|Culture, Environment, and Food to Prevent Vitamin A Deficiency (International Nutrition Foundation for Developing Countries - INFDC, 1997, 208 pages)|
|Part III. Assessing natural food sources of Vitamin A in the community|
|5. Community assessment of natural food sources of Vitamin A in Niger: The hausas of Filingué|
The research was conducted in the land-locked country of Niger located in the Sahelien region of West Africa. Erratic and low rainfall plagues this arid area, resulting in unpredictable harvests and insufficient food production to meet the population's needs. Three ecological zones span Niger including a relatively fertile strip in the savanna zone located at the southernmost part of the country where average annual rainfall is 300 to 650 mm, the pastoral or sahelien zone averaging 200 to 300 mm of water annually, and the Sahara zone which is part of the Sahara desert covering three-fifths of the country and inhabited primarily by nomadic groups (Ministère de la Santé, 1992). Most agriculture production is conducted in the savanna zone of the country where millet, sorghum, maize, and groundnuts are cultivated.
Nigerians generally characterize the country as having two seasons, dry and rainy. The dry season begins in October and lasts through June, with no precipitation during this period. Immediately following the rains, the month of October is hot and daytime temperatures reach close to 40° C. In November, the temperature begins to drop dramatically, and through February temperatures do not rise over 35°C and dip to below 10°C at night. This is also the time when dry season gardening takes place. Both indigenous and western varieties of vegetables are cultivated in small plots located either in the family compound or near water sources scattered in communities. Examples of indigenous plants are red sorrel or amaranth while newly introduced foods include lettuce, tomatoes, carrots, cabbage, and eggplant. In March the temperature rises on a daily basis and reaches a constant in April when oppressive heat in the midforties is to be expected. The rainy season begins in mid-May or June and goes through September, and in the most southern and fertile areas of the country rain may fall every three or four days. Rains can be dramatic, preceded by high winds precipitating fierce dust storms, and followed by torrential downpours that last from thirty minutes to several hours.
Five primary ethnic groups inhabit Niger including Hausa (55%), Djerma (23%), Toareg (10%), Fulani (5%), and Kanouri (5%). Islam is practiced by approximately 99% of the population (Kourgueni et al., 1993). Approximately 85% of the population lives in rural areas and engage in farming, although a recent increase in migration occurred as the desert rapidly encroached, environmental degradation escalated, and people were no longer able to rely on the precarious ecological conditions that existed.
In 1992, the population was estimated at 8.7 million, with the average birth rate at 3.4 and 7.4 live births per woman (Kourgueni et al., 1993). Although child arid infant mortality rates are among the highest in the world, demographers project that with the present birth rate the population will double in twenty-one years, putting an exorbitant amount of additional strain on already limited natural resources and a fragile ecosystem.
Literacy rates in Niger hover around 14%, with a discrepancy between males (20%) and females (10%) (Kourgueni et al., 1993). These rates are far more striking when analyzing the majority of the rural population where literacy among men is 14% and 6% among women.
Uncharacteristic of most places in the world, child and infant mortality rates in Niger have increased over the past few years. In 1992, a demographic survey found child mortality to be the highest in the world (123/1000), excluding war zones (318/1000) (Kourgueni et al., 1993). Vaccination coverage of children immunized against the illnesses targeted by the EPI program is estimated at a low 17% (Kourgueni et al., 1993).
The major causes of infant and child mortality are infectious and parasitic diseases aggravated by undernutrition, with respiratory infections the most reported childhood illness followed by malaria, diarrhea! diseases, measles, whooping cough, and meningitis (Issa, 1993). These health problems are related to many factors including harsh environmental conditions, poverty, poor sanitation and hygiene practices, poor access to health services, and a general lack of awareness among the population regarding causes of disease, preventive measures, and treatment.
Children's diets are both deficient in calories and poorly balanced, leading to undernutrition and high rates of chronic and acute malnutrition, and severe micronutrient deficiencies. Studies indicate that acute and chronic malnutrition are highest among children ages one to three, especially during the weaning period when children are abruptly removed from the breast and expected to follow the family meal pattern. The nationwide demographic study conducted in 1992 shows chronic malnutrition among children five and under at 33%, of which 16% are severely malnourished. Inadequate food intake coupled with exposure to illness leads to the classic synergistic cycle of undernutrition, poor health, and infection.
