Characterization of food consumption patterns in southern Mali Fatou Diawara Produced by World Vegetable Center Published by World Vegetable Center June 2015 www.africa-rising.net The Africa Research In Sustainable Intensification for the Next Generation (Africa RISING) program comprises three research-for-development projects supported by the United States Agency for International Development as part of the U.S. government’s Feed the Future initiative. Through action research and development partnerships, Africa RISING will create opportunities for smallholder farm households to move out of hunger and poverty through sustainably intensified farming systems that improve food, nutrition, and income security, particularly for women and children, and conserve or enhance the natural resource base. The three regional projects are led by the International Institute of Tropical Agriculture (in West Africa and East and Southern Africa) and the International Livestock Research Institute (in the Ethiopian Highlands). The International Food Policy Research Institute leads the program’s monitoring, evaluation and impact assessment. http://africa-rising.net/ This document is licensed for use under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License This document was made possible with support from the American people delivered through the United States Agency for International Development (USAID) as part of the US Government’s Feed the Future Initiative. The contents are the responsibility of the producing organization and do not necessarily reflect the opinion of USAID or the U.S. Government. Disclaimer The opinions expressed in this report are those of the consultant and do not necessarily reflect the views of AVRDC - The World Vegetable Center. Acknowledgement Our thanks go to:  AVRDC for its efforts in supporting and assisting agriculture and nutrition in Mali.  The residents of the three villages of the district of Bougouni: Dieba, Madina, Flola, and the three villages of the district of Koutiala: Nampossela, Sirakélé and M'Pessoba.  The health teams of the districts of Bougouni and Koutiala. Contents Summary.................................................................................................................................... 1 1. Context .................................................................................................................................. 1 2. Objectives .............................................................................................................................. 2 3. Operational definitions.......................................................................................................... 3 4. Literature review ................................................................................................................... 5 5. Methods ................................................................................................................................ 8 6. Results ................................................................................................................................. 10 6.1 Household characteristics ............................................................................................. 10 6.2 Basic knowledge in nutrition ......................................................................................... 12 6.3 Accessibility and availability of food in households ...................................................... 18 6.4 Work and responsibility sharing agreement between men and women ...................... 25 6.5 Characteristics of households’ food consumption and dietary patterns ...................... 26 6.6 Dietary diversity score ................................................................................................... 45 6.7 Difficulties reported by respondents and suggestions .................................................. 46 7. Comments and discussions ................................................................................................. 47 8. Conclusion ........................................................................................................................... 50 9.Recommendations ............................................................................................................... 51 10.References .......................................................................................................................... 52 11. Appendices ........................................................................................................................ 54 Table XXVIII: Level of education of the heads of households in the districts of Bougouni and Koutiala in 2013 ........................................................................................................ 54 Summary Introduction: In Sikasso there is a great potential of food crops with high nutritional value. However, food security cannot be ensured, justifying the completion of this study whose objective was to provide information on dietary diversity, knowledge of basic nutrition, access to food, intake of vegetables, composition of food, frequency, number of meals and their distribution within the family. Methodology: The study was a cross sampling simple random cross-sectional survey. It lasted 30 days and involved three villages from the district of Koutiala and three villages from the district of Bougouni, women of childbearing age from 15 to 49 years and heads of families. In total 134 women were interviewed and 12 focus groups conducted with six women and six heads of families. The data were entered on the software Epi Data 3.1 and analyzed with the software SPSS 20.0. We used the “khi deux” test of Pearson and Fisher's exact test. Main results: In Bougouni and Koutiala women had little knowledge about nutrition. It appeared that trained women had more knowledge compared to untrained women. The staple diet was cereal and baobab leaves, other foods were not used and undervalued and households had an average of three meals per day. The diet was not balanced and dietary diversity score was predominantly low to medium. As a conclusion, nutritional security was not achieved especially as food use was not ensured. Training had brought more noticeable knowledge in the village of M'pessoba than that of in the village of Sirakele. Keywords: knowledge, nutrition, dietary diversity score 1 1. Context Within the scope of “Africa RISING” project, modes of food consumption in Sikasso region represent an essential part. Vegetable consumption of 200 g/day observed in the region (FAO Nutrition Country Profiles, 2004) is much lower than the rate of 400 g/day recommended by the World Health Organization (WHO). This is especially valid for the region of Sikasso in Mali, where over 77% of the rural population lives in poverty and without means for a balanced diet (Development Program of United Nations, 2009). In this region there is a great potential for food crops with high nutritional value. This study is part of a series of activities conducted from May to December 2013, on selected representative sites of South Mali in Sikasso region. Its objective was to contribute to the achievement of the overall long-term objective of the project. This study aimed to provide information on the diversity of food, give an overview of basic nutrition knowledge of the villages surveyed, an overview on the access to food intake including vegetables, to know the composition of foods, the frequency of the number of meals and their distribution within the family. It covered six villages of the project "Africa RISING", three villages of Koutiala and three villages of Bougouni. 1 2. Objectives 1. 2. 3. 4. 5. 6. Assess the basic knowledge of nutrition; Describe the characteristics of food consumption; Identify the dietary habits and the way food is cooked; Monitor the availability and accessibility of food in households; Determine the scores of food diversity and consumption in households; Describe the existing food diversity and the parts of cereals, vegetables and animal products The results of research focus on improving the diet of households a. Study and understand the basic knowledge of nutrition through meetings of focus groups; b. Collect and document family recipes including baby food / weaning, in detail composition and cooking; c. Collect data on the diversity of local products available for household consumption (food groups, species by group, varieties by species); d. Identify the species cultivated by women in their own fields during the rainy season; e. Study the agreement on work and responsibilities sharing between women and men within family diet; f. Collect information on the main source of income and expenses for vegetables in households; g. Return the results of this study to stakeholders and if possible to villages 3. Operational definitions Food A substance that serves as food for living beings (Hachette Dictionary 2012 Edition. Diet Action, manner to provide or take food (Hachette Dictionary 2012 Edition). Supplementary diet Process is implemented when breast milk alone or formula milk alone is no longer sufficient to meet the nutritional needs of a baby. Therefore, other foods and liquids should be added to breast milk or breast milk substitute. The age trend of babies targeted by supplementary diet is usually from 6 to 23 months (Lexicon UNICEF, July 2011). Exclusive breastfeeding The infant is fed only with breast milk (including breast milk or sucked at a nurse). Drugs, oral rehydration solutions, vitamins and minerals, since they are recommended by health care providers are authorized during exclusive breastfeeding (UNICEF Glossary, July 2011). Micronutrient deficiency State observed when the body lacks vitamins or minerals due to a diet poor in vitamins and minerals, a generally inadequate food and / or a non-optimal assimilation of vitamins and minerals by the body (Glossary UNICEF, July 2011). Knowledge Exact idea of a reality, of its situation, its meaning, its characters and its functioning (Hachette Dictionary 2012 Edition). Diversification It’s the progressive introduction of nutrients other than milk at six months to get the child used, in a few months to a varied diet similar to that of adults (FAO, 2007). Emaciation A child may be suffering from moderate emaciation (weight between 70 and 80% of the average weight compared to the height) or severe emaciation (weight inferior to 70% of the average weight compared to the height) (Glossary UNICEF, July 2011). Malnutrition General term that is often substituted for the term of malnutrition or under nutrition, although, from the technical point of view, it also refers to over nutrition. A person is malnourished if his diet does not include nutrient suitable for his growth or his maintenance in good health or if he cannot fully digest the food he eats because of an illness (under nutrition).He is also malnourished if he consumes too many calories (over nutrition) (Lexicon UNICEF, July 2011). Household Food household, which brings together people who share most of the meals (FAO) Micronutrients: Essential vitamins and minerals required by the body throughout the life cycle, in tiny amounts (UNICEF Glossary, July 2011). Nutrient: A nutrient is anything that nourishes a living being which contribute to metabolism and growth. Hachette Dictionary2012 Edition). Nutrition: Process by which living organisms use food to ensure their growth and vital functions (Hachette Dictionary 2012 Edition). Edema Abnormal fluid retention in the body tissues (UNICEF Glossary, July 2011). Practices This is the usual way of acting (Hachette Dictionary2012 Edition). Diet This is the amount of food that a person must eat to ensure his normal growth and maintain his weight and health status (AG IKNANE A, OURRARA F, DIARRA M et al. Fundamentals of nutrition, vol 1, 2002) Stunting Stunted growth or stunting is a reduced growth rate in human development. It is a primary manifestation of malnutrition and recurrent infections, such as diarrhea and helminthiasis, in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother. (UNICEF Glossary, July 2011). Food security Exists when all people, at all times, have economically, socially and physically access to sufficient, safe and nutritious food that meets their dietary needs and food preferences to enable them to lead an active and healthy life (FAO, 2007) Nutritional security Nutritional security is an ideal situation where everyone enjoys: a food security, adequate care, a prevention and a suitable disease control, a stable environment (AG IKNANE A, OURRARA F, Diarra M et al. Fundamentals of nutrition, vol1, 2002). Weaning Gradual replacement of breast feeding by a more varied diet. (Hachette Dictionary 2012 Edition). 