CRC/C/MDG/3-4 - Office of the High Commissioner for Human Rights

375. The lack of comparable data makes it difficult to estimate the change in the rate of
malnutrition in the latest period. In 2003-2004 it was estimated that 48 per cent of children
under age five suffered from moderate chronic malnutrition (size/age), 42 per cent from
low weight and 13 per cent from acute malnutrition (weight/size/emaciation) (per the
DHS).
376. Conscious of these gaps, in 2004 Madagascar adopted the National nutrition policy,
complemented by the 2005-2009 National nutrition action plan (NNAP). The National
nutrition office was created to provide overall technical coordination and monitoring of the
NNAP according to the strategic directions of the National nutrition council.
377. Supervisory measures have recently been taken: preparation of a proposed order to
create and organize a National oversight committee and Regional committees to supervise
the marketing of breast-milk substitutes; the Draft decree regulating the marketing of food
for infants and young children.
11. Causes of infant malnutrition
378. The causes of malnutrition are insufficient dietary intake (quantitative and
qualitative), inadequate care, inappropriate dietary habits, inadequate access to health care
and food insecurity in households.
379. Although Madagascar has considerable agro-pastoral and fishing potential, the
Malagasy diet lacks variety and is not balanced.
380. Infant and young child feeding practices are still not satisfactory. Although the vast
majority of mothers breastfeed their children (estimated at 98 per cent in 2003), the practice
of exclusive breastfeeding is not yet widespread in children under six months (67 per cent
in 2003, 48 per cent in 1997). Therefore, there is early weaning in 36 per cent of children
under six months, of which 30 per cent are weaned at four to five months (per the DHS),
and late-stage weaning in 22 per cent of children ages six to nine months without the
addition of solid or semi-solid food to complement breast milk 11 .
381. The prevalence of illnesses routinely linked to malnutrition still remains high:
diarrhoeal diseases (10 per cent), fever (malaria) (20 per cent), ARI (nine per cent) and
measles (3.4 per cent), indicating that the health-care environment and access to basic
health-care services must still be improved.
382. Household food insecurity has decreased but remains widespread. According to the
National Nutrition Policy (NNP)/World Food Programme (WFP), it went from 65 per cent
in 2001 to 25 per cent (chronic) in 2005.
383. 75 per cent of total household expenses in rural areas is devoted to food (NNP), and
only 15 per cent of Malagasy are safe from food insecurity.
12. Implementation strategies
384. Seven "Essential nutrition-related actions," to be implemented concurrently, have
been identified, namely:
• Breastfeeding exclusively until six months of age;
• Breastfeeding supplemented with appropriate food;
• Feeding sick children, particularly the malnourished;
11 Source: Analysis of nutritional situation, draft 0 2008.
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