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Meal patterns and food utilization

Nigerians typically eat two large meals during the day and, depending on the family, may also consume a light breakfast. The most important meal is served at noon and generally consists of hura or sauce and tuwo, baobab or okra sauce poured over millet or sorghum paste. Rice with a sauce made of meat, pumpkin, and a green leafy vegetable is eaten daily by civil servants and prosperous merchants and may be served on a bi-weekly basis in more typical compounds. Two to three times a week, during the midday meal, Filingués try to include small servings of meat in the sauce. Informants viewed sauce without meat as lacking substance or "use for the body." Other sauce ingredients typically include peanut oil, tomato paste, an indigenous green leafy vegetable, onions, salt, and seasoning. The dinner meal is frequently corn paste with okra or baobab leaf sauce. Breakfast is the least substantial meal often consisting of leftovers from the night before, locally made fried donuts, or koko, a semiliquid millet porridge that is slightly fermented and spiced, and eaten hot.

Cooked midday and evening meals are served on large communal plates and shared among children according to gender and age. Although young boys and girls may eat from a dish with their mother, when children reach the age of seven or eight, the boys and girls are separated and meals are taken with other children of the same sex. Separate plates may be given to older children (also according to gender) depending on how many people are in the household. In Niger, the male head of household is served his own plate which includes a more generous portion of meat and other sought after foods.

Pregnant Women

Although women of reproductive age typically consume large quantities of hura both at mealtime or as between meal snacks, during pregnancy women indicated that they reduce their intake of this rich staple because "tana a sa nowi cikin ciki" (it puts too much weight in the stomach). Their consumption of millet, corn, and sorghum paste is also reduced for similar reasons. Mother-respondents indicated that they avoid gaining too much weight during pregnancy since they believe the food they consume goes to the fetus, so too many heavy foods will cause the fetus to grow too large leading to a difficult delivery.

Women suggested that their nutritional needs are greater when they are pregnant, and that they seek out both tasty and nutritious or special foods including snacks of meat, grilled liver, and green leaves. In particular, informants mentioned that during pregnancy women crave kupto which they try to eat in large quantities. They also indicated that they choose to eat rice and beans rather than millet or maize paste and desire fresh garden vegetables, such as lettuce and cabbage, which they consume in season. Baobab leaf sauce is thought to be a blood enhancer and a food good during pregnancy.

Lactating Women

Koko is the food most consumed during the immediate postpartum period and both koko and duca, millet bran mixed with water, are supposed to increase breastmilk and facilitate lactation. A primary goal during the forty-day period of seclusion following delivery is to increase pounds, which they indicated will strengthen the body and help restore health. Therefore, women strive to eat foods that are heavy and facilitate weight gain. Women drink large quantities of koko, hura, duca, or miyai (an uncooked version of hura) and may consume the equivalent of two buckets during the course of a day. The desire to fatten-up is so great that women interrupt their sleep to consume these liquids during the night. They also try to eat meat and liver to return the blood lost during the delivery and prefer a richer, tasty sauce made with leafy condiments and larger portions of meat that make millet or maize paste more appetizing and thus increases intake. Other foods that lactating women try to consume in large quantities are rice and beans, dambo and kupto. Eggs are widely restricted during lactation and are believed to give women kodai, a craving for too many good things.

Women indicated that they strive to gain weight and eat good foods during the postpartum period to restore their own health and to benefit the breastfeeding child. They believe that the nutritional value of food they consume is passed directly on to the child. One informant said, "We believe if the women benefits from these good foods, such as liver and kupto, so will the child." Another respondent said, "We think that it is much more important to eat lots of food when you are lactating than when you are pregnant. Furthermore, we believe that if we eat good foods, foods rich in vitamins, the breastfeeding child will also get the same foods from the breastmilk. Because of this we want to eat foods that are good for them, foods that are rich in vitamins." In addition, blood-rich foods, believed to increase circulation, energize the body, and restore health, are highly sought after.

Following delivery it is paramount that tsoho jini or the old blood be extracted from the body and replaced by new blood. During the forty-day postpartum period a bathing ritual called wanka biki is practiced in the early morning and afternoon. Women dip the branch of a local tree into boiling water swatting their bodies, particularly their backside, with the leaves dripping with scalding water. This action cleanses the body by extracting the old blood. In addition, the abdomen is massaged on a regular basis in an effort to encourage the blood to leave the body. The goal is to bude ciki or open the stomach to increase the appetite and allow the woman to gain weight, restoring health and strength.

