Burundi: world’s highest rate of food and nutrition insecurity
Too little land to feed a burgeoning population
by Elissa Jobson
Pascasie Miburo stands in the middle of a small clearing, seeking refuge from the sun under the meagre shade provided by a spindly tree. “This is my plot,” says the 30-year-old woman, stretching her arm to describe a ten-square-metre patch of parched earth in north-eastern Burundi smaller than a parking bay. “It’s the share we had from the family. It is all the land we have. It’s very small—can’t you see that?” she asks, well aware that this is painfully clear.
“I grow beans, also cassava, but I got sick and I couldn’t take care of these beans,” Ms Miburo says, pointing to the tendrils of desiccated plants, which creep fruitlessly along the ground. “I also attempted to plant sweet potatoes but I couldn’t do the work.” Ms Miburo’s 11-month-old daughter clings to her side. The baby, a surviving twin, is chronically malnourished—and weighs just 5.9kg. “I raised her for up to nine months without giving her anything other than milk…I tried everything. I would go to the market and buy flour to make porridge for her [but] she is still very small,” she laments.
Ms Miburo and her family are not alone. Burundi’s verdant, rolling hills belie the severity of the problem. This East African nation has the highest rate of food and nutrition insecurity in the world, according to the 2013 Global Hunger Index, which combines data on malnourishment, underweight children and child deaths. Around 58% of children under the age of five suffer from chronic malnutrition or stunting—a long-term condition that arises when infants do not have enough to eat on a regular basis and are lacking the vitamins and minerals essential for healthy growth. Only 19% of children in Burundi have a nutritious diet, according to the Food and Agriculture Organisation.
So what is the root of the problem? “The underlying cause of chronic malnutrition in Burundi is basically poverty,” says Sophie Leonard, chief of health and nutrition at the UN’s children’s agency (UNICEF) in Burundi. “Though the land seems green here, the area that a family can cultivate is too small to ensure the survival of that family.”
Burundi is one of the poorest countries in the world. Since 1995 it has consistently been among the ten lowest-ranking countries in the UN’s Human Development Index. Almost 95% of the population earn a living from farming and 81% survive on less than $1.25 a day. It is also one of the most densely populated states in Africa (each square kilometre supports about 354 people), with one of the world’s highest population growth rates, 3.2%, according to the latest World Bank figures.
“If you are in an economy that’s mainly rural, that’s mainly relying on the division of land for inheritance and for future families to have a subsistence, then obviously you can’t just go on dividing and dividing because in the end you have such small plots with very low productivity that can’t feed the families that are on them,” explains Johannes Wedenig, a UNICEF representative in Burundi. Declining soil fertility, land erosion and increased natural disasters are additional factors that “all combine into a vicious cocktail”, he adds.
The return of more than 500,000 refugees—displaced by a brutal 12- year civil war (1993-2005) and a series of pogroms among the Hutu and Tutsi communities dating back to independence in 1962—is adding to the pressure on land, as well as injecting an element of ethnic and familial tension into the mix. In May this year the expulsion of a Tutsi, Justin Nyakabeto, from the home he had occupied for 40 years, to accommodate a Hutu returnee, sparked violent protest in Bujumbura, the country’s capital. Stories abound of people returning from exile only to find that their land has been sold or annexed by a family member, sparking conflict and even bloodshed.
In addition to Burundi’s scarce and impoverished land, disease is a major contributing factor to Burundi’s alarmingly high level of chronic malnutrition. Malaria, diarrhoea and parasitic infections are the leading culprits, UNICEF’s Ms Leonard says. “If children have a lot of diseases they lose their appetite, their immunity becomes low and they get malnourished,” she explains. “So to tackle chronic malnutrition we have to address both food security and healthcare. But that’s not enough.”
Parents need to be taught to understand the health and nutritional status of their children, Ms Leonard says. A change in social mores is also required, in particular the creation of an environment in which women have access to cash—whether through income-generating activities or direct transfers for the most vulnerable families, she adds. This would enable mothers to purchase additional food from the market to supplement their own harvests and add diversity to the meals they prepare.
