dried shrimp and chop moringa leaves for their midday meal.
Over a 12-day period, the 15 mothers and their at-risk children will meet to learn and feast on new recipes. On the menu are corn, cassava, peanuts, shrimp and moringa. Noticeably missing is rice.
The women lay out all of the ingredients in raffia baskets. As each ingredient is added to the cooking pot, community health worker Florianne Finarimianta explains how it will benefit their children.
Misconceptions about proper nutrition abound: In the past Finarimianta had to convince women to exclusively breastfeed for the first 6 months. Most of the mothers, fearful that milk was not enough, had turned to feeding infants mushy rice or "ranapango," a local drink flavored with burned rice. The grain has been the staple meal for so long that learning about the nutritional value of other foods is a crucial lesson for mothers. In addition, the health worker encourages hand-washing before eating and use of latrines to help prevent diseases that lead to malnutrition.
Watching Remarkable Improvement
With the stew ready, the 15 small children line up and take turns getting their hands washed with water poured from a white plastic pitcher before they settle into their mothers' laps. They dip into the shallow bowl of steaming peanut stew with adult-sized spoons almost as large as their small hands. Eyes widen with delight as they slowly savor the new tastes.
In 12 days' time, they'll be reweighed. Each child is expected to gain an average of 14 ounces. Almost all of them will have moved up to the yellow or green zone.
Facing grim decisions about how to feed their children, two mothers turned to CRS and SALOHI for healthy solutions. Read their story.
For Angeline, the change in her son over those 12 days was remarkable. "He got off my lap and began to play outside," she says. "He is no longer listless."
Knowledge Mothers Need
Next month, the Mahatsara community health center will once again teem with mothers and their young children. Record books will fan overheated kids and health volunteers will once again document the nutritional status of each child on the center's wall chart.
During the dry season, food stocks run out and cause spikes in hunger. The hope is that, one day, all children in the community will be well nourished. In the meantime, CRS and SALOHI are providing a safety net to reduce poverty and provide mothers with the knowledge they need to nourish their children.
Sara A. Fajardo is CRS' regional information officer for
East Africa and southern Africa. She is based in Nairobi, Kenya.
Andrianambinina Randimbiarison is the communications director for the SALOHI program. He is based in Antananarivo, Madagascar.