4. Literature review The United Nations Fund for Food (FAO) in its 2012 report notes that between 2010 and 2012 chronic undernourishment affects approximately 870 million people worldwide, of which 15% live in developing countries [1]. In West Africa, according to FAO, hunger and malnutrition touched structurally in 2006-2008 over 33 million people. [2] These people are then in food and nutritional insecurity.[2] Food security: covers four dimensions: availability, access, stability and utilization. All these dimensions must be sustainable over time and be applied simultaneously. Access  Poverty  Purchasing power  Market and transport Infrastructures  Food distribution Supplies  Production  Import capacity  Food reserves  Food aid Stability  Climate risks  Prices fluctuations  Political factors  Economic factors Utilization  Food care and practices  Food quality and safety  Drinkable water  Health and environment Determinants of a good /bad nutrition Figure 1: Appropriate concept of food security and nutritional security Compared to nutritional security, every year 7.6 million children under five years die. About a third of these deaths are due to malnutrition and more than 70% occur in Africa and Southeast Asia. This mortality is higher in rural areas and in poor and less educated families. [3] Poverty is a major cause of malnutrition, although it is not alone. There are physical, psychological and social reasons why people do not eat enough food or do not have a quite varied diet. [4]. The causes are presented on three levels, namely the immediate causes, underlying causes and root causes. Figure 2: Conceptual framework of malnutrition causes adapted by UNICEF, 1991 High prevalence of Malnutrition can be the result of poor knowledge, attitudes and practices related to food and health as observed in Mauritania. [5] In Mali, according to the SMART survey (Standardized Moritoring and Assessment of the Relief and Transition) 2011, 10.4% of children under 5 years suffer from emaciation, 27% from stunting and 19.7% from underweight [6]. These prevalences observed in 2011 are higher than the threshold set by WHO (World Health Organization) to consider the nutrition situation as a matter of public health concern, which are 10% for emaciation and 30% for stunting. The chronic energy deficiency for women of childbearing age is 12.1% according to the same survey [6]. The stagnation of nutritional status in Mali since the last decade is mainly due to inappropriate feeding practices of young children (0 to 23 months) and to a poor complementary diet, a weak health system [7]. In Mali, although the region of Sikasso meets food security, nutritional security is not ensured there. In 2011, the prevalence of emaciation was 7.5%, 39.5% for stunting and 22.0% for underweight while emaciation prevalence was 12.9% [6]. The fight against malnutrition is therefore necessary and logically emerges as a public health priority. It is in this context that appears The World Vegetable Center (AVRDC), an international nonprofit organization of research on vegetable and development, founded in 1971 in Shanhua in the south of Taiwan [8]. Its main objective is "to reduce malnutrition and alleviate poverty in developing countries through improved production and consumption of vegetables [8]. Vegetables production promoted by AVRDC can be used in the poorest areas, where they can serve as "an important source of income" and can help to fight against micronutrient deficiency [8]. Within the scope of "Africa RISING" project, AVRDC conducts nutrition activities in partnership with ICRISAT, USAID, ICRAF, ILRI, AMEDD, by innovating in the context of research action and by making innovations accessible (improved seeds, recipes, cultivation techniques) at the village level [9]. The first phase of activity took place from June 2012 to September 2012 [10]. The center creates so opportunities to enable small farmers to fight against hunger and poverty through sustainable intensification systems to improve food, nutrition and income stability, especially for women and children while maintaining and improving natural resources [9]. People have nutritional needs which are assessed at three levels, namely energy needs (proteins, lipids, carbohydrates), non-energy needs (vitamins, minerals) and fluid needs (water) [11]. Foods according to their chemical composition are classified into seven groups. [11]  Group1: Water, liquids and drinks bring mineral ions and trace elements necessary for the functioning of cells.  Group 2: Fruits and vegetables rich in water, minerals and trace elements, vitamins and dietary fiber.  Group 3 : Cereals, starches, legumes, rich in slow sugars have a good energy value with starch and also contribute to intakes of dietary fiber, B vitamins, minerals (iron and magnesium).  Group 4: Milk and milk products provide essential proteins, animal fats, calcium, phosphorus, soluble vitamins.  Group 5: Meat, fish, eggs Foods in this group are mainly rich in animal protein and essential amino acids. They also provide the iron necessary for the synthesis of hemoglobin and the integrity of the immune system, vitamin B12 and trace minerals. Group 6: Sugar and sugary foods provide the body with simple carbohydrates, and energy  Group 7: Drinks that promote biochemical reactions. AVRDC achieves the development and promotion of the consumption of local foods rich in micronutrients. Vegetables fruits and leafy vegetables as sources of micronutrients especially of pro-vitamins A are available in the area, nearly throughout the year, at a low cost and accessible to households. Vegetables are usually eaten raw or cooked. The present study was initiated by AVRDC in the districts of Bougouni and Koutiala in Sikasso region as part of the characterization of food consumption patterns of these areas. 5. Methods Study Type: It was a cross-sectional simple random sampling survey. Time and place of study: It lasted 30 days and involved villages of Serekela, M'Pessoba, Nampossela from Koutiala district and Dieba, Madina and Flola from Bougouni district. Figure 3: Map of the region of Sikasso (Source DRPSIAP Sikasso) Study population: were included in the study women of childbearing age from 15 to 49 years and heads of families who were all present and who agreed to participate in the study. Sampling: The selection of villages was done in a reasoned way by the AVRDC team. The random selection was made for 10 trained villages and 10untrained ones. For individual interviews within each family a woman of childbearing age was chosen at random. In total 134 women were interviewed. Focus group discussion Semi-structured focus groups which lasted 30 minutes on average were organized. 12 focus groups carried out on the basis of 2 by villages. Six interviews were conducted with women of childbearing age and 6 with heads of families that is a ratio of one for each village. To collect the information we used multi-section individual questionnaires, an interview guide and audio recordings with a Dictaphone. Data Collection: Data collected allow to gather information on:  The basic knowledge in nutrition: definition causes and signs of malnutrition, what is a balanced diet, nutrition of pregnant/ lactating women diet, nutrition of a sick person;  The composition of the household diet, cooking time of family meals, infant feeding;  The local products available and consumed in households and the share of cereals, vegetables, animal products;  The species cultivated by women in their own fields during the rainy season;  The agreement on work sharing between women and men within the family and the distribution of responsibilities concerning the diet of the family;  The main source of income and expenses for vegetables within households;  Themes addressed in focus groups for women of childbearing age focused on the basic knowledge in nutrition, family recipes, recipes of babies complementary food and their method of preparation, the existing food diversity and the share of cereals, vegetables, animal products, proposals for greater vegetable consumption in households. The themes addressed for fathers focused on the diversity of local products available for diet during the study period, the availability of food in the household, the agreement on work and responsibilities sharing between women and men compared to the diet of the family, propositions for greater vegetable consumption in households. The research team: consisted of one principal consultant, three investigators including one locally recruited and a driver. Interviewers were trained and data collection tools were pretested. Processing and analysis of data Data collected were entered manually, the record was made with the EpiData3.1 software. The quality control of field data was provided by the consultant. A double data entry was made as well as a thorough cleaning of the database. Data analysis was performed with SPSS 20.0 software. We used the chi-square test of Pearson and Fisher's exact test (cases of theoretical numbers inferior to 5) for the relationship between vegetable consumption and the main variables. The risk of error α was equal to 5% and the values of p-value inferior to 0.05 were considered statistically significant. The information gathered during the focus groups were transcribed with a labeling of all the verbatim according to the theme and a weighting of the results was made. For ethical considerations: the free and informed consent of the community was obtained at the village level. No financial incentive was offered for the participation in the study. The interviews were confidential and were carried out taking into account the availability of participants. The latter could choose not to answer questions that would be uncomfortable and they could stop the interview at any time without harm. 6. Results 6.1 Household characteristics Table I: Distribution of surveyed households in the districts of Bougouni and Koutiala in 2013 District Village Number of households Number of surveyed households Bougouni Madina Diéba Fola Total 300 202 51 753 20 24 25 69 Koutiala M’pessoba Nampossela Sirakele Total 500 405 350 1255 22 23 20 65 In “nutrition” villages of Mpessoba and Sirakele households were divided into equal number between trained and untrained. Heads of households in Bougouni were male at 100% and at 99% in Koutiala. Table II: Distribution of households based on the average number of people in the district of Bougouni in 2013 Gender Male Female Total Productive males Productive females Total Average number of people per household Dieba n=24 Flola n=23 5.75 ± 8.639 3.00 ± 1.826 8.17 ± 10.897 3.48 ± 2.002 13.92 ± 19.188 6.48 ± 3.380 Average productive people per household 1.87 ± 1.849 1.36 ± 0.638 1.92 ± 2.701 1.20 ± 0.645 3.79 ± 4.452 2.56 ± 1.121 Madina n=20 4.05 ± 2.164 3.40 ± 2.349 7.45 ± 3.939 1.05 ± 0.224 1.15 ± 0.587 2.20 ± 0.696 In the district of Bougouni about a third of people in households was active and it was the same for three villages. Table III: Distribution of households by the average number of people in the district of Koutiala in 2013 Gender Male Female Total Productive males Productive females Total Average people per household Mpessoba n=24 Nampossela n=23 6.68 ± 7.266 4.13 ± 4.093 6.41 ± 7.744 4.43 ± 3.342 13.09 ± 14.540 8.56 ± 6.953 Average productive people per household 1.82 ± 1.532 1.57 ± 1.161 2.09 ± 2.543 1.48 ± 1.201 3.91 ± 3.987 3.05 ± 2.099 Sirakele n=20 4.60 ± 1.903 4.95 ± 3.348 9.55 ± 4.651 1.70 ± 0.979 2.05 ± 1.317 3.75 ± 2.173 A quarter of household members in M'pessoba and a third of them in Nampossela and Sirakele were active. Main source of household income The main source of income in all the surveyed villages was obtained through the sale of agricultural products with 100% in Dieba, 96.0% in Flola, 70.0% in Madina, 86.4% in M'pessoba, 82.6% in Nampossela and 100% in Sirakele. Participation of men in household expenses 100% of households in Dieba and Flola from the district of Bougouni and households in Nampessola and Sirakele productive men contributed to expenses. In the villages of Madina in Bougouni and M'pessoba in Koutiala, men participated in expenditures respectively with 95% and 95.5%. Table IV: Distribution according to the main household expenses in the districts of Bougouni and Koutiala in 2013 Districts Bougouni Koutiala Household expenses Dieba Flola Madina M'pessoba Nampossela Sirakele Condiments costs 6 25.0% 13 54.2% 0 0.0% 1 4.2% 4 16.7% - 8 32.0% 12 48.0% 0 0.0% 3 12.0% 2 8.0% - 8 40.0% 10 50.0% 2 10.0% 0 0.0% 0 0.0% - 13 59.1% 5 22.7% 3 8 34.8% 5 21.7% 3 13.0% 1 4.3% 1 4.3% 1 5 25.0% 8 40.0% 2 10.0% 3 15.0% 2 10.0% 0 24 - 1 4.5% 20 13.6% 22 4.3% 4 17.4% 0.0% 0 0.0% 20 Health costs Clothing Taxes Wedding costs Purchase of agricultural equipment school fees 25 Health care costs were the most important in Dieba, Flola and Madina. In other places condiments costs were predominant. 