The Republic of The Gambia, situated on the western coast of Africa, forms a narrow enclave in the Republic of Senegal except for a short seaboard on the Atlantic coastline. The population, very young, is now predominantly urban. Nevertheless agriculture remains a key sector of The Gambia’s economy and is the source of livelihood for more than three-quarters of the population. Economic performance has improved, but as yet, this has not translated into reduced poverty, which remains widespread and severe, with about 60% of the population below the poverty line.
Although a slight improvement has been observed since 2000, infant and under-five mortality rates remain high. A high maternal mortality ratio is also observed. Access to health facilities is relatively good, but poor quality of services reduces the effectiveness of the health system. Nevertheless, immunization coverage among children is expanding.
In the context of high population growth, agricultural production is limited and The Gambia depends heavily on imports of food staples. Dietary energy supply is barely sufficient to meet population energy requirements and 30% of the population is undernourished, a proportion which has increased over the last decade. Low agricultural production, recurrent droughts and poverty contribute to food insecurity among the population.
The diet is largely based on cereals, mainly rice and millet and, to a lesser extent, sorghum, maize, and wheat. The staples are complemented by vegetables, milk, fish and groundnuts. The share of most micronutrient- and protein-rich foods in the dietary energy supply has not increased while that of vegetable oils and sweeteners has increased substantially, reflecting the nutrition transition experienced by The Gambia. The share of lipids in the dietary energy supply reaches the upper limit of recommendations while that of protein remains at the lower limit.
Thanks to efficient promotion programmes, young child feeding practices have improved. Efforts should be maintained to encourage early initiation of breastfeeding, exclusive breastfeeding up to 6 months of age and adequate complementary feeding practices. Among preschool children, malnutrition remains a public health problem. More than a quarter of the children under-five is affected by chronic malnutrition (i.e. stunting), a prevalence which has slightly increased over recent years. Meanwhile, the country is undergoing a nutrition transition, with the emergence of obesity affecting especially women living in urban areas and, in parallel, the persistence of under-nutrition, particularly among women living in rural areas.
There is a lack of recent data on micronutrient deficiencies in young children and women. As observed among school-age children in 1999, prevalence of iodine deficiency disorders was high, with marked geographical disparities. Regions most at risk were Lower River, Central River and Upper River. A salt iodization programme recently started but coverage is still very low. On the basis of sub-clinical data, vitamin A deficiency was a severe public health problem among young children in the late 1990s. Broad vitamin A supplementation coverage among children and mothers may have reduced the prevalence of vitamin A deficiency but recent data are lacking to demonstrate this. Anemia was assessed in 1999 as being a severe public health problem among young children and women. Various programmes have been implemented to combat iron deficiency anemia, but impact still needs to be evaluated at national level. Overall, more long term measures, such as food diversification, need to be strengthened considerably to combat micronutrient deficiencies.
Trends in undernourishment and stunting are worrying and call for a strong reinforcement of all interventions aimed to improve the nutritional status of the population. In the context of the “double burden” of malnutrition, The Gambia also needs to tackle emerging nutrition-related chronic diseases.