Infant Feeding

In Filingué the infant is fed sugar water before the colostrum is offered. Although colostrum is generally given the day of delivery, there is a waiting period when the woman squeezes the initial colostrum called the baki-baki, that refers to the old milk, from the breast. Women believe the milk has been sitting in the breast for too long a period (between the time the last child was weaned and this birth) and therefore this very first milk is not good for the newborn. Once this milk has been extracted the woman washes her breasts thoroughly, fixing her body, and starts to give the colostrum.

Female respondents generally recognized that colostrum is beneficial to the health of the infant. For example, when inquiring about colostrum one women said, "The child will not be well if he does not get this milk. We think this is very good for the child."

In more rural areas traditional practices can delay or prohibit the use of colostrum. In a village surveyed just five kilometers outside of Filingué where six respondents were interviewed, a postnatal ceremony is followed that may prevent its introduction. The following conversation with one of the key-informants describes this tradition.

"After giving birth we give the baby water and sugar. We don't give the breastmilk at first if the milk (colostrum) is no good." The respondent was asked how they know whether the breastmilk is good and she replied, "We empty the colostrum into a calabash. We then put ants in the colostrum. If the ants can crawl out of the milk the colostrum is good. If the ants die in the colostrum the milk is no good, it will give the children kai-kai" (an affliction that causes severe itching followed by lesions). The informant was then asked what is done if the ants die in the colostrum. She said, "We give her medicine if the ants die in the colostrum, the pounded wood that I showed you earlier. We boil the wood in water and then she drinks it. This will fix her milk and make the milk good." When asked what is given to the baby if the milk is no good she answered, "We give sugar water, juice made with oranges, water, and sugar, and cows' milk." Finally the interviewer inquired when they give breastmilk if the initial milk is no good. She answered, "We can give the milk after the mother drinks the medicine and the milk becomes white."

Sugar water is given to infants throughout the first week and is mixed with orange juice starting in the second week and fed until porridge is introduced. Women perceive the juice as the initiation of the gradual weaning process. The liquid is additionally used as a purgative.

Infants spend all of their time either on their mother's back or by their mother's side and are breastfed on demand, and mother's milk is considered a critical source of nourishment. Unless the breastmilk is insufficient or the child is an orphan no other forms of milk are fed to the child. Whole milk obtained from animals is believed to give infants and children diarrhea.

When the mother becomes pregnant again the child is abruptly taken off the breast. The breastmilk is no longer considered good for this child and will give the child diarrhea and lead to poor health. If the mother does not get pregnant during the second year the child is generally removed from the breast between twenty-four and thirty months. Women indicated that household economics may dictate their decision when to wean, as it is financially advantageous for the child to breastfeed.

Supplementary foods are introduced to the infant's diet anywhere from three to eight months, generally depending on whether the woman has attended baby weighing in the health center. (Women frequenting weighing are instructed to begin feeding infants a porridge at four months). At about eight months infants are introduced to millet paste and sauce, that the mother feeds to the infant with her fingers, and for many children the leaves in the sauce may be their first exposure to foods rich in vitamin A. Also at eight to twelve months women begin to introduce the infant to kupto, perhaps a teaspoon at a time. Meat is first given to infants at eight to ten months and may include beef that the mother has chewed or pounded pieces of liver.

Child Feeding

Children are weaned from mother's milk anywhere from seventeen to thirty months. Between the age of one and two years children start to eat like adults, following the family eating schedule. Children generally consume two main meals, one at lunchtime and the evening meal. As indicated earlier breakfast is less substantial, consisting of the evening meal leftovers, two to three bean cakes, fried donuts, hura or koko.

Mothers do not encourage young children to eat. They wait for them to indicate when they are hungry or allow them to feed themselves. Before the child develops wuyo, which literally means cleverness and occurs around age two to three, the child is at a disadvantage since he does not have the ability to verbalize his needs and, as one informant pointed out, may not be able to assess or identify the feeling of hunger as well as older children. His only option is to follow the family meal schedule. Furthermore, at this pre-wuyo stage he is not as mobile as his older siblings who are able to obtain street foods or forage for foods, nor has the small child mastered the ability to solicit small gifts of pocket money from adults.