6.2 Basic knowledge in nutrition 6.2.1 Definitions of malnutrition Table IV: Distribution of women of reproductive age according to the definition of malnutrition in Bougouni in 2013 Definitions Do not know Weakness Lack of useful food for the body Do not have the food you want to eat Lack of foods rich in vitamins Childhood disease Poor quality of consumed food If no vaccinations received Dieba n=24 14 (58.3%) 1 (4.2%) 5 (20.8%) 3 (12.5%) 1 (4.2%) - Flola n=25 21 (80.0%) 2 (8.0%) 1 (4.0%) 1 (4.0%) - The majority of women did not know the definition of malnutrition. Madina n=20 13 (65.0%) 1 (5.0%) 1 (5.0%) 2(10.0%) 1 (5.0%) 2 (10.0%) During focus groups activities it was clear that the definition of malnutrition was little known by women. Some, however, in the focus groups said that it was called "balo dèssè bana" (disease due to the lack of food). Table V: Distribution of women according to their definition of malnutrition in the district of Koutiala in 2013 M’pessoba Do not know Lack of vitamin in the body Childhood disease Foodborne disease Lack of food rich in vitamin Lack of blood Vitamin deficiency in meals Poor diet of the mother Trained 1 (9.1%) 3 (27.3%) 1 (9.1%) 0 (0.0%) 5 (45.4%) 1 (9.1%) - Untrained 9 (81.8%) 0 (0.0%) 1 (9.1%) 1 (9.1%) 0 (0.0%) 0 (0.0%) - - - Nampossela Sirakele 10 (43.5%) - Trained 0 (0.0%) - Untrained 6 (60.0%) - 1 (4.3%) - 1 (10.0%) - 0 (0.0%) - 9 (39.2%) - 4 (40.0%) - 1 (10.0%) - 2 (8.7%) 1 (4.3%) 5 (50.0%) - 3 (30.0%) - Some women knew malnutrition and some of them in Sirakele said that there is a link between malnutrition and hygiene and breastfeeding during focus groups activities. The majority of women didn’t give any definition. 6.2.2 Causes of malnutrition 4,2 90% 16,7 80% % cités 70% 60% 4 8 4 10 Mauvaise façon de préparer les aliments 10 Maladie de l'enfant 10 12,5 50% 30% 90% 80% 5 8,3 84,0 40% 100% 65,0 58,3 Insuffisance d'apport d’aliments riches en vitamines Insuffisance d'allaitement Insuffisance d'alimentation en quantité 20% Inaccessibilité financière aux denrées 10% Grossesse rapprochée 60% Flola Madina 26,3 Ne sais pas 15,0 72,7 Sevrage mal fait 61 25,0 75 50% 40% 30% 20% 49,1 0% Ne sais pas 9,1 9,1 10% 0% Dieba 5,0 10,0 8,2 4,1 4,1 8,2 70% % cité 100% 9,1 Formé Non formé 8,7 4,3 Maladie de l’enfant 35,0 17,4 10 8,6 Formé Mauvaise façon de préparer les aliments Manque de produits naturels dans le corps Inaccessibilité financière 10,0 5,0 5,0 5,0 Insuffisance d’aliments riches en vitamines Insuffisance d’aliment en quantité suffisante Non formé Mpessoba Nampessola Sirakele Villages de Bougouni Villages de Koutiala Chart 1: Distribution of women of childbearing age according to their knowledge of the causes of malnutrition in the district of Bougouni in 2013 Chart 2: Distribution of women of childbearing age based according to their knowledge of the causes of malnutrition in the district of Koutiala in 2013 The majority of women in Bougouni didn’t know any cause of malnutrition. According to the respondents who were able to answer this question there are three main causes, namely: financial inaccessibility to food, ignorance of the disease and lack of food rich in vitamins. During focus groups activities in Bougouni and Koutiala, women of childbearing age who knew no cause of malnutrition were the most numerous and there was confusion between the definition and the causes. It stemmed from the focus groups that some women had prerequisites they did not seem to realize. % cités 6.2.3 Signs of malnutrition 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 4,2 25,0 4,0 8,0 4,0 5,0 30,0 Retard de croissance Maladie de l'en fant 12,5 Diarrhee et vomissement 84,0 65,0 58,3 Amaigrissemen t Ne sais pas Dieba Flola Madina Villages de Bougouni Chart 3: Distribution of women of childbearing age according to their knowledge of the signs of malnutrition at Bougouni in 2013 Female respondents overwhelmingly knew no sign of malnutrition. During focus groups, respondents recognized malnutrition because of certain signs like growth retardation, swollen belly, red hair, weight loss, body edema and nonchalance. 100% 90% 80% % cités 70% 60% 8,6 4,3 9,1 18,2 18,2 9,1 9,1 39,2 5 10 20 20 Manque d'appétit et amaigrissement 20 Cheveux sec et roux et nervosité 10 10 50% 40% 30% 54,5 72,7 40 10% 0% 50 47,9 20% Amaigrissement, gros ventre, cheveux secs et cassants Petite taille pour l’âge 15 9,1 Formé Oedemes, et amaigrissement Non formé M'pessoba Formé Nampossela Non formé Sirakele Amaigrissement Ne sais pas Villages de Koutiala Chart 4: Distribution of women of childbearing age according to their knowledge of the signs of malnutrition at Koutiala in 2013 At Koutiala in trained villages M'pessoba’s women had better knowledge of malnutrition signs. At Sirakele 15% of trained women do not know any malnutrition sign. At Nampessola an untrained village, women were able during the focus groups to name signs. On the whole signs were not known by women. 6.2.4 Balanced diet Definition of a balanced diet In the district of Bougouni, 62.5%, 92.0% and 75.0% of women respectively in Dieb, Flola and Madina did not know what a balanced diet should contain. The majority of women in all the villages had cited beef, mutton, fish, poultry and eggs separately or together as being a balanced diet. Vegetables were cited as part of this diet in 8.4% of cases at Dieba, 4.0% at Flola and 10% at Madina. In the district of Koutiala like in Bougouni, animal proteins were the most cited among other foods. 18.2% of trained women at M'pessoba did not know the definition and the same proportion cited vegetables as part of it. Untrained women did not know up to 81.8% and did not cite any vegetable. At Nampossela, 65.2% of women did not know the definition and 8.6% had cited vegetables. At Sirakele, trained or untrained women were 30% who did not know what a balanced diet was. Trained women had cited vegetables in 10% of cases against 20% for untrained women. In most cases vegetables were few cited by women. And just like in Bougouni animal proteins were the most cited among other foods. Pregnant / lactating woman’s diet At Bougouni animal proteins have been reported in the majority of cases. In villages vegetables were cited respectively 16.6% in Dieba, 15% inMadina and 16% in Flola. At Koutiala, trained women argued that a balanced diet for pregnant / lactating women included vegetables with 45.5% in M'pessoba against 18.2% for the untrained, 20.0% in Sirakele against 10 0%. In the village of Nampossela 30.2% of the food included vegetables. All women who did not know had not been trained, with 63.6% in M'pessoba, 43.5% in Nampossela and 30% in Sirakele. Women were able to cite vegetables and some other foods. Vegetables were most cited by women who benefited from training on nutrition. Sick person’s diet Cited meals for sick people included few vegetables in the villages of Bougouni at the rate of 16.8% in Dieba, 12.0% in Flola, 25.0% in Madina. In the villages of Koutiala meals cited for sick people did not include vegetables in Sirakele for trained women against 20.0% for the untrained. They included few vegetables in Nampossela with 12.9%, 27.3% in M'pessoba for trained women and 9.1% for the untrained. Diet for old people No difference was made between the diet of an old person and that of a healthy adult. Vegetables were not cited and no difference was made during the focus groups between the diet of the sick person and that of the persons mentioned above. Concerning the balanced diet. Apart from the fact that the majority of respondents did not know what the different definitions were, those who were able to answer did not know the different food groups and this regardless of the village. Focus groups didn’t bring additional elements. 6.2.5 Advantages of vegetables consumption Table VI: Advantages of vegetables consumption cited by women in the district of Bougouni in 2013 Advantages Improves health Provides energy Provides vitamins Enhances health Do not know Villages of the district of Bougouni Dieba Flola Madina 4 (16.7%) 13 (54.2%) 2 (8.3%) 5 (20.8) 2 (8.0%) 10 (40.0%) 4 (16.0%) 9 (36.0%) 3 (15.0%) 3 (15.0%) 6 (30.0%) 1 (5.0%) 7 (35.0%) Most women knew the advantages of vegetables consumption Table VII: Advantages of vegetable consumption cited by women in the district of Koutiala in 2013 Advantages Improves health Provides vitamins Good for health Balances the diet Strengthens the body Protects health Enhances health Do not know Villages of the district of Koutiala M'pessoba n=22 Trained Untrained Nampossela n=23 2 18.2 1 9.1% - 0 0.0% 0 0.0% 0 0.0% - 1 4.3% 4 17.4% 0 4.3% - - - 1 10.0% 2 20.0% 1 10.0% - - 2 8.6% - 1 9.1% 10 90.9% 5 21.7% 10 43.5% 1 10.0% 1 10.0% 7 70.0% 0 0.0% 1 10.0% % 1 10.0% 4 40.0% 1 9.1% 1 9.1% 6 54.5% - Sirakele n=20 Trained 1 10.0% - Untrained In M'pessoba the advantages of vegetables consumption were most known by trained women. At the level of untrained women, those who did not know were the most numerous with 90.9% in M'pessoba, 43.5% in Nampessola and 40.0% in Sirakele. The majority of women in Bougouni knew the advantages of vegetables consumption. All trained women in Koutiala knew at least one advantage of vegetables consumption. 