Addressing the Double Burden of Malnutrition in West-Africa: A Twelve-Year Experience with Institutional Partners in Benin, Burkina Faso and Mali

Introduction: While the prevalence of child undernutrition remains high in low- and middleincome countries, the rapid nutrition transition entails an escalation of chronic diseases such as obesity, diabetes and cardiovascular diseases. Even low-income countries of sub-Saharan Africa are affected by this double burden, particularly in urban areas. Addressing the double burden of malnutrition is compelling and should translate into vigorous measures to halt chronic disease progression. As part of its mandate as a WHO Collaborating Centre on Nutrition Changes and Development, TRANSNUT of University of Montreal has addressed the double burden of underand overnutrition with partners from three West African countries for more than a decade. The purpose of this presentation is to discuss the activities that were carried out in the framework of projects funded by Canada in order to better equip the partners to tackle this double nutritional burden. Methods: Project components included new university training programs and training of Ph.D. students in nutrition, a primary school intervention, applied research, and advocacy and communication. In 12 urban primary schools of Benin and Burkina Faso, the "Nutrition-Friendly School Initiative" of WHO, which is intended to prevent the double burden of malnutrition, was implemented on a pilot basis, reaching more than 7000 pupils. New university training programs in nutrition were initiated, with the development of a professional bachelor program in dietetics and nutrition and a Master program in public health nutrition at the Abomey-Calavi University of Benin. On-line courses on the management of severe malnutrition, and on the nutrition transition and chronic diseases, were used in degree-granting and continuous education programs. Research on eating practices and lifestyles in connection with obesity and other cardiometabolic risk factors was a major contributor to the development of a Food Guide in Benin. As regards advocacy, the focus was on the control of type 2 diabetes and for this purpose, the diet-related challenges of patients were investigated in Mali and advocacy tools were developed including a standardized costing tool to estimate the out-of-pocket expenditures of patients for appropriate management of diabetes without or with complications. Results: Every year, there are around 20 graduates of the undergraduate nutrition program and 10 of the Master's program. Ph.D. graduates participate in the training and pursue their research. The school intervention resulted in improved nutritional quality of the food served to pupils and better sanitation in school precincts. Underweight, which was more prevalent than overweight, declined in intervention schools compared to control schools. It is expected that better school eating practices will contribute to prevent overweight. The Food Guide was adopted by the government of Benin and is used by health and nutrition professionals. Conclusion: The community, university and school activities described above are on-going for the most part but their sustainability is a challenge. Although their impact on the double burden cannot be assessed directly, we strongly believe that they contribute in the long run to better policy, programs and practices. (author)