As children get older and develop wuyo they leave the compound and seek snacks. Snack foods constitute an important part of children's diets and range from treats they buy on the street with pocket money given to them by their parents or visitors, to foods that are foraged in the area. These between meal foods may include wild fruits, oranges, mangoes, liver, carrots, dates, peanuts, fried bean cakes, cookies, candy, or a green leafy vegetable boiled and mixed with peanut extract. Older children also venture out to the surrounding bush to gather wild leaves that they consume fresh. Not only are these foods often nutritious but between meal snacks provide an opportunity for a child to eat on his/her own without having to share with siblings in this society where both gift-giving and sharing of consumable items are implicit tenets. In a group setting social norms compel people of all ages to share food.

There do not seem to any be feeding differences between boys and girls. Portion sizes are simply divided according to the ages of the children eating from the communal plate.

Cultural beliefs about Vitamin A-rich foods

Animal sources of vitamin A, particularly liver, eggs, milk, cow's butter, and meats, are considered prestigious foods and are well liked by the population. They are most frequently described as healthful, strengthening, or fattening, characteristics that people seek out in food, and blood-rich or having the quality of increasing blood or returning blood to the body. This concept related to the blood level in the body came up over and over again throughout the duration of the research. People in the Filingué area believe that the amount of blood in the body fluctuates considerably affecting circulation and health status. If consumption of blood-rich food is limited the blood will sit in the body allowing blood levels and circulation to decrease. This can have a negative impact on the overall health and energy level of the individual, leaving the person more susceptible to illness. The consumption of blood-rich food returns new blood to the body, thus increasing circulation and positively affecting overall health status. Liver, the food richest in blood, is believed to eliminate deficiencies or special needs the body has and facilitates weight gain, leading to a stronger constitution.

People of all ages need blood-rich food on a regular basis and particularly when in poor health. Liver is fed to both adults and children when they are ill and, as the food richest in blood, is believed to restore health. Liver is also viewed as an important children's food and was described by a significant percentage of the respondents as specifically "returning blood to children" or "increasing the blood of children." Furthermore, blood-rich food is consumed as medicine for nigh/blindness and intake of liver is a common treatment.

Both liver and eggs were consistently cited as children's foods, foods rich in vitamins, foods that increase weight, and foods that make them feel good. Mother-respondents described vitamin-rich substances as foods that make both children and adults big or fat and increase the appetite. These foods enhance the health of children and conversely, if consumption of these foods is insufficient, they will lose weight making them more vulnerable.

Respondents most frequently described green leafy vegetables as healthful and tasty. The research results suggest that respondents also perceive these green leafy foods as vitamin-rich, filling, increasing blood, and fattening, all attributes that are sought after in foods. One key-informant described kupto as magani talaka or medicine for the poor. She explained, "We know that it is good, that it can do the same good things for our bodies that liver does, but it is more affordable."

Other carotene-rich foods, including pumpkin and vegetables grown in the off-season gardens, such as carrots, lettuce, and tomatoes are well liked and described as healthful, tasty, and vitamin-rich. Unfortunately, the garden season is very short and gardening seems to be decreasing in popularity.

Mangoes, available from March through September, are enjoyed by both adults and children and were most frequently described as tasty, and children's food. Children use pocket money that they are given or earn to purchase mangoes as between meal snacks.

Vitamin A deficiency

There is a word for nigh/blindness in all four of the local languages spoken in the area (dundumi in Hausa) and nigh/blindness is most commonly reported by pregnant and lactating women. In a study I conducted in 1994, 21% of women reported experiencing episodes of nightblindness during pregnancy or lactation and one-third of these cases suffered from repeated episodes. Results indicate a strong correlation between cases of nightblindness and poor socioeconomic status. Nightblindness is additionally believed to be an affliction that old people get because, as one key-informant suggested, "their blood has changed because they don't get good foods." Informants consistently indicated that nightblindness is associated with lame (a deficient diet) or rishin ci albinci (inadequate consumption) leading to yumwa (hunger). In particular, nightblindness indicates that the individual is lacking in intake of blood-rich foods such as liver, meats, and milk. Traditionally this affliction is most appropriately treated by feeding the nightblind person foods that are referred to as magani dundumi (medicine for nigh/blindness). For example, when inquiring about nigh/blindness, a male head of household said, "People get this when they don't eat meat, when they don't drink milk. If people have animals they don't get this. If they have animals they receive milk and this isn't a problem." A female informant said, "Nightblindness is related to the diet. Also anago (a drastic change in the diet or the removal of an important component of the diet) can give you eye problems." When asked what people think of dundumi another female informant said, "They know that they haven't eaten well, that they haven't consumed enough food with vitamins and blood in them, like liver or meat or leaves." Others said that it is carried to them by iska or the devil.