6.3 Accessibility and availability of food in households 6.3.1 Accessibility 4,3 35 64 58,3 50 43,5 5 45 deux hommes 50 52,2 50 aucun homme Sirakele Madina 36 Nampossela 37,5 un homme M'pessoba 65 Contribution 4,2 Flola 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Dieba Contribution Expenses on vegetables 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 18,2 10 10 10 30 45,5 81,8 80 60 36,4 M'pessoba Sirakele Villages de Koutiala Chart 6: Distribution of households according to the number of men participating in the expenses for the purchase of garden produce in the districts of Koutiala and Bougouni 2013 6.3.2 Availability Family cultivable plots Almost all households in the district of Bougouni (97.1%) and Koutiala (95.4%) had a cultivated family plot. Cultivable plots owned by women Table VIII: Distribution of women according to the possession of cultivable plots in Bougouni in 2013 Dieba Flola Madina M'pessoba Nampossela Sirakele un homme aucun homme In the villages of Dieba and Flola less than 50% of men participated in the expenses for vegetables in the household. The maximum men participating in the expenses for vegetables in households came from M'pessoba with trained women. Plots farmed by the woman Yes 20 83.3% 8 32.0% 14 63.6% 16 80.0% 10 43.5% 20 100.0% deux hommes formé non formé formé non formé Bougouni Koutiala Cercle-village Chart 5: Distribution of households according to the number of men participating in expenses for growing market garden crops in the districts of Koutiala and Bougouni 2013 18,1 No 4 16.7% 17 68.0% 8 36.4% 4 20.0% 13 56.5% 0 0.0% P 0.000 There was a statistically significant relationship between the possession of plots by women and the village they belong to. Gardening practice by women Table IX: Distribution of women according to the practice of gardening in their plots in the Districts of Bougouni and Koutiala in 2013 District Bougouni Villages Total Yes 5 38.4% 4 30.8% 4 30.8% 13 No 19 33.9% 21 37.5% 16 28.6% 56 M'pessoba 7 15 30.4% 7 30.4% 9 39.1% 23 35.7% 16 38.1% 11 26.2% 42 Dieba Flola Madina Koutiala P Garden crop Nampossela Sirakele Total 0.663 0.555 The practice of gardening by women had no statistically significant relationship with the village. Table X: Distribution of women according to the practice of gardening in trained and untrained villages of the District of Koutiala in 2013 Gardening Yes No Total Training Trained 11 52.4% 10 47.6% 21 Untrained 5 23.8% 16 76.2% 21 P 0.057 The practice of gardening had no statistically significant relationship with training in the district of Koutiala. Table XI: Crops grown by women in their plots in the district of Bougouni in 2013 Gardening Local name Djaba Tomati Ngan Forotô Goyo Concombre Pomporo Naboulou Dieba French name Oignon Tomate Gombo Piment Aubergin e Concomb re Poivron Naboulou Maïs Kaba Petit mil Sagno Riz Malo Kenike/bimbiri(fl Sorgho ola) Fonio Fini Arachide Flola Home Home 4 Home consumptio 4 consumption/sale 1 consumption/sale n =2 =12 =4 3 2 Home consumptio 1 n/ sale=7 2 2 2 2 1 1 2 Cereals 4 Home 3 consumpti 3 4 on 16 8 /sale=28 1 4 Others Home consumptio n/ sale=27 5 7 Chô Haricot Banancou Manioc Home 20 consumpti 8 on /sale=22 1 Sira Tabac 1 Tika Madina 4 Home 2 consumption/sale =7 1 Home consumptio n/ sale=6 Exchange with rice=2 1 Home 3 consumption/sale =12 Sale solely=1 20 Table XII: Crops grown by women in their plots in the district of Koutiala in 2013 Local name French name Oignon Tomate Gombo Piment Aubergine Concombre Poivron Salade Melon Naboulou Cereals Maïs Kaba Petit mil Sagno Riz Malo Kenike/bimbiri(flola) Sorgho Fonio Fini Others Arachide Tika Haricot Chô Manioc Banancou Pois de Tikanicourou terre Pomme de Pomme de terre terre Patate Wosso douce Cotton Cori Djaba Tomati Ngan Forotô Goyo Concombre Pomporo Salade Melon Naboulou M’pessoba 6 Home 4 consumption /sale=18 5 Nampessola Gardening 4 Home 4 consumption/ sale=4 Sale solely=8 2 2 Sirakele 2 1 12 Home 4 consumption / sale=29 6 2 5 11 Home 12 consumption/ sale=32 4 4 1 7 7 7 2 2 1 1 Home consumption/ sale=28 1 2 9 5 8 2 1 Home consumption /sale = 17 Home consumption=8 3 Home 13 Home 18 Home consumption=6 consumption 2 8 consumption/ / sale=10 sale=34 1 1 solely=3 4 2 1 3 Table XIII: List of vegetables grown in plots owned by women in the districts of Koutiala and Bougouni in 2013 Local name Djaba French name Oignon Scientific name Djaba Echalotte Tomati Tomate Ngan Gombo Forotô Piment Allium cepa var.aggregatum Lycopersicon esculentum Abelmoschus esculentus Capsicum frutenscens Goyo Aubergine Solanum aethiapicum Allium cepa L. Group/Fam Kind ily Liliaceae Allium Liliaceae Specy cepa L. Allium cepa var.aggregatum Solanaceae Lycopersic esculentum on Malvaceae Abelmosch esculentus us Solanaceae Capsicum frutenscens Solanaceae Solanum aethiapicum Concombr Cucumis sativus e Pomporo Poivron Capsicum annuum Cucrbitacea Cucumis e Solanaceae Capsicum sativus Naboulo u Aubergin Aubergine Solanum melongera L. e Choux Choux Brassica oleracea Solanaceae Solanum melongera L. Cruciferes oleracea Salade Salade Lactuca sativa Composites Lactuca sativa Melon Melon Cucumis melo Cucurbitace Cucumis ae melo Concon Brassica annuum Table XIV: List of cereals grown in plots owned by women in Koutiala and Bougouni in 2013 Local name Scientific name Sagno French name Mil Malo Riz Kind Species Variety Pennisetum Graminaceous glaucum (L.) R. Br. plants Pennisetu m Typhoïd or glaucum Oriza sativa/glaberrrim a Graminaceous plants Orysa sativa or glaberrima Kenike/bimb Sorgho iri(flola) Sorghum bicolor (L) Panicoïdées/ graminaceous plants Sorghum bicolor Fini Digitaria exilis Graminaceous plants Digitaria exilis Sanioba, Toroniou C1, Souna, Djiguifa, M9b3, ITMV, M12D1 Nerica4, BG 90-2, ITA 304, Gambiaca kokoum, BH2, Dourado précoce, MSP10, DM16, Kogoni 91-1, DK3, Segadis, Mali sawn Grinka or Tiandougou Coura, Seguenata, Mutant Sorg88-10-02, Tinbora, IRAT S6, CSM388, Malisor 92-1 CFIGE 26, 37, 48,60, 1, 3 Fonio Group Sotubaka, Dembanyma, Malihybride 7, DMR (Niéléni), SR 22 et T Z E S R Table XV: List of others crops grown in plots owned by women in Koutiala and Bougouni in 2013 Local name French name Scientific name Tika Arachide Arachis hypogaea Chô Haricot (niébé) Tikanicour ou Wosso Pomme de terre Banancou Pois chiches (voandzou) Patate douce Pomme de terre Manioc (Vigna Papilionaceous Vigna unguiculata (L.) plants Walp Vigna subterranea Papilionaceous Vigna plants Ipomea batatas Concolvulacea Ipomea e Solanum Solanaceae Solanum tuberosum Manihot Euphorbiaceae Manihot esculenta SIRA Tabac Nicotiana tabacum Group Kind Species Variety Hypogaea Solanaceae Nicotiama Virginia variety: 28-206; 1040; GH119-20/ Valencia-Spanish variety: 47-10; 28-204; 55-437; Valencia variety; valencia 247. Unguiculat KVX 745-11P, a Dounanfana, Korobalen Subterrane les CMV: CMV3a 1, CMV8-4 Batatas Tuberosum Sahel, Pamina, clostar, Mondial utilissina et Manihot esculenta palmata, Manhot aïpi Tabacum Burley 21, Bringh cospaia, Paraguay, Kentucky 104 6.4 Work and responsibility sharing agreement between men and women For women, in the two districts : It appeared from analysis of the information obtained during the focus groups, that women worked in the family farms and practiced mainly gardening without men support. For the responsibility for household nutrition, men were responsible for providing households with cereal and women sometimes to care for condiments costs. They had the responsibility to enrich meals. Sometimes in case of cereal shortage women sold vegetables to buy some. But the head of household could also allow a portion of grain to be sold so that to buy condiments. Women sold vegetables to meet their personal expenses and those of their children. Vegetables were mostly for sale, so not consumed much in households. Within households only unsold vegetables, or not being good quality or enough for sale were consumed. At mealtime, everyone in the household ate the same meal is shared between men, women and children. Those faster in eating had the largest share at the expense of the very young, sick or elderly. Sometimes porridge was offered to these three groups. In case of meals improvement privilege was given to heads of households when sharing. For men Market gardening was mostly practiced by women, they sold a portion to pay for condiments. Men grew cereal and were in charge of providing the household with cereal. The vegetables were for sale and not much consumed or used to enrich meals in households. Some men from M'pessoba said they supported women in their business. Men argued that if women gardening grew more they may then invest financially in the household. 6.5 Characteristics of households’ food consumption and dietary patterns 6.5.1 Feeding the under 5 years child Breastfeeding time At Bougouni respectively 50%, 52.0% and 80.0% of children were breastfed immediately after birth in Dieba, Flola and Madina. Few children were breastfed more than 24 hours after birth with 9.1% Dieba, 15.0% in Madina. At Koutiala 80,0 % mise au sein 70,0 63,6 70,0 63,6 70,0 65,2 60,0 50,0 40,0 36,4 36,4 30,0 34,8 20,0 20,0 10,0 moins de 1 H 20,0 10,0 10,0 formé non formé de 1 h à 24 H Plus de 24 H 0,0 formé non formé M'pessoba Sirakele Napessola Villages de Koutiala Chart 7: Distribution of women of childbearing age based on the breastfeeding timeframe of their children in the district of Koutiala in 2013 Colostrum and exclusive breastfeeding In the surveyed villages more than 90% of children had received colostrum except at Flola with 88.0% and Sirakele with 80%. Compared to exclusive breastfeeding, the lowest rate was recorded at Sirakele with 50.0%. It was 59.1% in Dieba, 64.0% in Flola, 68.2% in Madina, 73.7% in M'pessoba and 63.6% in Nampessola. Some respondents said during the focus groups that especially exclusive breastfeeding is a determining factor in the growth of the child but also an insufficiency of breast milk may be a cause of malnutrition. Complementary feeding Table XVI: Distribution of women of childbearing age in terms of the average age of introduction, in months, of complementary feeding in the districts Bougouni and Koutiala in 2013 Villages of Bougouni n % Average age of introduction Standard deviation Dieba 20 18 .2 6.67 2.887 Flola 18 16.4 5.53 3.533 Madina 18 16.4 Trained Untrained 10 10 16 9.1 9.1 14.5 Trained Untrained 9 9 8.2 8.2 12.80 8.67 7.85 7.93 7.42 8.00 9.089 5.987 4.234 3.494 3.906 4.456 M'pessoba Nampossela Sirakele The age of introduction of complementary feeding set at national level at 6 months was not observed in all the surveyed villages. The food supplement was given on average 3 times in all villages and this regardless of the age of the child. In the focus groups, respondents in the majority recognized the role complementary feeding in the prevention of malnutrition. 24-hour recall Céréales Bouillie familiale Graisses animales Lait artificiel, produits laitiers Légumes Protéines végétales Protéines animales Lait naturel Fruits Jus de fruits Tisane, thé, infusion 50 4,8 9,5 11,9 14,3 0 0 73,8 35,7 33,3 28,6 21,4 20 40 60 % consommé 80 Chart 8: Food consumed in the previous 24 hours by children aged 6 – 59 months in Bougouni 2013 Céréales Bouillie familiale Graisses animales Lait artificiel, produits laitiers Légumes Protéines végétales Protéines animales Lait naturel Fruits Jus de fruits Tisane, thé, infusion 33,3 3,7 11,1 3,7 1,9 0 61,1 14,8 25,9 51,9 9,4 42,6 10 20 30 40 50 % consommé 60 70 Chart 9: Food consumed in the previous 24 hours by children aged 6-59 months in Koutiala in 2013 Children's 24-hour food recall showed that 11.9% contained vegetables in Bougouni against 3.7% in Koutiala. The vast majority of children had eaten the family orridge with 73.8% in Bougouni and 61.1% in Koutiala. % consommé 120,0 80,0 60,0 40,0 20,0 100,0 100,0 90,0 100,0 80,0 60,0 40,0 10,0 30,0 71,4 60,0 40,0 10,0 10,0 14,3 11,1 Formé 77,8 non formé 44,4 28,6 28,6 11,1 0,0 Aliments consommés Chart 10: Food consumed in the previous 24 hours by 6-59 months children in the village of M'pessoba in 2013 22,2 120 100 % consommé 100 80 50 60 44,4 44,4 44,4 40 33,3 33,3 22,2 20 11,1 11,111,1 11,1 11,1 20 60 100 66,7 50 20 20 Formé non formé 0 Aliments consommés Chart 11: Food consumed in the previous 24 hours by 6-59 months children in the village of Sirakele in 2013 At M'pessoba 40% of children whose mothers had benefited from training had received vegetables against 10% for those untrained. In the village of Sirakele children of untrained women had received more vegetables with 22.2% against 11.1% for those trained. Infant porridge It appears that just over a quarter of trained women cooked infant porridge in Koutiala and 18.2% of the untrained women also cooked. In Bougouni 20.0% of trained women and 25.0% of untrained women cooked infant porridge. Most of infant porridge (68.2%) had a liquid consistency regardless of the child’s age. Table XVII: Composition of infant porridge in the district of Bougouni in 2013 Dieba n=24 Moni Roui Flola n=25 Moni Baka/seri Baka nafama /Séri nafama Moni nafama Roui Madina n=20 Moni Baka/seri Roui Composition do not cook maize, water Cooking time 60 mn Consistency Liquid Liquid 35 mn 15 mn 20 mn Liquid Liquid Liquid 4.2% 15 mn Liquid 12 2 1 1 3 1 2 48.0% 8.0% 4.0% 4.0% 12.0% 4.0% 8.0% 60 mn 60 mn 60 mn 50 mn 60 mn 35 mn 60 mn Liquid Liquid Thick Liquid Thick Liquid Thick Thick 1 4.0% maize, groundnuts, beans, water maize, water, rice, beans, sugar 1 4.0% don ’t know Liquid 1 4.0% 60 mn Liquid do not cook 10 50.0% - maize, water, sugar, lemon 1 1 1 3 3 1 5.0% 5.0% 5.0% 15.0% 15.0% 5.0% 18 mn Liquid 18 mn 15 mn 60 mn 60 mn 15 mn Liquid Thick Liquid Thick Thick maize, water, lemon maize, water, sugar maize, water, pearl millet, beans, sugar maize, water, salt, sugar do not cook maize, water maize, water, salt, sugar maize, water, salt, sugar, lemon maize, water, sugar maize, water maize, beans, water maize, beans, water, oil, sugar