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Background discussion of Niger
Food sources of Vitamin A
Meal patterns and food utilization
Cultural beliefs about Vitamin A-rich foods
Vitamin A deficiency
Summary and recommendations
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.
MAP 3. The FES Protocol was Tested in the Village of Filingué in Niger
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.
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
The research results illustrate that a range of vitamin A-rich foods are available throughout the year. Animal sources of vitamin A include meat, liver, eggs, cow's butter or ghee, milk, and poultry. As in most parts of the sahelien zone of Niger, where Fulani pastoralists spend most of the year, meats including beef, mutton, and goat are viewed by the inhabitants of Filingué as a critical component of the diet. Villagers try to include small portions of meat in the sauce, generally goat or mutton which are less expensive than beef, two to three times a week. When distributing the sauce the mother apportions pieces of meat according to the age of the children eating from a communal plate. Occasionally, the mai gida also purchases grilled meat, most frequently mutton or beef, from one of the many meat vendors, preparing meat over an open fire pit, scattered around the town of Filingué. Grilled meat, which may include pieces of liver, is bought in quantities ranging from 100 CFA to 500 CFA (one-half pound to two pounds) and may be a weekly, bi-monthly, or monthly treat depending on the socioeconomic status of the family. The meat is wrapped in paper, carried home, and partitioned among the family members. The female head of the household distributes the meat and apportions it according to the age of the child. If liver is included in the purchase a women will generally give the larger portions to the youngest children. Liver is a highly valued food that people try to buy on a bi-weekly basis in small quantities, particularly to feed young children in the household.
Although liver and eggs are recognized as foods with special qualities for children, research results show that due to their cost, consumption is infrequent. Among children six months to six years (liver is introduced at eight to twelve months) portions of liver consisting of two to three small bite-size pieces are consumed at most once a week and more often biweekly. When asked whether people can afford to buy liver one informant replied, "Not really, unless they are sick. Then they think that it is important to eat. Liver provides protection because it is full of vitamins and blood, which gives us good health." Eggs are available mostly during the rainy season but can be found at other times of the year in the Sunday market or obtained from individuals who raise poultry. However, eggs are scarce during the hottest months of April and May. Mothers try to feed children one egg a week during the rainy season when eggs are plentiful and less costly. When eggs are expensive consumption falls dramatically and eggs may only be acquired as a gift. Consumption of eggs is higher among households who raise chickens or guinea hens, where on a weekly basis a couple of eggs may be scrambled and fed to the children, once again as a special treat.
Nigerians use large quantities of oil in sauces, side dishes, and in dressings for salads and green leafy snacks. Although peanut oil is most commonly used, cow's butter, also known as ghee, is the preferred source of cooking oil in Filingué and is considered to enhance the taste of the sauce. Butter is skimmed from cows' milk and sold in the market either in liter bottles or in small tablespoon-sized portions. Depending on the economic status of the family, butter may be purchased by the liter and used on a daily basis in the sauce. In this case respondents suggested that they measure a couple of tablespoons of butter into the sauce or actually pour the ghee directly from the container into the pot. Mothers indicated that the more ghee the better the sauce tastes. Use of butter is significantly higher among families who own cows.
Milk is consumed on a daily basis by a majority of Nigerians in hura. However, the staple millet porridge is a combination of pounded and cooked millet and milk. The milk is purchased skimmed and thus is lacking in vitamin A. Whole milk is considered a luxury and is not affordable by most families, and those who do consume whole milk generally have cows in their compound.
Both chicken and guinea hens are raised in the Filingué area but, due to the expense, are consumed only on special occasions such as holidays, weddings, or baptisms.
Carotene-rich foods include indigenous green leafy vegetables, cultivated greens, and garden vegetables that are grown in the area or transported in from more southern regions, and fruits that are also brought into the region. Indigenous green leafy vegetables begin to sprout after the first rains in June and are gathered in the bush by women and children throughout the rainy season. At sunrise groups of young girls and elderly women can be seen heading toward the surrounding bush of Filingué with large gourd containers in which they collect a variety of wild leaves. These foragers return in the evening with mounds of leaves that they take home for household consumption, sell fresh door-to-door, or sell in pockets of town where foods are sold during the week or in the Sunday market. Other local greens such as red sorrel are intercropped with millet or sorghum in farmer's fields during the summer months.
