Child malnutrition is affecting the Diourbel region. It has reached alarming levels. Between poverty, repeated droughts, and limited access to healthcare, many children's growth and health are compromised from their earliest years. This silent scourge highlights the urgent need for a multisectoral response.

Sitting on one of the beds in the small hospital room, Ndèye Niane, looking exhausted and lost in her gaze, holds her daughter, who has just finished receiving an IV drip. The bright red and yellow color of the bed sheet contrasts with the paleness and fragility of the child's body. Dressed in denim pants and a white top that barely conceals her bony shoulders, little Y. Ngom's feet are slightly swollen. This is edema. Her head, disproportionately large compared to her body, accentuates the impression of her thinness. Her large eyes, set in her oval face, express chronic fatigue.

"This is my fourth child. Since birth, she has suffered from growth retardation associated with asthma," confides Ndèye Niane. After giving birth, the young woman became critically ill and was hospitalized. Her baby was placed in a daycare center, "deprived of breastfeeding for a month and ten days." As a result, Y. Ngom has been suffering from malnutrition for four years.

It's at the pediatrics department of Diourbel Hospital that Ndèye Niane comes to seek the solution for his daughter. The walls are painted mauve, green, and white, to amuse the children he welcomes during their visits. But no! Y. Ngom's condition doesn't allow him to notice this. The harmony of colors on the walls neither brightens nor brings him joy.

On the morning of Tuesday, July 15, 2025, despite the stifling heat, several mothers and their sick children are impatiently waiting in the corridors for a consultation. In the treatment room, the piercing, insistent cries of a little boy fill the room. The atmosphere is oppressive.

Poverty, heat…: the roots of evil

In the room next to the one where the little girl Y. Ngom is being cared for, is little CAB Diouf, aged one and a half. His sad expression is obvious, his growth retardation is obvious, as his height is clearly no more than 80 cm. Worse, his frail legs do not allow him to stand properly, let alone take steps without falling. According to his mother Ndèye Aw, he refuses to eat or when he does, it is to vomit immediately. In addition, CAB Diouf suffers from "chronic diarrhea."

"Faced with this worrying situation, I decided to take him to the sisters (Editor's note: The nuns), because they offer remarkable medical support, particularly for children suffering from malnutrition," says his young mother.

CAB Diouf is in this situation because his mother didn't exclusively breastfeed him for six months because of the heatwave in Diourbel. "I gave him water, and I think that's the cause of his fragile health," she admits, her voice weak and her face tired, as if every memory of suffering still deeply affected her.

With a total population of 2,208,281 and located 150 km east of Dakar, Diourbel is the third most populated region in Senegal, after Dakar and Thiès. The area is a commercial and agricultural hub, particularly for peanuts and other rural products. Not to mention its cultural and religious dynamism, with the Grand Magal of Touba, the holy city that welcomes thousands of followers of the Mouride brotherhood from the country and the diaspora to commemorate the departure into exile in Gabon of their religious leader.

However, it is a region prone to frequent droughts. "These episodes significantly reduce agricultural production, affecting the availability of staple foods. This leads to chronic food insecurity, especially among rural populations," explained Mame Bousso Amar, head of the Bureau of Information, Education and Health Promotion (BREPS). This was during the caravan organized by the Association of Journalists in Health, Population and Development, in partnership with the Bill and Melinda Gates Foundation, as part of the "Health and Light" project, on the theme "Issues and Challenges of Malnutrition: The Opinion of Communities."

Diourbel, record number of malnourished children

However, agricultural dependence, particularly on peanuts, compromises nutritional security, with few fruits, vegetables, or varied protein sources in local diets. "In the event of a poor harvest or falling prices, incomes decline and malnutrition increases," BREPS points out.