millet, beans, maize rice, beans, maize maize, water, sugar maize, water, rice, beans, sugar maize, milk powder Number 16 1 4 1 % 66.7% 4.2% 16.7% 4.2% 1 4.2% 1 30 Table XVIII: Composition of infant porridge in the district of Koutiala in 2013 Local name M’pessoba n=22 Baka/Seri Moni Roui Nampossalta n=23 Moni nafama Composition Number % do not cook 12 54.5% 4 18.2% 2 9.1% 1 1 4.5% 4.5% 2 9.1% 15 65.2% 2 8.6% 1 4.3% 1 4.3% maize, water, salt, sugar 1 4.3% Liquid maize, water, sugar, milk 3 13.0% Liquid do not cook 11 55.0% Thick 1 5.0% 1 5.0% 1 5.0% 1 5.0% 1 1 5.0% 5.0% 3 15.0% millet, beans, maize, water, milk, sugar petit millet, beans, maize, water, milk, sugar maize, water, sugar, beans, salt, milk maize, water, sugar, lemon, milk maize, water, salt, sugar, millet, groundnuts oil do not cook maize, beans, groundnuts, monkey bread, oil, salt, water, sugar maize, beans, groundnuts, rice, millet, water, sugar maize, beans, groundnuts, rice, millet, water, sugar, oil, tamarind Moni Sirakele n=20 Moni nafama Moni: Baka /Seri nafama maize, beans, groundnuts, rice, millet, water, sugar maize, beans, groundnuts, rice, millet, water, sugar, oil, tamarind maize, beans, water, sugar maize, rice, millet, water, sugar, soya, monkey bread maize, water, salt, sugar maize, water, salt, sugar, lemon maize, beans, groundnuts, monkey bread, oil, salt, water, sugar Cooking time Consistency Liquid Liquid Thick Liquid Thick Liquid Liquid Thick Liquid Thick Liquid Liquid Liquid Liquid Thick Thick Liquid 40,0 35,0 35,0 % consommé 30,0 31,8 27,3 20,0 20,0 18,2 20,0 Formées ne préparent pas 25,0 22,7 25,0 Formés et préparent Non formés et préparent 15,0 Non formées ne préparent pas 10,0 5,0 0,0 M'pessoba Sirakele Villages de Koutiala Chart 12: Infant porridge cooking in the trained villages of the district of Koutiala in 2013 Millet flour at Flola Corn flour and green leaves at Flola Children’s weaning Table XIX: Average age for children’s weaning in the villages of the districts of Bougouni and Koutiala in 2013 Districts Villages Number Minimum Maximum Average age for Standard weaning deviation Bougouni Dieba Flola Madina M'pessoba Nampossela Sirakele 7 19 8 6 15 11 14 6 19 17 10 6 22.00 14.74 23.13 24.83 19.27 15.45 Koutiala 27 24 24 36 24 24 4.655 6.261 1.808 6.145 5.837 6.977 32 Bougouni < 24 mos ≥ 24 mois Sirakele Nampessola M'pessoba Madina Flola Dieba % d'enfants 84,0 90,0 77,8 77,8 75,0 80,0 70,0 60,9 55,0 60,0 45,0 50,0 39,1 40,0 25,0 30,0 22,2 22,2 16,0 20,0 10,0 0,0 Koutiala Villages des cercles de Bougouni et Koutiala Chart 13: Weaning month for children in the villages of the districts of Bougouni and Koutiala in 2013 6.5.2 Households’ food patterns Family food The staple food in households in the two districts was cereals, specifically maize and baobab green leaves. On average, families both in Bougouni or Koutiala had on average three meals, regardless of the village. Maize in Flola Baobab leaves being driedNimpessola Sorghum in M'pessoba Table XX: Households’ breakfast composition in the district of Bougouni in 2013 Dieba n=24 Local name Composition Number % Cooking time Moni maize, water 1 4.2% 60 mn maize, water, lemon 1 4.2% 40 mn maize, water 10 41.6% 23 mn 1 4.2% 30 mn maize, water, sugar 1 4.2% 40 mn maize, water, shea butter 8 33.6 32 mn millet, water maize, water, potash, okra, salt 1 1 4.0% 4.0% 40 mn 60 mn Moni maize, water Baka/seri maize, water maize, water, lemon maize, water, sugar Wosso sweet potato, salt 2 12 1 9 1 8.0% 48.0% 12.0% 28.0% 4.0% 52 mn 40 mn 37 mn 30 mn 40 mn Moni maize, water 9 45.0% 58 mn maize, water, milk 2 10.0% 60 mn 4 20.0% 48 mn maize, water, lemon 1 5.0% maize, water, sugar 2 10.0% 30 mn maize, water, potash, baobab leaves, salt 1 5.0% maize, water, potash, okra, salt 1 5.0% Baka/Seri maize, water, lemon Tô Flola n=25 Madina n=20 Baka/seri maize, water Tô 30 mn 60 mn 60 mn Table XXI: Households’ lunch composition in the district of Bougouni in 2013 Dieba n=24 Flola n=25 Madina n=20 Local name Composition Baka/Seri maize, water Tô maize, water, potash, baobab leaves, salt, soumbala millet, water, potash, baobab leaves, salt, soumbala Foyo fonio, okra, water, salt, shea butter, onion Kini rice, water, okra, salt, soumbala rice, water, groundnuts dough, salt, onion, dried fish Niènèkini maize, water, okra, salt, soumbala Cooking Number % time 1 4.2% 30 mn 18 75.0% 60 mn Bassi Chô Kini 1 4.2% 60 mn 1 4.2% 90 mn 1 1 4.2% 4.2% 90 mn 90 mn 1 4.2% 60 mn maize, water, salt, shea butter, onion beans, potash, salt, shea butter rice, water, groundnuts dough, salt, onion, dried fish Baka/seri maize, water maize, water, potash, baobab leaves, Tô salt, soumbala 1 1 1 4.0% 4.0% 4.0% 90 mn 90 mn 12 mn 4 18 16.0% 60 mn 72.0% 60 mn Moni maize, water, lemon, sugar Baka/seri maize, water Chô beans, potash, salt, shea butter millet, water, potash, baobab leaves, salt maize, water, potash, baobab leaves, Tô salt Maize, water, potash, okra, salt 1 1 1 5.0% 5.0% 5.0% 1 5.0% 15 75.0% 1 5.0% Crushed corn seed in Dieba 60 mn 60 mn 90 mn 60 mn 90 mn 60 mn Unhusked rice in Madina Table XXII: Households ‘dinner composition in the district of Bougouni in 2013 Dieba n=24 Local name Baka/Seri Tô Diétô Flola n=25 Baka/Seri Kini Tô Niènièkini Madina n=20 Moni Baka/seri Chô Kini Kini Tô Tieké Maize at Dieba Composition maize, water, sugar Number 1 % 4 maize, water 2 8 maize, water, potash, baobab leaves, salt, soumbala millet, water, potash, baobab leaves, salt, soumbala pumpkin, water, salt 19 1 1 7 4 4 maize, water rice, water, groundnuts dough, salt, dried fish rice, water, groundnuts dough, salt, maize, water, potash, baobab leaves, salt millet, water, potash, baobab leaves, salt maize, water, okra, salt 1 2 2 18 1 1 4 8 8 7 4 4 maize, water, lemon, sugar maize, water beans, potash, salt, shea butter rice, water, groundnuts dough, salt, onion, dried fish rice, water, salt, onion, tomato paste millet, water, potash, baobab leaves, salt maize, water, potash, baobab leaves, salt maize, water, potash, okra, salt cassava, fish, pepper 1 1 2 2 1 1 10 1 1 5 5 1 1 5 5 5 5 5 Tomato at Flola Table XXIII: Households’ breakfast composition in the district of Koutiala in 2013 M’pessoba n=22 Local name Composition Baka/Seri maize, water, lemon, sugar maize, water maize, water, milk maize, water, salt maize, water, sugar maize, water, sugar, milk rice, water, sugar millet, water, sugar, salt millet, water, potash, baobab leaves, salt Tô maize, water, potash, baobab leaves, salt millet, groundnuts dough, tomato Bassi paste, salt rice, groundnuts dough, salt, dried Kini fish Moni maize, water, salt, milk Baka/seri maize, water, oil Nampessola maize, water, salt n=23 maize, water, sugar maize, water, sugar, milk millet, ginger, water, sugar Tô maize, water, potash, baobab leaves, salt Sirakele n=20 Moni maize, water, milk, sugar, lemon Baka/seri maize, water, salt maize, water, salt, sugar maize, water, sugar, milk maize, water, sugar, salt, shea butter Cooking Number % time 2 9.1% 60 mn 5 22.8% 20 mn 1 4.5% 60 mn 1 4.5% 30 mn 1 4.5% 40 mn 1 4.5% 40 mn 1 4.5% 30 mn 4 18.4% 15 mn 60 mn 2 9.1% 2 9.1% 1 4.5% 1 4.5% 4 1 3 8 1 1 17.4% 4.3% 13.0% 34.9% 4.3% 4.3% 5 21.8% 1 2 10 1 5 5.0% 10.0% 55.0% 5.0% 25.0% 60 mn 90 mn 60 mn 60 mn 60 mn 40 mn 30 mn 40 mn 60 mn 60 mn 60 mn 40 mn 30 mn 30 mn 40 mn Table XXIV: Households’ lunch composition in the district of Koutiala in 2013 M’pessoba n=22 Nom Baka/Seri Tô Composition maize, water, sugar maize, water, potash, baobab leaves, salt maize, water, potash, baobab leaves, salt, dried fish maize, water, potash, okra, salt Kini rice, water, okra, salt, died fish rice, water, groundnuts dough, salt, onion, dried fish maize, water, groundnuts dough, Niènièkini salt Tiganicourou peas, water, salt Nampessola Kini n=23 Baka/seri Tô Sirakele n=20 Moni Baka/seri Kini Niènièkini Tô Bassi rice, water, groundnuts dough, salt, onion, dried fish rice, water, groundnuts dough, salt, onion, soumbala maize, water, sugar, milk maize, water, potash, baobab leaves, salt maize, water, potash, baobab leaves, salt, soumbala maize, water, potash, okra, salt millet, water, potash, baobab leaves, salt maize, water, lemon, sugar maize, water, sugar maize, water, sugar, milk rice, water, groundnuts dough, salt, onion, dried fish millet, water, groundnuts dough, salt maize, water, potash, baobab leaves, salt maize, water, potash, okra, salt maize, water, lemon, baobab leaves, salt maize, water, salt, tomato paste, onion Cooking Number % time 1 4.5% 20 mn 14 63.9% 65 mn 1 4.5% 90 mn 1 1 2 4.5% 4.5% 9.1% 60 mn 60 mn 60 mn 1 4.5% 90 mn 1 4.5% 60 mn 3 13.0% 1 4.3% 4 10 17.4% 60 mn 60 mn 43.6% 1 4.3% 2 8.7% 2 8.7% 1 1 1 5.0% 5.0% 5.0% 1 5.0% 1 5.0% 10 50.0% 3 1 15.0% 60 mn 60 mn 5.0% 1 5.0% 67 mn 60 mn 60 mn 90 mn 88 mn 60 mn 60 mn 60 mn 60 mn 90 mn 90 mn 90 mn TableXXVI: Households’ diner composition in the district of Koutiala in 2013 M’pessoba n=22 Local name Baka/Seri Tô Composition maize, Peas atwater, Sirakele sugar maize, water, potash, baobab leaves, salt Foyo fonio, okra, water, salt, tomato paste, onion Kini rice, water, okra, salt, dried fish maize, water, groundnuts paste, Niènèkini salt Tiganicourou peas, water, salt Kini Nampessola n=23 Baka/seri Tô Moni Baka/seri Kini Sirakele n=20 Chô Niènèkini Tô rice, water, groundnuts paste, salt, onion, dried fish maize, water, sugar maize, water, potash, baobab leaves, salt maize, water, potash, baobab leaves, salt, soumbala maize, water, potash, okra, salt maize, water, lemon, sugar maize, water, sugar rice, water, groundnuts paste, salt, onion, dried fish beans, potash, salt, shea butter millet, water, groundnuts paste, salt millet, water, potash, baobab leaves, salt maize, water, potash, leaves de baobab, salt maize, water, potash, okra, salt maize, water, lemon, baobab leaves, salt Number % 1 4.5% Cooking time 20 mn 60 mn 15 68.2% 1 4.5% 3 1 13.6% 90 mn 90 mn 4.5% 1 4.5% 1 4.3% 4 16 17.4% 60 mn 60 mn 69.6% 1 4.3% 1 4.3% 60 mn 1 1 5.0% 5.0% 1 5.0% 60 mn 60 mn 60 mn 1 5.0% 3 15.0% 2 20.0% 8 40.0% 2 1 10.0% 60 mn 5.0% 90 mn 90 mn 120 mn, 60 mn 90 mn 90 mn 90 mn 60 mn 90 mn Food groups consumed during the day in households in the districts of Bougouni and Koutiala % consommé 100% 80% 60% 4,2 4,2 4,2 33,3 8,3 83,3 95,8 40% 20% 0% 50,0 4,2 8,3 4,2 Dejeuner Petit dejeuner Diner Repas de la journée Céréale-eau Céréale-eau-huiles Céréale- eau-légume Céréale-eau-fruits Céréale-eau-sucre Légumes -eau Chart 14 : Food groups consumed in a day in Dieba in 2013 4,0 80% 28,0 60% 12,0 % consommé 100% 4,0 4,0 5,0 5,0 76,0 85,0 40% 20% 0% 56,0 16,0 Petit dejeuner 5,0 Diner Dejeuner Repas de la journée Céréale-eau Céréale-eau-huiles Céréale- eau-légumes Protéogineux-eau-huile Céréale-eau-fruits Céréale-eau-sucre Tubercules-eau Céréales-eau-oléagineux Chart 15 : Food groups consumed in a day in Flola in 2013 % consommé 100% 5,0 5,0 10,0 10,0 10,0 5,0 50% 5,0 10,0 10,0 5,0 85,0 65,0 65,0 0% Petit dejeuner 5,0 Dejeuner 5,0 Diner Repas de la journée Tubercue-poisson-légume Protéogineux-eau-huile Céréale-eau-sucre Céréale-eau-fruits Poisson Céréale-eau-fruits-sucre Céréale-eau-lait Céréale-eau Chart 16 : Food groups consumed in a day in Madina in 2013 100% % consommé 80% 60% 4,5 4,5 9,1 9,1 0% 4,5 4,5 40,8 86,5 77,4 40% 20% 4,5 13,6 27,5 4,5 4,5 Petit dejeuner Dejeuner Repas de la journée Céréales-eau-oléagineux Céréale-eau-lait Tubercules-eau Céréale-eau-sucre 4,5 Diner Céréale-eau-lait-sucre Protéogineux-eau-huile Céréale- eau-légumes Céréale-eau-huiles Chart 17: Food groups consumed in a day in M'pessoba in 2013 % consommé 100% 80% 60% 40% 20% 0% 4,3 17,4 4,3 17,4 4,3 21,8 78,3 78,3 39,2 4,3 13,0 17,4 Petit dejeuner Dejeuner Diner Repas de la journée Céréale-eau-huiles Céréale-eau-fruits-sucre Céréale- eau-légumes Céréale-eau-fruits Céréale-eau-lait Céréales-eau-oléagineux-légume Céréale-eau-huiles Chart 18: Food groups consumed in a day in Nampessola in 2013 100% 5,0 5,0 5,0 10,0 % consommé 25,0 5,0 5,0 20,0 5,0 50% 0% 60,0 70,0 10,0 5,0 Dejeuner Petit dejeuner 70,0 Diner Repas de la journée Céréale- eau-légumes-fruits Céréale-eau-lait-sucre-fruits Céréales-eau-oléagineux-légume Céréale- eau-légumes Céréale-eau-huile Céréale-eau-fruits-sucre Protéogineux-eau-huile Céréale-eau-huiles Chart 19: Food groups consumed in a day in Sirakele in 2013 6.5.3 Vegetables consumption Table XXV: Distribution of women according to vegetable consumption in the districts of Bougouni and Koutiala 2013 District Bougouni Village Vegetable consumption Yes No Total Dieba 15 62.5% 11 44.0% 10 50.0% 9 37.5% 14 56.0% 10 50.0% 24 12 54.5% 10 43.5% 14 70.0% 10 45.5% 13 56.5% 6 30.0% 22 Flola Madina Koutiala M'pessoba Nampossela Sirakele P 0.420 25 20 0.217 23 20 Vegetable consumption was higher in the district of Koutiala in M'pessoba and Sirakele without this relationship being statistically significant. Table XXVI: Distribution of respondents according to vegetables consumption in the district of Bougouni in 2013 Village M'pessoba Sirakele Vegetable consumption Training P Trained Untrained 9 3 81.8% 27.3% 7 7 70.0% 70.0% 0.010 1.000 Vegetable consumption had no statistically significant relationship with the training at the village Sirakele. 