Mali

SUMMARY

In Mali, the nutritional status of children under five years of age is extremely worrying. The results of the latest national survey carried out in 1996 show rates vastly above those established by WHO: 11% are wasted (half of them severely wasted), 49% are stunted and 27% have a low weight-for-age. This situation is particularly worrying, as it has not improved over the past ten years. The Demographic and Health Surveys of 1987 and 1995-96 indicate that during this period the malnutrition rates for children under three years of age have practically doubled. There are significant differences at a regional level : the Kayes region has twice more wasted children than other regions (22%, 14% of whom severely wasted); and the regions of Timboctu/Gao (urban areas), Mopti and Sikasso have a higher rate of stunted children (around 55%). Taking into account the three main anthropometric indicators (weight-for-height, height-for-age, weight-for-age), the nutritional situation is better in Bamako and the Koulikoro region.

As regards adults, BMI rates below 18.5 indicate that thinness is more frequent among women than men (19% as opposed to 15%). Great regional disparities again underscore a more serious situation in the Kayes region (25% of women and 18% of men have a BMI <18,5).

The greatest micronutrient deficiencies are primarily in Vitamin A and iodine. Although these deficiencies are better documented for some regions than for others, they point to a serious public health problem at the national level. The rate of night blindness (indicative of Vitamin A deficiency) in children under five was 6.5% in Timboctu and Ségou. Goiter is endemic in most regions, particularly in Ségou, where over 60% of school-aged children are affected.

The Consumption Expenditure Survey for 1988-89 indicates that food intake provides an average of 2,250 kilocalories per person per day throughout the country. it also shows regional differences, linked on the one hand to household incomes and on the other to food and cultural habits. The latter in turn differ according to ecological areas and people's life styles. The level of energy intake does not seem to reflect the malnutrition rates mentioned above. Indeed, energy intake is higher than these rates would seem to indicate, which means that factors other than food have contributed to malnutrition. Although widespread throughout the country, breast-feeding is not always practiced correctly. For instance, in Kayes, in spite of the fact that 60% of children from 0 to 3 months old are exclusively breast-fed, only 31% of children 6-9 months old receive supplementary feeding ; on the other hand, in Ségou these rates were found to be the lowest (21% and 25%, respectively).

Health and socio-economic conditions also vary considerably from region to region. The lowest percentage of children 12-23 months of age having received all vaccinations for those diseases targeted by the Extended Vaccination Programme (PEV) are in Kayes (13%) and Mopti (22%). Diarrhea is a frequent problem in Mali ; the highest prevalence is found in the Mopti region (37%), followed by Kayes (22%). Moreover, in Mopti and Ségou access to drinking water and adequate sanitary structures is lowest. It should be noted that the populations of Mopti and Kayes are those most affected by malnutrition.