Relief officials say better access to health care and family planning education can help reduce the number of malnourished children in Niger, where malnutrition rates remain above emergency levels, despite stronger rains and better harvests.
Despite record harvests in October, more than 300,000 Niger children were treated for severe acute malnutrition. This is more than Niger’s last major food crisis in 2005.
Agriculture and livestock regularly suffer from massive droughts and floods in Africa's Sahel region. Coupled with basic farming technology, limited access to doctors, and a burgeoning population, Niger's 15 million people are repeatedly affected by annual food crises and pushed deeper into poverty.
But the UNICEF nutritional specialist for West and Central Africa, Robert Johnson, says fighting malnutrition in Niger is not simply a matter of food quantity.
"Food security is considered the access and availability to an adequate amount and quality of food," he said. "And that is very different from nutrition, which is actually getting the food into your mouth and using them for your best possible development."
Niger has one of the highest birthrates in the world with an average of eight children per family. Relief officials say more than half will die before the age of five. For those who do survive, a majority will suffer from chronic malnutrition and stunted growth.
"There is a clear link between access to healthcare and acute malnutrition being a disease and not only a deficiency of food," said Patrick Barbier, head of the Niger mission for Doctors Without Borders. "Access to health care is poor, so the health status of the children is poor. So whenever there is a food shortage they are immediately affected, because they do not have resources, they do not have coping mechanisms, they do not have strong immune systems. So they fall very quickly and they die at the end."
Niger has more than 270 feeding centers to provide nutritionally-rich food and drink. But Robert Johnson says treating malnutrition only when it becomes a serious problem puts everyone in a very difficult position.
"There is a movement towards risk reduction," he said. "We have to focus a lot stronger on education and making sure girls get through education and not having children at 14, 15 years of age."
Aid agencies help supplement local diets with high-caloric, nutrient-dense foods. This helps ensure children get the required vitamins, minerals and proteins.
"This helps to build a nutrition resilience that allows children to get through the most vulnerable two years of life and then have a chance to go to school, have a chance to learn, have a chance to grow up and be healthy during adulthood and be productive," Johnson said.
Johnson says the number of malnourished children is greater than those with HIV and tuberculosis combined, yet tackling malnutrition is far cheaper.
"With all the work in HIV and TB, it took a long time to convince people that treatment actually worked," he said. "And then once treatment actually worked, I think everybody got on board and started to say, 'O.K. now we have treatment covered let’s be serious about prevention.' And I think that is where we are starting to get to with the treatment and prevention of acute malnutrition."
As Niger's military government prepares to return the country to civilian rule with presidential elections on Monday, one of the most pressing concerns for the new government will be providing better family planning and access to healthcare to reduce chronic malnutrition.