43 6.5.4 Hygiene measures Hands washing with soap and water Most women washed their hands before meals by 69.4% in Bougouni, by 62.5% in Dieba and by 73.7% in Flola and Madina. In Koutiala 87.3% of women washed their hands before cooking food, with 77.3% in M'pessoba, 93.3% in Nampossela, and 94.4% in Sirakele. At M'pessoba, trained women washed their hands by72.7% and those untrained by 81.8%. At Sirakele 100% of women trained were doing this activity against 87.5% for those untrained. Children's hands washing with water and soap before meal: it represented the majority with 70.1% in Bougouni and 68.8% in Koutiala. In the district of Koutiala Dieba achieved 62.5%, Flola 73.9% and Madina 75.0%. At Koutiala Nampossola reached 50%, M'pessoba trained women 81.8% and 72.7% for those untrained. At Sirakele both those trained and untrained accounted respectively for 80.0%. Before the consumption of raw vegetables disinfection was made in 36.4% of these cases at Bougouni and in 40.0% of cases at Koutiala. At Sirakele (trained village) 60% of respondents practiced disinfection against 36.4% at M’pessoba Storage of drinking water Water storage container was clean at 100% in all the villages except for a household at Sirakele. It was covered in 100% of cases at Dieba and over 95% in the other villages. 6.6 Dietary diversity score Table XXVII: Score of household dietary diversity for the districts of Bougouni and Koutiala in 2013 Villages Dietary diversity score Low Average 25.3% 58.0% 44.0% 36.0% 50.0% 22.7% 25.0% 40.0% 39.1% 39.2% 45.0% 25.0% Dieba Flola Madina M’pessoba Nampossela Sirakele High 16.7% 20.0% 27.3% 35.0% 21.7% 30.0% 24,0 68,0 90,9 Madina 95,8 5,0 15,0 1,0 7,7 80,0 91,3 Bougouni 1,5 3,5 Autres 95,0 Produits animales Légumes Sirakele 0,5 8,6 Nampessola 8,0 M'pessoba 4,2 Flola 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Dieba % consommés Place of cereals: They were consumed by 100% of the surveyed households in all the villages. Koutiala Villages Chart 20: Share of vegetables and animal products in the dietary diversity score in households of Bougouni and Koutiala in 2013 Almost all vegetables consumed were baobab leaves. Sometimes it was okra and onions and tomatoes rarely. 6.7 Difficulties reported by respondents and suggestions Concerning gardening the major difficulties reported by women were water shortages with the drying up of wells and the lack of fences for the gardens. In the dry season they cultivated in the river bed, but the gardens were destroyed by animals for lack of fences. Concerning gardening the major difficulties reported by men were water shortages which constituted an obstacle to the development of market gardening and the use of poor quality seed. Difficulties concerning gardening activities Bougouni At Dieba, we listened to this 27 year old woman "we face difficulties. We have no more water, and on top of that we carry wood on our head to the river bank. We dig and we drive in the poles. Despite the harsh sun we tie them; but after the passage of cows we have to resume the work. There is no water. Wells diggers work the dry season long, but we do not find water. " Koutiala At Sirakele an 18 year old woman spoke, "When we dig wells, and there is water, that can boost your gardening." Still at Sirakele, a 43 year old woman said, "I think we love gardening, but the water problem is a constraint. When we find water we can do gardening, but if there is no water it’s impossible. ". She added, "Regarding gardening, it is very difficult here. We do not have equipment. If what is used to prepare the sauce is not enough. Suggestions for enhanced vegetables consumption From women  Solving the problem of water shortage by digging deeper wells and installing pumps;  Installing fences around gardens to protect them against animals.  Lacking the financial means to achieve all these works, they rely on external partners. From men At Dieba  Establish a cooperative to enable women to generate resources;  Fences for farms;  Dig boreholes;  Make quality seeds available;  Train women and their husbands to good farming practices;  Explain to men the importance of vegetables in the diet. 7. Comments and discussions Concerning the objectives’ achievement The main objective of the study was to provide information on the diversity of food, basic nutrition knowledge, food access including vegetables intake, the knowledge of the composition of food and the frequency of meals, and their distribution within the family. The study focused on six villages of "Africa RISING" project, i.e. three (3) villages in the district of Koutiala and three (3) villages in the district of Bougouni. Of these, two villages had benefited from training in nutrition. Our sample was representative with 134 individual interviews conducted, with 69 in Bougouni and 65 in Koutiala. 12 focus groups carried out on the basis of 2 by villages. Data collection tools were reliable and standardized. Sample characteristics There were on average, in the district of Bougouni 13 people per household in Dieba, 6 in Flola and 7 in Madina. In the district of Koutiala the average number of persons per household was 13 in Mpessoba, 8 in Nampossela and 9 in Sirakele. In 2008, the average number of persons living in the same household was 12 at the national level according to EBSAN II survey [12]. The high number of people living in households could justify the low consumption of some groups of food that can be expensive for them, and result in a significant financial gap. Main results Regarding women's knowledge about nutrition In the districts of Bougouni and Koutiala women had little knowledge about nutrition. The definition of malnutrition was not known by more than 50% of them, as well as the causes. The different food groups were not known by women. It appeared that trained women had more knowledge compared to those untrained. Malnutrition signs could not be cited by at least 50.0% of untrained women. This poor knowledge of women could be at the basis of nutritional issues, namely malnutrition that we could probably meet with children and women of childbearing age. These observations are similar to what observed in Mauritania in 2008 where high rates of malnutrition were related to poor knowledge, attitudes and practices in the area of food and hygiene [5]. Similarly in 2006 in the district of Kita, the high prevalence of malnutrition was due to a poor understanding of the causes of malnutrition by 32.3% of women [13]. Regarding food patterns Exclusive breast feeding in our study ranged between 59.1% and 68.2% at Bougouni and between 50.0% and 73.7% in Koutiala. The majority of women especially in Bougouni (80.0%) had given colostrum to their children. Our results were higher than those of the study conducted in Sikasso in 2010, in which 51.2% of children were put on breast milk immediately after delivery [14]. They were also significantly higher than those of MIV EDS in 2006 where only 46% of children were breastfed within the first hour after birth, and this at national level [15]. This difference could be due to all the outreach activities conducted on this subject, but also to the training in nutrition conducted by Africa RISING project. The average age of introduction of complementary feeding of six month was not observed in almost all the villages surveyed. Complementary foods were given to children on average of 3 times a day regardless of the age of the child. That suggested that the quantitative and qualitative nutritional requirements for some children were not covered. In the focus groups, respondents in the majority recognized the role of complementary feeding in the prevention of malnutrition. However, this knowledge was poorly reflected in dietary practices; this inadequate diet, often, was due to a lack of time, women being busy. Our results regarding children’s 24-hour recall food were identical to those obtained in Sikasso in 2010 with cereals as the most consumed food. In contrary some local products (tubers, fruits, vegetables, milk ...) were not used and valued. [16] Infant porridge was not much given as complementary food, it is the family porridge that was given to children by 73.8% in Koutiala and 61.1% in Bougouni. Trained women gave a little more frequently infant porridge in Koutiala compared to untrained ones and 20.0% did it in Bougouni. These results highlighted the fact that children from 6 months not receiving essential nutrients for their healthy growth. This situation was compounded by the nondiversification of the daily diet. These child porridges had liquid consistency in 68.2% of cases and this regardless of the age of the child leading to insufficient daily energy intake. In the district of Bougouni in 2009, poor infant feeding practices were one of the causes of the high prevalence of malnutrition [17]. Also in Burkina Faso in 2009, poor food cooking for children is responsible for malnutrition [18]. Weaning children was practiced in majority of cases before 24 months in 3 villages out of 6 namely Flola (84.0%), Nampessola (60.9%) and Sirakele (55.0%). Early weaning in a 2010 study in Sikasso was one of the determinants of malnutrition, with nearly 26% of children weaned before the age of 6 months [16]. Concerning hygiene Hands washing with soap and water by women of childbearing age was not systematic before feeding the child or when leaving the toilet. It was the same for those with children. The present result is similar of the one observed in Kita in 2007 [9].. Poor practices of breastfeeding, weaning and hygiene can also explained the high rate of malnutrition observed within the Target villages observed [19]. Before the consumption of raw vegetables disinfection was not systematic. It was done in 36.4% of cases in Bougouni and 40.0% of cases in Koutiala. At Sirakele (trained village) 60% of respondents practiced disinfection against 36.4% at M'pessoba. In the Sahel in 2009 [20] sanitation and hygiene practices were also identified as the cause of high rates of malnutrition among children. Concerning dietary diversity score Cereals were the staple diet for the three main daily meals of the households. Other foods such as fruits, vegetables, milk, eggs and tubers were only slightly consumed. This could be justified by the fact that these foods were not taken into account in dietary habits and consumption patterns, that the level of knowledge on the nutrients intake of these foods was low and that the nutritional needs of each category of people were unknown. Vegetables consumed consisted in most cases in baobab green leaves. Other vegetables were a bit more consumed in the village of Mpessoba by trained women. The diversity score was mostly acceptable at Dieba, M'pessoba and Nampessola. It was mostly low at Flola, Madina and Sirakele. The highest diversity score was at Mpessoba. This could be explained by the fact that on top of the increase in knowledge due to training in nutrition, men participated in nutrition and gardening related expenses. However, the biggest expense was the cost of condiments highlighting the insufficient use of local production. In the villages of Bougouni the biggest expense was related to health care costs; this could be understandable since there is a link between health, nutrition and hygiene. Yet in these villages most households had a low score of diversity, hygiene conditions were not observed and they had very little knowledge about nutrition. 