Mortality of children aged five years and below has remained one of the troubling public health issues, particularly in developing countries. Dettwyler (2014) was an anthropologist who undertook a study in in Mali to understand child health situation, particularly in Dogo region. She managed to expound on social, cultural, as well as structural factors that impact child health and nutrition in Dogo region. Mali is among the developing nations considered risky for a mother to give birth as the likelihood of child’s death before the age of five is alarmingly high. Most of the deaths occurring in poor countries can be evaded if the affected communities have the proper access to quality healthcare facilities and competent community health workers. This study will focus Dogo region in Mali, which is perceived to be generally poor, as children in this region are likely to be severely malnourished.
Social factors are practices that promote or inhibit survival within the social environment. Poverty is considered as being among the social factors that affect child health in Dogo, leading to malnutrition. It is manifested through inequality, where women experience inequalities while seeking alternative means to earn for their livelihood (Singer and Erickson 2013: 35). Women in Dogo region spend most of their time doing farm work and house chore, leaving less time to consider the health and nutritional requirements for their children. Dogo region and the entire country are susceptible to nutritional deficiencies, as well as communicable diseases that include malaria, measles, and tuberculosis, among others. Women do not attain sufficient education to appreciate the essence of good nutrition and appropriate methods to eradicate communicable diseases.
Poverty is also portrayed through eating the same kind of food, which results in cases of malnutrition in Dogo region. Moving around Dogo region, one could notice children with round and puffy face, and “enormously swollen abdomen” (Dettwyler 2014: 71). Children suffer from kwashiorkor when they stop being breastfed after the arrival of the second child. After weaning, it becomes hard to find high-quality protein foods to replace mother’s milk.
Cultural factors immensely contribute in the expansion of child health and nutrition. In Dogo region, women do not contribute on decisions concerning child-bearing and child-spacing, as they hardly do family planning. Most men in the Muslim community are permitted to marry at most four wives, but taking care of four wives is always a burden to many men in Dogo (Dettwyler 2014: 76). It implies that the more children a family has, the more the children are exposed to malnourishment and early deaths.
Culture also manifested by the way children are perceived in the society. The Malian societies measure men’s success based on the number of children they have, and this has resulted to some families having many children that they can hardly manage to offer the right nutrition. Women also hold the notion that children do not deserve to eat good food, as they do not need much energy to survive (Dettwyler 2014: 94). Thus, most children in Dogo end up eating the same kind of food, which lead to poor health and malnutrition.
One of the structural factors that hinder child health and nutrition in Dogo region is a lack of proper infrastructure to access health facilities. The trip to Dogo is not a smooth one, as the roads are quite rough amid hot temperatures. Dogo is about 120 kilometers from Bamako, the capital city, with “two hours of travel on paved roads, followed by two more hours over a twisting, rutted dirty track” (Dettwyler 2014: 65). The villages are congested and there is no appropriate human waste disposal, which expose residents to infectious diseases. Many residents live in traditional mud hut amidst bushy areas that are infested with mosquitoes. The likelihood of contracting malaria is quite high as most homes cannot afford mosquito nets or coils.
Various interventions have been made to eliminate malnutrition and child mortality in Dogo. NGOs have established health education programs, which can promote behavioral changes and consequently yield benefits that could enhance child survival. Women in Dogo have been receiving assistance from AMIPJ, an NGO based in France that assists communities to establish income generating projects, as well as boosting their literacy through education program (Dettwyler 2014: 59). Although Dogo region is considered relatively self-sufficient with regard to food production, the area is prone to malnutrition. Most interventions suggested by the West are driven by the common misconception that overpopulation leads to poverty and malnutrition. Limiting population through family planning hardly applies to rural Africa, as overpopulation is not the underlying cause of child malnutrition.
AMIPJ normally receive the funds from Freedom from Hunger in order to facilitate economic and technical support for its rural credit development program. The project enables women to earn income through small-scale projects that include selling rice, millet, butter, and trading salt. Most women in Dogo admitted that their first priority after making profits is to enhance the health status of their children (Dettwyler 2014: 61). It is the reason of NGOs’ having concentrated on offering educational programs to promote literacy and knowledge on nutrition.
Child mortality and malnutrition is a common occurrence in rural Africa, and is normally triggered by social, cultural, and structural factors, which can be managed with appropriate planning and support. Women in Dogo region in Mali are usually denied rights to make decisions concerning their work, child-rearing and other family issues. Men are left to make the decisions concerning resource allocation, education, and household finances, leading to gender inequality. The promotion of child health and nutrition should begin by educating societies on the benefits of staying healthy.
Dettwyler, Katherine A 2014. Dancing Skeletons: Life and Death in West Africa, 20th Anniversary Edition. Long Grove, Il: Waveland Press.
Singer, Merill, and Pamela Erickson 2013. Global health: an anthropological perspective. Long Grove, IL: Waveland Press.