Chronic malnutrition is not simply a health concern. “It’s a development issue,” Mr Wedenig says. “If you have two out of three children at age three chronically malnourished all other investments will be affected. You will have less returns on your investment in education, higher costs in terms of health and lower productivity in your population…There is no way that you can have development without dealing with chronic malnutrition.”
The effects on the economy of Burundi are clear and quantifiable. “We are losing $102m every year in productivity and healthcare costs,” the equivalent of the government’s current health budget, says Dr Déo-Guide Rurema, deputy chief of staff to the vice-president in charge of social and economic affairs.
Burundi has recognised the problem and is beginning to address it. The government aims to reduce the rate of chronic malnutrition from 58% to 48% over the next four years, Dr Rurema says.
Some of the key measures for achieving this include fortifying flour with vitamins and micronutrients, promoting breastfeeding, nutritional education and the reintroduction of school meals.
This last measure is already producing results, says Godefroid Dusabumremyi, headmaster of
a school in Karimbu Hill in Muyinga province in north-eastern Burundi. The school canteen programme has produced three major benefits, he maintains. “The first is that results have increased significantly,” Mr Dusabumremyi says proudly, adding that the school’s academic ranking has gone from 16th to 8th since it started serving fortified rice. “Second, when you see those pupils lined up in the morning you can see that physically they have made a good improvement. The third is school dropouts have decreased remarkably—especially among girls,” he continues. Mr Dusabumremyi’s school has also seen a large increase in pupil enrolment, many from neighbouring schools. At the beginning of the year 1,074 students registered in his school compared to around 500 for others in the district. He attributes this directly to the provision of a midday meal.
World Vision, a US-based NGO, manages the school canteen programme and has also initiated the distribution of shoes, soap and deworming medication, which Mr Dusabumremyi maintains has consolidated his school’s performance and attendance gains. This kind of collaboration with external partners is essential for the government, which is dependent on donor assistance for between 50% and 60% of its budgetary expenditure. Without this aid, it may not reach its ambitious target for the reduction of chronic malnutrition. However, even the cut of ten percentage points the government is striving for will not be nearly enough for Burundi to halve the proportion of people suffering from hunger, one of the targets of Millennium Development Goal One, which is the eradication of extreme poverty and hunger. The country has seen food insecurity rise 17% since 1990, according to the Global Hunger Index.
The ministries of health and agriculture are employing an approach known as home learning and nutritional rehabilitation (referred to by its French acronym, FARN), which uses community role models—Mamans Lumières (light mothers)—to teach mothers with chronically malnourished children how to prepare balanced meals. UNICEF, with the support of local NGOs, has introduced a 12-day course focusing on nutrition and hygiene in Muyinga.
At her clean and well-tended home in Karimbu Hill, Noela Citegetse has just finished her nutritional education session. “We cooked beans, we added some banana, colocasia [a tuber]. We also added Irish potatoes, green vegetables, pounded dried fish, palm oil and leeks,” she explains. “I was teaching my fellow mothers how to cook meals at home, looking at the three [food] groups—vitamins and minerals, proteins, and carbohydrates and sugars. That was the first lesson. There are other lessons like how to breastfeed a child from birth to six months and there is also another topic on how to feed a baby from six months on.”
This 42-year old mother of 10 children has been a Maman Lumière, an entirely voluntary position, for five years. Pathfinder, a US-based NGO, with backing from UNICEF and the health ministry, trained her for a week. Now Ms Citegetse is a firm believer that nutritional problems stem from a lack of education. “If a family has enough knowledge, from the little [food] that they have, they could mix their food so that none of their kids get malnourished. It is true that families are poor but looking at my experience, I had three FARN sessions and among those children [whose mothers] passed through, none has become malnourished again, which means that the knowledge they gained here helped them,” she insists.
Pascasie Miburo is one of the mothers who attended Ms Citegetse’s lesson. “It was my first time there. Today I learnt how to cook a balanced meal,” she says. “I expect to be taught how to breastfeed, how to be clean and wash hands and also how to feed my child well so that she will have a good life and be healthy. A big weight has been lifted from my heart.