Mother-respondents also suggested that dundumi is caused by too much exposure to the sun causing blood to fall into the eyes and wahala or hardship related to inadequate food intake. People from a lower socioeconomic status spend most of the daytime hours in the harsh Nigerian climate, and a shortage of millet resulting from a poor harvest seriously affects subsistence farmers and their families who rely solely on millet production. Poor production leads to a decrease in millet consumption and thus calorie intake as well as a reduction in purchasing power perpetuating less frequent intake, smaller portions of vitamin A-rich sauce ingredients, and a reduction in snack food consumption. A classic synergistic cycle results-granary stores are depleted early forcing both men and women to seek labor intensive sources of income such as collecting and transporting straw or wood from the bush. Nutritional needs are increased at a time when both quality and quantity of food intake has decreased. Once the millet stores are exhausted it is common for indigent families to subsist on gari rogo, a course cassava flour prepared with water and mixed with oil, onions, and pimento, or watered down hura. It is important to emphasize that results showed an association between socioeconomics and nigh/blindness, and among those who suffered from nigh/blindness several women experienced multiple episodes indicating severely deficient vitamin A stores.

Many women indicated that although nightblindness is considered a serious problem it is a normal symptom of pregnancy and a temporary affliction, caused by tiredness and overwork generally during the sixth or seventh month, which will pass with delivery. Since it is viewed as short-term, treatment is not often sought outside the home.

There are several ways in which liver is used as a home remedy for stages of xerophthalmia. One treatment is to place a piece of liver over the eyes while another portion is bitten into. The blood from the liver is believed to be transmitted to the eyes and subsequent to this pieces of liver are consumed.

During an interview a Fulani respondent described the liver treatment as follows:

"When we have dundumi we buy liver, we take some of the liver and bite into it." She continued, "We take two pieces of liver and place it on our eyes to transmit the heat. (She explained that they then throw these pieces of liver away). We then eat the remaining liver." When asked how much liver they buy she said, "We buy anywhere from 100 to 150 CFA (1/2 to 3/4 cup). " When asked how long they go through this process she responded, "Until we can see, until enough heat from the liver gets into the eyes."

Most pregnant or lactating women who experienced episodes of nightblindness indicated that they consumed small portions of liver as a treatment.

Another traditional treatment is to consume baobab sauce or red sorrel. When asked about nightblindness a female informant offered the following information:

"If people don't eat meat or if they are in the sun too long they get dundumi. Dundumi comes from wahala (hardship), from too much exposure to the sun and not enough meat." When asked what people do when they have dundumi she said, "Here we cook surre (red sorrel), place it in a dish and put the dish in a room at prayer hour when the sun is setting and there is little light. We allow the person with dundumi to seek out the leaves in the dark. When she finds the dish she puts it near her eyes so that the wind from the leaves gets into the eyes. Afterwards that person is supposed to eat the leaves." She was then asked how many times they go through this exercise and she replied one or two, indicating that about six cups of the leaf mixture is actually consumed. She also emphasized that the leaves are only for that person to eat, that the person with dundumi is not supposed to share the leaves with anybody else. As previously mentioned this is very unusual since food is always shared. She continued, "All of this is from lame, rishin ci nama (not eating enough meat). They don't eat good foods, like meat and oil, and this leads to rishin gani (not being able to see)."

A case scenario illustrating a pregnant woman with nigh/blindness was presented to mother-respondents who were asked what they recommended for treatment. Out of a sample of fourteen women, five initially responded that the appropriate homecare action would be for the woman to consume grilled liver and to apply the juice of the grilled liver to the eyes. Seven of the fourteen women indicated that strenuous work coupled with the pregnancy caused the nigh/blindness, and that the woman in question required foods that were good for her, especially meats.

Although the traditional liver treatment is appropriate, the amount and frequency of consumption often appears to be insufficient to resolve the problem. As mentioned previously, since women feel that nightblindness will pass with delivery, if the affliction persists following the liver treatment women generally do not seek other curative measures.