8. Conclusion At the end of the study it appeared that:  Women in general have little knowledge about basic nutrition. However, trained women had more knowledge than untrained ones.  Men began to support women in gardening activities especially at Dieba and Flola but mostly M'pessoba.  The dietary diversity score was not high and vegetables apart of baobab leaves were hardly consumed.  The main difficulties reported that hinder more cropping and vegetable consumption were the lack of water for gardening activities and the lack of fences to protect gardens. According to assertions, consumption will increase only if production increases.  Training brought a more noticeable increase of the level of knowledge in M'pessoba compared to Sirakele where training just started, the process of behavior change being slow with adults. 9.Recommendations  Continuing villages training in adapting the themes to the realities of each village, taking into account the prior growing of garden produce, in involving men to ensure women with a support in farming, but also in family vegetable consumption. Especially insist on a balanced diet through the different food groups and the link between nutrition, health and hygiene;  Focusing actions on the use of foodstuff for food diversification in conducting continuous and permanent participatory communications for behavioral change in favor of women and men;  Encouraging women farmers to grow vegetables during rainy season;  Providing women with seed not requiring large quantities of water;  Conducting a study integrating the evaluation of the nutritional status of children and women of childbearing age in order to assess the links that can affect health through a balanced diet. 10.References FAO. L’état de l’insécurité alimentaire dans le monde. Résumé 2012. http://www.fao.org/docrep/016/i2845f/i2845f00.pdf SOULE B G. Les perspectives de sécurité alimentaire pour l’Afrique de l’Ouest jusqu’en 2025. http://www.inter-reseaux.org/IMG/pdf/Soule__Les_perspectives_de_securite_alimentaire.pdf UNICEF. Faire reculer la malnutrition c’est faire avancer le droit des enfants. Document électronique ; reculer- la- malnutrition -c'est-à-dire- avancer-les-droits-de lenfant.html », www.infosdelaplanete.org/4816/faire Diakité BD. Rapport d’étude : Placer la Nutrition au Cœur des Politiques de Développement. Analyse du financement de la nutrition au Mali, Banque Mondiale Juin 2009, 75p. AG IKNANE A, DIARRA M, KANTE N, YATTARA H, TRAORE M, FOFANA A. Evaluation rapide de l’état de santé et nutritionnel dans la commune de Medbougou (Préfecture de Ayoune El Atrous) en Mauritanie. Mars 2008, 87p. INSAT/UNICEF/DNS. Enquête nationale nutritionnelle anthropométrique et de mortalité Rétrospective SMART. Mali juin-juillet 2011, 80p. AG IKNANE A, KANTE N, MAIGA M. Evaluation du projet de lutte contre la malnutrition infantile et maternelle dans trios aires de santé du cercle de Kangaba, 2007, 80p. 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Appendices Appendix 1: Socio demographic information Table XXVIII: Level of education of the heads of households in the districts of Bougouni and Koutiala in 2013 District Bougouni Koutiala Village None Dieba n=24 Flola n=25 Madina n=20 M’pessoba n=22 Nampossela n=23 Sirakele n=20 Level of education of head of household Primary Secondary Higher 15 8 0 0 (62.5%) (33.3%) (0.0%) (0.0%) 21 0 1 0 (84.0%) (0.0%) (4.0%) (0.0%) 7 7 4 1 (35.0%) (35.0%) (20.0%) (5.0%) 16 (72.7%) 20 (87.1%) 17 (85.0%) 4 (18.2%) 1 (4.3%) 1 (5.0%) 0 (0.0%) 1 (4.3%) 1 (5.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Literate 1 (4.2%) 3 (12.0%) 1 (5.0%) 2 (9.1%) 1 (4.3%) 1 (5.0%) In the dstrict of Bougouni the literacy rate for men was, 37.5 in Dieba, 16.0% in Flola and 65.0% in Madina. In Koutiala it was 27.3% in M'pessoba 12.9% in Nampossela and 15.0% in Sirakele. Table XXIX: Distribution of heads of household and women of childbearing age according to their average age in the districts of Bougouni and Koutiala in 2013 District Village n Minimum Maximum Average age in years Standard deviation 24 25 20 22 23 20 16 23 25 27 27 25 40 54 65 77 54 70 35.33 40.92 40.70 46.59 38.87 52.00 7.682 9.721 9.895 14.188 6.511 14.586 Women of childbearing age Bougouni Dieba 24 Flola 25 Madina 20 Koutiala M'pessoba 22 Nampossela 23 Sirakele 20 16 17 18 17 17 21 40 45 48 49 48 49 23.92 26.80 28.15 31.27 27.57 38.65 6.379 7.616 7.278 9.632 7.186 8.139 Heads of household Bougouni Dieba Flola Madina Koutiala M'pessoba Nampossela Sirakele Table XXX: Level of education of women of childbearing age in the districts of Bougouni and Koutiala in 2013 District Bougouni Village None Dieba n=24 Flola n=25 Madina n=20 Koutiala M’pessoba n=22 Nampossela n=23 Sirakele n=20 Level of education of women of childbearing age Primary Secondary Higher Literate 15 8 0 0 1 (62.5%) (33.3%) (0.0%) (0.0%) (4.2%) 18 5 0 0 2 (72.0%) (20.0%) (0.0%) (0.0%) (8.0%) 10 9 1 0 0 (50.0%) (45.0%) (5.0%) (0.0%) (0.0%) 19 (86.4%) 16 (69.7%) 16 (80.0%) 2 (9.1%) 5 (21.7%) 1 (5.0%) 0 (0.0%) 1 (4.3%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (4.5%) 1 (4.3%) 3 (15.0%) The literacy rate of women was 37.5 in Dieba, 28.0% in Flola, 50.0% in Madina. In the district of Koutiala it was 13.6% in M'pessoba, 30.3% in Nampossela and 20.0% in Sirakele. Occupation: Men were farmers by 97.0% in Bougouni and 98.0% in Koutiala. The main occupation of women was farmer with respectively 63.8% in Bougouni and 56.9% in Koutiala. Appendix 2: Women focus groups Definitions of malnutrition At Bougouni At Dieba, a 30 year old woman said, "What I have to say here is difficult. We have food, but what we grow is without vitamin and that is why we do not have enough the water in our bodies. " Another woman aged 20 in Dieba said: "We eat, we have something to eat but it is without vitamins." At Flola, a 26 year old woman said: "the idea that we have on malnutrition among children as well as pregnant women, is that we do not find much complete food here and we eat what we can find ". At Koutiala At Nampossola a 32 year old woman said, "We know a little, it is a disease caused by the fact that children do not find enough elements necessary for their body; so make sure that children eat properly at mealtime ". Some women established a relationship between malnutrition and hygiene. At Sirakele, a 30 year old woman said that malnutrition was "Hygiene means, for a woman when you sleep and wake up, you must go right to the toilet and wash. The clothes you wore at night you must change them. You clean your house, you wash your utensils with soap. " In the same village another woman established the relationship between malnutrition and breastfeeding: "malnutrition means when you give birth to a child and that you don’t have enough breast milk because you eat family meal. » Causes of malnutrition At Bougouni In Madina, a 30 year old woman mentioned as being a cause "it is the way you eat and cook. If there are other ways of cooking different from what we do, we could adopt that. " Another woman from the same village to add "Malnutrition is present here, we eat only dry sauce; we like bananas if we can afford them. “ A of 25 years old woman at Dieba said "the problem we face now is that our children until they reach six months we do not give them thick food except water, from that date on when we were said that we must combine beans, maize, along with many other things and add salt and sugar a little. But we do not know how to do that. That is why our children are malnourished. " At Flola a woman aged 27 said "what I know about malnutrition, is that mothers do not know what to do. They don’t know how to cook food to address malnutrition. Combining ingredients to come up with a beneficial food for the child, we do not know. If you can give us those kinds of information, we will be pleased. " At Koutiala In the focus groups, to a woman 18 years Sirakele said "malnutrition happens when there is not enough breast milk and when you eat common meals; you need to cook another meal to eat." Signs of malnutrition At Bougouni Some women of Flola said "some children are swollen and weak" and at Madina "the child loses weight, he is permanently sick and the family is worried." At Koutiala At Nampessola an untrained village, women were able to mention signs. A 32 years old woman said "The child has light hair, the body shows oedema, it becomes thin, the belly becomes large, and he becomes sad with his mother." Another 38 years old woman in the same village said, "I wish to add that when a child is malnourished, he becomes amorphous, he is stunted compared to the other children of his age." Work and responsibility sharing agreement between men and women Focus groups of men At Bougouni At Dieba "Regarding food expenditures, men and women are doing something because when we have food we measure and give women; for fresh condiments costs there are days when you give a little money and other days when you do not give; they take a few cereals to pay for condiments.” "The crops we grow, much is not sold. We grow sorghum and rice; as for gardening crops, during the dry some women practice it. If the produce is much we may to sell part of it but if it is not we just keep it for consumption. " "Women practice gardening here and men are not many. What women get, they use it to cook for their husbands." "As we talk about gardening there are some men who practice it but not much. They grow pepper, eggplant but large gardening is practiced by women; men do not help them much, they do it by themselves.” At Flola «Here we only grow maize, sorghum which is rare, as well as rice and fonio. Now for water sake and since there is not much space to grow rice everybody crops a small plot on the bank." "My main activity is gardening; I grow tomatoes, pepper which is our base; right now I finished watering them; the difficulty we face is related to animals; we need to prevent animals from destroying our plots; we also face problems with pests that destroy our crops; women also practice gardening by our side. At Madina "For food men and women are not equal. I think the largest part is ensured by men; women do less. " "Cereal production we keep it, but if we know we may have something later we sell it." Koutiala At M'Pessoba "There is no big difference with regard to the access of men and women; what is cooked is accessible to all, except when there a special dish for the family head in some families, maybe for children. “ "It's easy to have food as people grow and that's what they eat, but some is also sold." "During this period of the year we have lots of things like millet, maize, rice, which are all accessible, fresh products are not available now, there are also fruits like guavas, oranges. Beans are also available now; it is very helpful for the diet. Vegetables are also available currently in Mpessoba." At Nampossela "I am a farmer in Nampossela, and I practice gardening at home; carrots, cabbage, salads are grown here; potatoes, even rice is grown in our plain and plenty of other things like millet and cotton; we also have mango plantations, banana plantations." "In my place, women play an important role because they work in garden and fields, they have their own cooperative; right now they have a hectare of land where they grow all kinds products (onion, cabbage, sweet potato, carrot and salad; they have a groundnut field of one hectare, they have a machine to make various types of soaps, they help men in farms. " "When it has rained, we harvest and we sell what is for sale like cotton, bananas, and garden produce but we keep millet for our own consumption. But when we have a lot of millet we may sell part of it. " At Sirakélé "Much of the food rests with men; it is the man who cares of all the family expenses. There are women who do gardening. The income is for the expenses of the wife and children. They do not care for the family expenses, it is the man who cares of everything. " Women focus groups Preparing infant porridge This infant porridge, very often, was not prepared for lack of funds. Bougouni