The Republic of Malawi is known throughout Africa for the warmth and generosity of its people. In fact, many say Malawian kindness explains at least in part how the nation has been able to cope during hardship. Here, tucked in sub-Saharan Africa, strife comes in the form of drought, famine and widespread AIDS and other diseases. Malawi has one of Africa’s highest HIV rates (one in six people is infected with the virus), which, according to a recent report by the United Nations Development Programme, is further lowering the national average life expectancy of 37 years. In the past, Malawians lived into their 80s and 90s, and even past 100. But like its neighboring countries, the health problems Malawi has faced are not all due to the spread of HIV.
Throughout the 20th century, and in particular the 1990s, poor harvests resulted in significant food shortages. Drought, disease, corruption and mismanagement of agricultural resources have contributed to past famines, and most recently, food price inflation has become a driving force behind hunger in Malawi. Steep increases in food prices made it difficult or impossible for Malawi’s poorest citizens to purchase food–a sizeable percentage of its population of 12 million.
Following the creation of the Department of Nutrition and HIV, a series of policies in 2006 made nutrition a top national priority. One of the government’s initiatives is to create posts for nutritionists in key positions at every level of the system–from local communities to bureaucratic offices. The message nutritionists are spreading to parents, teachers and community leaders is the importance of variety within the diet through emphasizing indigenous foods.
“Just because a household has food does not necessarily mean its individuals are getting an adequate amount of nutrients,” says Beatrice Mtimuni, a nutrition professor at Bunda College. Chronic malnutrition for children under the age of five in Malawi hovers around 50 percent. “What is important is that people stop thinking of maize as the only food.”
Malawi’s main staple is nsima, a thick porridge made from water and flour. The flour is usually ground from maize, cassava (a tapioca-like root) or millet. Because these starchy staples are rarely combined with other foods such as legumes and nuts, vegetables, fruits, animal foods, fats and oils, the typical diet in Malawi is severely lacking in such nutrients as vitamin A, iron/folate and iodine.
Reintroducing a variety of foods to the diet has as much agricultural significance as it does nutritional and cultural importance. For while Malawi is one of the financially poorest countries in the world, the country is rich in natural resources. “We have a 12-month growing season and almost 600 different local foods that we could be choosing to grow and eat, yet we have been ignoring these in favor of growing one crop–maize,” says Stacia Nordin, RD, who first came to Malawi 11 years ago through the Peace Corps to work with people with HIV. “Many of the causes of poor yields–droughts and floods, for example–are actually made worse by overreliance on one or two crops.”
In 2002, the media attributed a much publicized food shortage in Malawi to widespread drought. However, when the World Food Program released its rainfall statistics for that year, much of Malawi had actually received 100 to 125 percent of the average annual rainfall. The “drought” was in fact a two-week gap in rains that made highly vulnerable maize crops fail to mature fully. Crops other than maize–grains, legumes, fruits and vegetables–had relatively normal harvests, says Nordin.
Through the new nutrition programs, people may learn to prepare avocado leaves, sweet potato or fish cooked with green bananas, depending on the area’s resources. Along Lake Malawi, Africa’s third-largest lake, the main staple is cassava, which is peeled and soaked in water for several days until soft, then washed and sun-dried. The lake itself offers 500 species of fish. Harnessing these resources is another component of the government’s food and nutrition goals, and initiatives emphasize self-sufficiency through providing subsidies for seeds, fertilizers and other resources. So far, it seems to be working.
Government nutritionist Sylvester Kathumba coordinates a program that has nearly eradicated acute childhood malnutrition in Dowa, a vast rural region of tobacco farmers hit hard by famine. Dowa and several other regions have been piloting unique outpatient approaches to treating health problems among mothers, children and people living with HIV/AIDS. Known as community-based therapeutic care, the program primarily manages acute malnutrition, which typically causes stunting and, less commonly, wasting and edema. Whereas community volunteers previously focused on weight assessment alone, now they are being trained in anthropometrics, edema assessment and basic nutrition. Education about indigenous foods is central to the program, and in addition to instructions on better nutrition and counseling on breastfeeding, hygiene, sanitation and family planning, families receive seeds for crops.
Since the Dowa program began in 2002, acute malnourishment in children 0 to 5 years old has dropped from17.5 percent to 0.4 percent and moderate malnutrition is down to 2 percent in the region. While the statistics may be impressive, it is the faces of individuals that bring it home for Kathumba. He recalls a 4-year-old boy who was admitted for acute malnourishment. Every member in his family was HIV-positive, which is not uncommon in Malawi. The boy was recently discharged from the program and his family’s overall condition stabilized. “They implemented everything [about nutrition and farming] that we told them,” says Kathumba. “Now they are producing a lot of crops that they are selling.”
Stories like this continue to motivate Nordin, who today works with the Malawian government’s School Health and Nutrition program as an advisor. “In 1999 the Ministry of Education, Science and Technology began a school feeding program that relied heavily on food donations,” says Nordin. “My role is to work with government staff to help build systems of coordination so the program becomes more sustainable on a national level by using local resources.”
Nordin runs a pilot program for food and nutrition sustainability. School and community leaders across the country are taught about improving nutrition through a more diversified diets and shown how to harvest crops using a sustainable agriculture approach known as permaculture. Following the training, some schools go on to harvest a variety of crops for consumption while others sell their bounty at local markets. Facilitating this process involves regular meetings and communication to develop community-based strategies, action plans, calendars of events, databases and other tools that connect various teams and contacts within the program, as well as five separate government ministries plus development partners, such as United Nations agencies or other governments.
“Already we have seen 40 schools adopt these improved food and nutrition practices. If this pilot scales up, we will be aiming to get the same results at over 5,000 primary schools throughout the country,” says Nordin. “We’re right on the brink of a massive breakthrough.” And the schools are not alone. Local farmers, extension workers, development organizations and government policies are starting to implement and support similar local initiatives all over Malawi. “It is extremely rewarding to see the self-confidence that has grown in these communities as a result of finding sustainable solutions to local problems,” says Nordin.