The Republic of Mali, vast landlocked sahelian country of West Africa, is subject to strong climatic and natural constraints. A high population growth exerts pressure on the country’s resources. The population, young and predominantly rural, is largely engaged in the agricultural sector, which is the mainstay of the economy. Poverty affects more than half of the population.
Limited access to basic health care, insufficient quality of care and low immunization coverage contribute to very high young child and maternal mortality rates, although both are declining. The situation is further worsened by limited access to safe water in rural areas and lack of adequate sanitation.
The agricultural sector has developed considerably due to policies that have had a positive impact on cereal production and rice production in particular which has increased considerably. Livestock rearing is also an important component of the agricultural sector. Domestic production generally meets population needs in cereals but the vulnerability of agriculture to fluctuating rainfall patterns forces the country to rely on emergency food aid some years. Dietary energy supply meets population requirements. Undernourishment affects about 10% of the population, a proportion which has decreased slightly over the last decade. Although food security has improved, households remain highly vulnerable and chronic food insecurity persists.
The diet is mainly based on cereals (millet, rice, sorghum, maize). The staples are complemented by dairy products and to a lesser extent by pulses (cowpeas), starchy roots (sweet potatoes, yams, cassava) and fruit and vegetables. The diet lacks diversity and is poor in essential micronutrients. Cereals represent more than two-third of the dietary energy supply. The share of traditional cereals (millet, sorghum) in the cereal supply has declined in favour of rice and maize. In urban areas, food consumption patterns are changing and rice has become predominant.
Breastfeeding is common and early initiation of breastfeeding is becoming more widely practiced. However, exclusive breastfeeding rate until the age of 6 months remains low and complementary feeding practices are inadequate. These practices, combined with limited access to health care, chronic food insecurity and poverty are the main causes of malnutrition among young children. The prevalence of wasting among children under 5 years of age (15% in 2006) places the country at a very high level of malnutrition. The prevalence of stunting among young children (38% in 2006) has declined slightly since the early 2000s. Meanwhile, the country is undergoing a nutrition transition, still strictly limited to urban area, where almost a third of adult women are overweight or obese. In parallel, under-nutrition persists among women, especially in rural area.
The universal salt iodization strategy has resulted in a substantial regression of iodine deficiency disorders. On the basis of clinical data, vitamin A deficiency is considered as a public health problem among women. There is a lack of national data on vitamin A deficiency in young children. Vitamin A supplementation coverage, relatively broad among children, should be expanded among mothers. Anemia is a severe public health problem among young children and women. Iron supplementation coverage of pregnant women needs to be upscaled and more long term measures (food diversification, deworming) need to be strongly strengthened.
A reinforcement of short-term interventions is needed to improve the nutritional status of the population. In the context of a strong development of the agricultural sector and an observed improvement of the food security situation, Mali currently has opportunities to improve agricultural diversification and the nutritional quality of the diet.