Vitamin A Situation
Given the high rates of malnutrition, it is not surprising that vitamin A deficiency constitutes a significant health problem in Niger. In 1986, a morbidity assessment (Sloan et al., 1986) found rates of xerophthalmia at two to three times the WHO critical level among children under six years of age. Following this study, Niger was included on the WHO/IVACG/UNICEF list of twenty-four countries in which vitamin A deficiency is a significant public health problem (WHO/UNICEF/IVACG, 1988).
Since 1986, research has substantiated the initial findings; included were a study conducted in 1987 in five regions, by WHO/UNICEF/Ministry of Health and the World Bank, that found nightblindness to be eleven times the WHO critical level among children (Ministère de la Santé, 1991) and a national xerophthalmia survey, carried out in 1989 that replicated the results of the 1986 study (MOM, Niger, 1989).
Keith (1991a) conducted a more qualitative assessment in southern Niger on vitamin A food availability and factors affecting the intake of vitamin A-rich foods. Despite the fact that many preformed vitamin A and carotene-rich foods are available year round, the results indicated that nearly half of the children ages thirteen to thirty-six months are at high risk of developing vitamin A deficiency and 62% of children thirty-six to seventy-two months also fall into the high risk category.
The Research Site-Ecological, Climatic and Demographic Factors
The study was conducted in the village of Filingué located in the Department of Tillabery, 185 kilometers north of the Nigerian capital, Niamey (Map 3). Filingué is the county seat and the home of regional government offices and services, including the sous-prefecture or local government structure, the regional health center, the central post office, and two secondary schools.
There are approximately 12,700 inhabitants in Filingué representing a range of ethnic backgrounds including the majority Hausa group (70%), Djerma (10%), Toareg (10%), and Fulani (5%) (Ministère des Finances et du Plan, 1990). The rest of the inhabitants include a mix of people from neighboring countries. The interaction among this exotic range of cultures and backgrounds, representing different lifestyles, makes for a rich and dynamic environment.
Filingué is situated in a rift with dramatic cliffs only a couple of kilometers from the town center. A wadi, which is fullest in the summer when it is replenished by the annual rains and dries out around April or May at the height of the hot season, is on the northern end of the town, providing a source of water for herds of animals passing through or voyagers traveling on camel or horseback. During the cold season that lasts from December through February, people make use of this water source for off-season gardening.
Having been a fertile area in the past, the vast majority of the population are agriculturalists. More recently, Filingué, located on the border of the sahelien ecological zone which averages 200 to 300 mm of rainfall annually, has experienced extremely poor harvests as the desert rapidly invades the area. Although people continue to practice agriculture, severe economic strain has forced household heads to migrate to southern regions during the dry season in search of a supplementary income often leaving their families for several months at a time. Economic hardship and the need for additional financial resources has perpetuated an increase in female involvement in small enterprise, including sewing projects, the preparation and selling of snack foods and condiments, and local commerce such as the selling of traditional cloth.
The primary crop and staple food cultivated in the surrounding region is millet, which is planted after the first rain in June or July and harvested in October. If the harvest is good, people set aside a stock for the family's annual consumption and sell the remainder for cash in order to purchase food staples such as maize, meat, and sauce ingredients, as well as to ensure for family provisions. Cowpeas and sorghum, although less fruitful in this arid climate, are also cultivated. Fields are generally intercropped with indigenous green leafy vegetables that are an important sauce ingredient.
During the rainy season an array of indigenous green leafy vegetables can be found growing wild in the bush surrounding Filingué. These leaves are collected by women and children and are sold by street hawkers who circulate the streets, going from one compound to another, or who may sell the fresh leaves in central locations around the town. At this time of year both local wild green leafy vegetables and imported fresh greens are abundant on market day, while during the dry season leaves are sold in a dried form. From October through May female vendors from more southern regions travel to Filingué with huge burlap sacs full of baobab and horseradish tree leaves and other varieties of green leaves that had been dried during the summer months.