Malnutrition in Diourbel (with its four districts—Diourbel, Touba, Mbacké, and Bambey) affects several population groups due to their physiological, social, or economic vulnerability. These include young children, pregnant or breastfeeding women, and the most isolated rural communities. These groups suffer the combined effects of poverty, limited access to healthcare, food insecurity, and precarious living conditions.

Regional Director of Health (DRS) of Diourbel, Dr. Mamadou Dieng, provided an update on malnutrition in the region. "We have global acute malnutrition , which affects almost 17.1% of children aged 0 to 5, compared to 10% at the national level. Regarding stunting, we are at 17%, while the national average is 14.3%. For underweight, the region is at 22.3% compared to 16% for the national average. For exclusive breastfeeding, we are at less than 30%, while the national average is 34%," he listed.

Returning to the statistics, the very accessible public health specialist says that this means that women's adherence to breastfeeding must be improved. Because until now, there are those who continue not to breastfeed exclusively. For him, these women must be made aware and encouraged to respect it since it is very beneficial for the child, for his growth and, above all, it protects him from diarrhea.

In this region, malnourished children often come from peri-urban areas and from all districts. "With the commune of Touba, which has the largest demographic weight, we find more malnourished children in the department of Mbacké. Bambey and Diourbel follow," he reports.

“(…) children are fed like adults, with rice and fish, whereas…”

What about solutions? Dr. Dieng points out that the health sector cannot fight malnutrition alone. He believes an integrated, multisectoral approach is needed, involving the community in the proposed responses.

According to him, we need to increase awareness and food availability, improve food security, facilitate access to water and combat unsanitary conditions, prevent diarrheal diseases, and ensure that food is available for children. The fight against poverty is essential. "Where there is poverty, there are often cases of malnutrition," says Dr. Dieng. He then suggests, "Children need to receive more attention when it comes to their diet."

Because, continues Dr. Mamadou Dieng, it is common to see children in households being fed like adults, with rice and fish, even though their age does not necessarily allow them to digest this type of food.

In some families, even health professionals are not immune to the realities of child malnutrition. The health worker working in the Diourbel health district,   Tabara Ndiaye humbly shares the story of her daughter AC Ndiaye's recovery from malnutrition. She says: "My daughter was constantly sick, suffering from chronic diarrhea and persistent malnutrition because my in-laws asked me to give the child water and food from the first few months. Thank God, today she is much better. She is gaining weight and her health has improved significantly."

Best practices in IYCF

With a shy air, she explains that during her first visits to the sisters, they gave her good advice on how to feed her properly and encouraged her to strictly adhere to the prescribed nutritional intake. "Perhaps my lack of availability contributed to this malnutrition, because I work from 8 a.m. to 4 p.m. and during my absence, she only took bottles with artificial milk," explains Tabara Ndiaye.

The health worker said he regretted not fully respecting exclusive breastfeeding, which involves giving the baby nothing but breast milk for the first six months.

Furthermore, the head of BREPS recommends, among other things, that the Directorate of Motherhood, Health and Childhood (DSME) ensure the availability of nutritional inputs, provide the region with anthropometric equipment (115 double weighing scales, 230 Shakir strips and 115 measuring rods) and advocate with the Ministry of Health and Social Action (MSAS) for the integration of nutritional products into the supply chain of Senegal-National Supply Pharmacy ( SEN -PNA).

Regarding technical and financial partners, they are asked to support the awareness of populations on good practices in nutrition and child survival as well as the delivery of nutritional inputs to the districts of the region.

Yet, optimal infant and young child feeding (IYCF) practices are essential for the health and survival of young children. These include early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months, continued breastfeeding for two years or more, and the introduction of safe, appropriate, and adequate complementary foods at 6 months of age. These supplements will cover the needs of energy, protein, iron, zinc, and vitamins A and C.

In the meantime, Fatma Wade of HKI points out that antibiotic therapy is available for children suffering from severe acute malnutrition (SAM). "We know that antibiotic therapy can lead to resistance developing," she points out. A start to a solution...