Two respondents indicated that pills are available that can cure nightblindness. If the liver treatment does not resolve the problem the next step would be to go to the market to obtain these pills that they described as a quick and easy way to resolve the problem. The research team investigated the availability of capsules and found that mega-doses of vitamin A come from Nigeria and are sold in vast quantities in the market. The price for the mega-dose capsules can be negotiated down to about ten cents a capsule, less than, what a woman would pay for a visit to the dispensary. Other vendors were selling encapsulated cod liver oil, evidently imported to Nigeria from India and transported to Niger.

The market survey suggested that people seek and purchase vitamin A in the area. It is interesting to note that in a more southern region where similar research was being; conducted, vitamin A capsules were not available, and nigh/blindness is rare, although markets are infiltrated with medications from Nigeria.

Using a story format to describe a three-year-old child suffering from nightblindness six of the sixteen mother-respondents advised that the mother place a piece of uncooked liver on the child's eye so that the eye could absorb the blood from the liver. Subsequent to that, women suggested that the mother feed the child grilled liver. Seven respondents indicated that the child was suffering from hunger, and if the child were fed foods rich in vitamins, such as liver, meat, green leaves, eggs, and milk, the problem would be resolved.

Women suggested they would take the child to the dispensary for treatment if nightblindness persisted. There are two apparent problems. The first is that there is a delay between the time when the affliction is detected and when the child is taken to the dispensary. This may be due to the fact that since the appearance of the eye is still healthy or pretty, nigh/blindness is not considered a precursor to more advanced stages of eye problems causing visible signs and possibly manifesting decay. In addition, although nightblindness may be detected among an older cohort of children, the research results suggest that it is not recognized as often among two- to three-year-olds who are less able to express themselves and who often go to sleep early in the evening. Given poor weaning practices, high rates of disease and malnutrition, and the fact that these children are not encouraged to eat but are expected to indicate when they are hungry, this age group appears to be the most vulnerable to develop severe vitamin A deficiency.

The same story format was used to gather information on children suffering from childhood illnesses accompanied by eye afflictions. Data generated from three case scenarios, with illustrations of the ocular stages leading to nutritional blindness, showed that mother-respondents associate several childhood illnesses with the later stages of xerophthalmia. Women indicated that a white spot in the conjunctive was a danger sign that could manifest into a severe eye problem leading to the loss of one or both eyes. Several respondents conveyed that the underlying cause of this white spot is related to chronic malnutrition beginning at the time when the mother's milk was no longer sufficient to sustain the child's nutritional needs (lame), and general hardship exacerbated by childhood illnesses including diarrhea, malnutrition, and measles.

When asked about corneal xerosis one key-informant said, "If there is no water in the eye, or if it dries up, the eye will close and be lost. Because of this when the eye has problems we try to keep it open." Respondents indicated that corneal deterioration in one eye could lead to the loss of the second eye, and is an indication that the child's life is in jeopardy.

The childhood diseases most often associated with eye problems are measles followed by chickenpox. Both diseases can cause extreme "heat" in the eye, "put lesions in the eye," and "eat away at the eye," and can potentially "ruin" one or both eyes. Other illnesses include malnutrition or a poor diet, diarrhea, zahi or heat in the stomach, and kai-kai, which leads to severe itching and a red eye, and can manifest lesions in the eye. Lame was consistently mentioned when discussing causes for eye lesions, as was daikashi, which is goat's milk fed to orphans or infants whose mother's breastmilk is considered bad.

Most women indicated that children with eye problems other than nigh/blindness should first be treated in the health center. These problems can "destroy the eye" and, as one informant stated, "can enter the body and kill the child." Household remedies commonly mentioned for eye signs resembling Bitot's spots and corneal xerosis include medicinal plants soaked in water, a sodium/water mixture dropped in the eye, and consumption of various traditional leaf and twig concoctions. These treatments all have cooling properties and are believed to counteract the zahi or heat that has manifested in the eye and can lead to lesions. A home remedy recounted on several occasions entailed placing onions around the eye. The burning sensation will force the eye to remain open exposing it to air and save the eye from permanent closure and thus the loss of the eye.

If the treatment at the health center is ineffective local health practitioners most often consulted for serious eye problems are old women who sell medicinal plants in the market, a local sorcerer, and the marabout. When all else fails, women indicated that they would go home and pray to God.

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