The market, which is held on Sunday, is critical to the livelihood of people living in Filingué and the surrounding region. People trek ten kilometers by foot or as far as thirty kilometers by camel or horseback to visit the Filingué market. There are also vendors who travel up to eighty-five kilometers in bush taxis to purchase goods in Filingué which they resell in local markets. During the rainy season, the market is particularly lively and colorful when it is stocked with a greater variety of foods. As is true of market settings throughout Africa, it serves as a meeting center where nomadic groups and sedentary agriculturalists from different ethnic backgrounds convene to conduct business transactions and exchange news and information.
Large sacks of staple foods such as millet, sorghum, maize, and dried cassava are plentiful on market day. Most fresh fruits (people generally buy a supply of fruits for a two- to three-day period) and vegetables are purchased in the market, as are tubers, dairy products such as eggs, cow's butter, and milk, and sauce condiments. Large quantities of meat are also obtained in the Sunday market and consumed during a special noontime or evening meal.
Filingué residents purchase smaller quantities of foods on a daily basis. Meat can be acquired from a local butcher and other sauce ingredients are purchased from market vendors or from one of the small food stores located at the center of town.
In 1992, health indicators collected by the medical center in Filingué show that among children under five years of age, malaria was the most common illness followed by respiratory illnesses and diarrhea (Ministère de la Santé, 1992). Rates of moderate malnutrition (weight-for-age) among children under two years of age attending the well-baby clinic were estimated at 16%, while severe malnutrition was over 4% (Ministère de la Santé, 1992).
As is true in most Nigerian villages the population in the town of Filingué is concentrated. High density housing without pumped water, the absence of latrines, and poor sewage disposal coupled with waste produced by ruminants that spend the night in the family compound all contribute to poor sanitary conditions. While adults defecate in the surrounding bush area, children relieve themselves within the compound. The fecal waste is covered with dirt and discarded in the street. A general lack of water further aggravates the sanitation problems manifesting poor hygiene and contributing to infection and disease.
Household finances are maintained separately and financial obligations follow Moslem tenets and are thus distinct and well-defined. According to Islamic principles, the mai gida or male head of household is responsible for purchasing all household food items and is expected to provide for clothes and medical needs. If a female head or co-wife is involved in petty commerce and her husband is unable to obtain the necessary staples she may choose to participate in the household economy by occasionally obtaining sauce ingredients or providing food from her personal stock.
Typically, the mai gida leaves a small sum of money every morning for his wife or wives to use to buy sauce foods. Men claim that women have a tendency to pocket small amounts of this daily sum for their own use and therefore they are justified in forgetting to supply the food money occasionally. By neglecting these obligations or leaving an inadequate sum the mai gida places pressure on his wife to supply or supplement daily purchases. There is virtually no communication between the husband and wife concerning finances, and spouses, knowing their roles, are reluctant to confront the situation. As indicated by both Hill (1969) and Keith (1991 b), a general feeling of secrecy, deception, and mistrust associated with money manifests itself in Hausa compounds and in households where women are economically viable. Competition surrounding finances can be fierce. Men express a resentment for the unwillingness of women to contribute to the household economy, while women partaking in economic endeavors strive to attain independence and security in this unpredictable environment where divorce is common, male off-season migration is high and often leads to long-term absences, and average lifespan is short.
The researcher arrived in Niger in late October. Before traveling to the research site, approximately one week was spent in the capital city acquiring the necessary government permission to conduct the research, meeting with Ministry of Health personnel, and identifying a local botanist who would be available to assist in the research. The study was initiated in Filingué in early November. During the first few days the researcher introduced the project to government officials, traditional leaders, and health personnel, identified two research assistants, and selected key-informants. A census conducted in 1989 was used to identify the various neighborhoods and to select the locations in which the structured interviews would be conducted. A sample of respondents was chosen in five neighborhoods representing a range of ethnic backgrounds and socioeconomic levels. Each respondent was visited on four occasions.
The research team consisted of the primary investigator and two research assistants who administered structured interviews. Following a brief training period with the two assistants, the initial series of structured interviews began within a week of the primary investigator's arrival to the area. Twenty-seven compounds were visited over five weeks where structured interviews were carried out with mother-respondents. Key-informants included three experienced mothers, one male and one female village elder, one male head of household, a government health worker, and a traditional health practitioner. Interviews with these individuals continued for the duration of the research period. The primary investigator returned to Niamey in mid-December where data were analyzed and the preliminary report written.