An elderly informant suggested that consumption of these wild greens is higher when millet production is poor or during times of hunger or hardship. He stated, "If people are full of millet they don't need to gather wild foods. If there is no millet people look for these foods in the bush and eat them. We aren't petting as much millet as we used to, so people are resorting to wild greens growing in the bush."
Most of the indigenous leaves are preferred at the beginning of the rainy season, when they are still young and tender. As a result, the young leaves are consumed on a regular basis at the outset and midway into the rainy season. As the season progresses and the leaves lose the young fresh quality sought after by the Filingué population, consumption of fresh leaves decreases. The more mature leaves are dried over a two- to three-day period in direct sunlight and stored in a sheltered structure for household consumption or sold in the Sunday market at other times of the year.
Leaves are commonly prepared in the afternoon and evening as sauce. The leaves most frequently used as a sauce ingredient are the baobab leaf and red sorrel, both of which are available either fresh or dried throughout the year. Other leaves added to the sauce are amaranth (there is a wild and cultivated variety), sickle, and jute, but these leaves are less abundant and therefore most frequently consumed fresh during the summer months.
Women also use indigenous green leaves to make two traditional dishes called kupto and dambo. Kupto is a combination of boiled leaves mixed with onions, peanut extract, oil, salt, and hot pepper, and is sold by street vendors in small cup size mounds. The use of horseradish tree leaves is the most popular way to prepare kupto and is highly desired by married women who share this vitamin A-rich concoction with their young children during the morning meal or as a late afternoon snack. Dambo is a combination of boiled greens and dried maize, cassava, millet, or sorghum mixed with onions and oil, and is also sold by hawkers in small cup size portions. This traditional dish is described as both nutritious and filling, attributes which Nigerians strive to attain in food consumption. During the summer months these dishes are made with fresh leaves.
Other sources of carotene are grown in local gardens during the cold period (December-February) of the dry season and sold in the community. Gardening was commonly practiced in the mid- to late-1980s, particularly following the 1984-1985 Sahelien drought when the Nigerian government implemented nationwide campaigns promoting dry sea son cultivation. However, the past few years the number of gardens has declined. Residents indicate that since they are limited to planting large garden plots by the wadi on the outskirts of town they are unable to protect the produce, which is pillaged by young children. Small gardens are also cultivated within households where a portion of the compound may be sectioned off to plant lettuce, tomatoes, and red sorrel, that are used during the winter months for home consumption or distributed as gifts to neighbors or relatives.
Carotene-rich garden food includes carrots, lettuce, and tomatoes, and are widely consumed when available. During the months of January through March, local table vendors can be seen walking the streets marketing freshly picked carrots that they carry on their heads. Lettuce and tomatoes are available on a daily basis in the market or can be purchased from one of several coastal women who prepare salads of lettuce, tomatoes, and onions marinated in a dressing made predominantly of peanut oil with vinegar and salt.
Pumpkin is brought to the Filingué area from southern regions year-round and prepared in the sauce by residents a couple of times a week. Typically, slices of pumpkin are purchased in the market in the morning or obtained from street hawkers who sell their produce door-to-door. Cubes of pumpkin are cooked for twenty to thirty minutes toward the end of the preparation of the sauce. A popular lunch dish is sauce made of pumpkin and red sorrel poured over rice.
vitamin A-rich fruit widely consumed in the area is mango that is
available March through September. Both a large, meaty mango
transported from Niamey and a local variety can be purchased.
While the larger mango is more expensive and therefore not
afforded by most, the local variety is a popular snack food for
both children and adults, and can be obtained daily in the market
place. The height of the mango season falls during the hottest
months of the year, April and May, a time when other fresh
produce is rare and unaffordable. During this period mangoes
provide an important source of vitamin A and may replenish and
build low vitamin A stores for the coming months.
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