At Dieba, a 29 year old woman said, "When we cook porridge we put a few sugar in. This is what we can afford”. Still in Dieba a 20 year old woman said: "When we wean children we do not give them porridge, but coffee (milk, sugar, instant coffee) because we do not have the products for porridge.” At Flola a 26 year old woman admitted: "You need to cook the porridge for your child so that he does not cry for lack of breast milk. It replaces breast milk and strengthens your child." "At Flola, a 36 year old woman explained" Regarding infant porridge, you take millet or pearl millet. You wash it, dry it, and then process it when adding beans flour.” Koutiala At Sirakele a 40 year old woman knew a fairly complete porridge recipe: "The enriched porridge given to children must be cooked with hygiene. You process the non-pounded millet into flour. You also transform groundnuts and beans into flour. This is how enriched porridge is cooked. And Baobab powder. Baobab powder gives health. Non-pounded millet brings sugar, beans strengthen bones. We cook it for sick children also. " Similarly at Flola a 25 year old woman said, "What we eat is sorghum, maize, millet, beans; we pound them and we cook them, after having incorporated groundnuts dough and sugar; the meal is then given to the child.” Family meal Bougouni At Dieba a 20 year old woman said: "What is frequently cooked at home is To. We grow maize but often prepares “To” with it." Another 29 year old woman from the same village said: "We cook properly “To”, but the sauce does not contain vitamins." Then she added: "we have children and feeding them is a concern. We do not have vitamin food to give them." It appears that women frequently prepared kini, tô and nièniè kini using maize or sorghum flour and the sauce was cooked with beans or baobab leaves. Koutiala At Sirakele to cook the traditional meal “to" a 30 year old woman explained, "When water boils in the pot, you pour the flour and you stir; you keep stiring when adding flour until it is thick. For Kini, Nièniè kini" you "used grounded cereals. For the sauce you use groundnuts dough. You need to observe hygiene when cooking”. Vegetables consumption At Dieba a 31 year old woman said: "We grow gardening products, we need to consume them as well. » Another woman from Dieba added: "Regarding our vegetable crops, changes need to be made; even if we grow these crops for consumption, because of difficulties we sell them progressively." Suggestions for improving the accessibility and availability of vegetables Beyond suggestions for making water available, a suggestion regarding the sale of the production arose from most villages. Bougouni At Dieba a 27 years old woman said: "I have an idea of how to draw profits. We suggest if we could consume what we are growing, and not sell them. If not the products will be sold away progressively.” Koutiala At Nampossela a 32 years woman said: "I think we should increase the amount of vegetable crops so that all the families can afford some; we need to reduce the sales of garden produce". Appendix 3: Survey forms Questionnaire on the characterization of food consumption patterns in southern Mali (Sikasso) District __________ Commune ____________ Village ____________ Number of households |___|___|___| Household N° |___|___| Date :|___|___| |___|___| |___|___|___|___| administrator: |___|___| Name of respondent: ______________ 1. Socio demographic information Q01 Age of head of household (CM) in years Q02 Educational level of CM Q03 Gender of the head of CM Q04 Age of respondent in years Q05 Ethnic group of respondent 1. Bambara 2. Mianka _________________ Q06 Q07 |___|___| 0. No education 1.Primary 2.Secondary 3.Higher 4. Literate |___| 1. male |___| 2.female |___|___| 3.Malinké 4. Other |___| 0. No education 1.Primary 2.Secondary 3.Higher 4. Literate Educational level of respondent Occupation of respondent 1. Housewife 2.Petty trade _________________ |___| |___| 3.Gardening 4.Other |___| Q08 Parity of respondent |___|___| Q09 Total number of living children |___|___| Q10 Total number of persons in the household Male | ___ | ___ | Female | ___ | ___ | Number of productive people Male | ___ | ___ | Female | ___ | ___ | Q11 2. Q12 Q13 Q14 Q15 Total | ___ | ___ | Total | ___ | ___ | Income and Expenditure Main source of income trade 3.Paid worker 1. Sale of agriculture products 2. Petty 4.Other specify _______________ Number of persons contributing to the household expenses Men | ___ | ___ | Women | ___ | ___ | Main household expenses 1. ______________________ 3.________________________ |___| Total |___|__ _| 2. _______________________ 4. _______________________ Number of persons contributing to expenses over vegetables (crops) Man | ___ | ___ | Women | ___ | ___ | Total |___|__ _| Q16 3. Q17 Number of persons contributing to expenses over vegetables (purchase) Man | ___ | ___ | Women | ___ | ___ | Dietary diversity at household level From what you ate and drank yesterday was there...? Q17.1 CEREALS Q17.2 ROOTS AND TUBERS Q17.3 PROTEIN Q17.4 OLEAGINOUS VEGETABLES Q17.5 RICH IN VITAMIN A Q17.6 VEGETABLES LEAVES Q17.7 VEGETABLES FRUITS FRUITS RICH Q17.8 IN VITAMIN A Q17.9 Total |___|__ _| OTHERFRUIT S White sorghum, red sorghum, millet, pearl millet, rice, maize, pasta (macaroni ..), wheat (couscous, bread, cakes ...), fonio ... White sweet potatoes, potatoes, yams, taro, other tubers (fabirama ...), cassava (atieke, gari), plantain (alloco) Beans (cowpea), peas potatoes, peas, chickpeas, lentils and other pulses Groundnuts (or other paste), soya, sesame, cashew nuts, shea nuts, wild nuts, cotton seeds, palm kernels ... Squash, pumpkin, carrot, red pepper, orange-fleshed sweet potato Sorrel, pigweed, salad, baobab leaves, mallow (bulvaka), spinach, onion, beans, cassava, potatoes, etc. + all wild leaves, kapok, etc. Tomatoes (except concentrated), fresh or dried okra, eggplant, zucchini, cucumbers, cabbage, turnips, onions, green peppers, green beans ... Mango, red papaya / orange, orange melon, locust bean (fruit or flour) Pineapple, banana, guava, dates, watermelon, jujube, sugar cane, cinnamon apple, orange, lemon, etc., fresh fruit juice (squeezed fruit juices), fruit, tamarind, monkey bread, etc. YES NO NSP If doubting, * please give NSP details 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 Q17.1 OIL RICH IN 0 VITAMIN A Q17.1 OTHER OILS 1 AND FATS Q17.1 EGGS 2 Q17.1 DAIRY 3 PRODUCTS Q17.1 LIVER / FULL 4 OFFALS OTHER Q17.1 OFFALS / 5 INSECTS Q17.1 MEAT AND 6 POULTRY Q17.1 FISH AND 7 SEAFOOD Q17.1 SIMPLE 8 SUGARS Q17.1 ALCOHOLIC 9 BEVERAGES Red palm oil Vegetable oil (sauces, seasonings, fried stuff), butter (milk or shea butter), margarine, mayonnaise.. Chicken, guinea fowl, duck, turkey eggs... Fresh milk, milk powder, condensed milk (sweetened or not), yogurt, cheese, cream ... Liver (veal, mutton, poultry,,,) full offal (heart, kidneys, spleen, lung) and black pudding Offal other than full offal (guts, oxtail, etc.) or insects Beef, mutton, goat, pork (including deli meats), tongue, rabbit, bush meat, chicken, guinea fowl ... Fresh fish, smoked, salted, dried fish (except pinch of powder), canned (sardines, tuna ..), all seafood Powdered sugar or in pieces (in tea, coffee, porridge ...), soft drinks (sweet drinks, zom-kom, hibiscus, ginger juice ...), sweetened condensed milk, honey, candy, sweet cakes ...? Beer, dolo, chiapalo, bangui, wine, sangria, pastis, whiskey, etc. 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 2 3 Q17.2 CONDIMENT tomato paste, soumbala, chili ... 1 0 S Other food not mentioned. If Q17.2 OTHER yes, specify: 1 Q17.2 Total 2 *Do not know = the respondent does not know whether any of the items of a given food group was included in one of the meals eaten. 4. Q 1 8 Q 1 9 Q 2 0 Knowledge on nutrition Q18.1 Do you know malnutrition 1. Yes | ____ | 2.No | ____ | If yes Q18.2 What is malnutrition? .................................................. ............................................ ............................................................................................................................................... .................. Do not know Q18.3 What causes malnutrition? ...................................... .......................................... ............................................................................................................................................... ............... Do not know Q18.4 Give me the signs of malnutrition........................................................................................ .................................................. ............................... ................... .......................... .............. .......... ....... Do not know What is a balanced diet? ....................................................................................................................... .............. ................................... ................................................. .................................. ....................... .. Do not know 1. 2. 3. What should the diet of a pregnant / 4. lactating woman include? 5. Others______________________ Q What should the diet of a child under 2 5 years include? 1 Q 2 2 Q 2 3 1. 2. 3. 4. 5. Others______________________ 1. 2. What should the diet of a teenager 3. include? 4. 5. Others______________________ 1. 2. What should the diet of an old person 3. include? 4. 5. Others______________________ Q What should the diet of a sick person 2 include? 4 Q What are the benefits of vegetables 2 consumption 5 Q 2 How do you consume vegetables 6 Q Before consuming raw vegetables 2 which hygienic precautions are you 7 taking? 1. 2. 3. 4. 5. Others______________________ 1. 2. 3. 4. 5. Others______________________ 1. Raw 2. Boiled 3. In sauce 4. Others____________ 1. Washing with plain water 2. Washing with disinfectant |____| |____| Q If washing with disinfectant how many 2 |____|____| minutes? 8 Generally on what occasion do you Q29 usually wash your hands with soap or other detergent? Generally on what occasion do you Q30 usually wash the hands of your children under 5 years? Q31 REMARK: The container for storing water in the house 1. Before preparing food Before eating 2. Before feeding the child 3. After leaving the toilet 4. After cleaning a child who defecated 5. Other: ______________________ |____| 1. before eating 2. After leaving the toilet 3. Do not wash hands 4. Other: ______________________ |____| Q301.1 – is it clean? 1. Yes | ____ | 2.No | ____ | Q31.2 – is it covered? 1. Yes | ____ | 2.No | ____ | 1. Cropping Land cultivated by the household Q32 1. Yes 2.No (if no, go to questionnaire on diversity) Land cultivated by the woman Q33 1. Yes 2.No (if no, go to questionnaire on diversity) Q34 Type of crops in the land cultivated by the woman Q34 Gard .1 ening Local Scientific Group Specy 1.yes 2.no name |___| |___| Variety name |___| Q34 .1.1 Usag e Q34 Cerea .2 ls 1.yes 2.no |___| 1. Selling | ___ | 2.Self-consumption | ___ | 3. Exchange | ___ | 4.Other ___________________________ Local name Scientific name Group Specy Q34 .2.1 Usag e Other , Q34 specif .3 y 1. Selling | ___ | 2.Self consumption | ___ | 3. Exchange | ___ | 4.Other ___________________________ Local name Scientific name Group 1. yes 2.no |___| Q34 .3.1 Usag e 1. Selling | ___ | 2.Self consumption | ___ | 3. Exchange | ___ | 4.Other ___________________________ Specy 2. Culinary recipe in households Q35 How many meals did you have a day? Q36 1.1 Meal 2.2meal 3.3 meal 4.4 meal and more |___| What dishes did you eat yesterday in the household? Local name Composition Preparation Cooking (mn) 3. Q3 7 Child nutrition How old is your last child, in months? |____|____| Q3 8 Q3 9 Q4 0 Q4 1 Q4 2 Q4 3 Q4 4 Q4 5 Q4 6 Q4 7 Q4 8 Child’s date of birth |___|___|/ |___|___|/|___|___| Checking the date of birth on a document Yes 2. No Has the child ever been breastfed? 2. No (if no, go to Q47) How long after birth did it take you (name) to breastfeed for the first time? 1. |____| 1. Yes |____| 1. Less than one hour 2. 1-24 hours 3. Days (specify) ______________________ | ____ | Did you give colostrum 1. Yes to that child? | ____ | 2.No 3.NSP Type of breastfeeding practiced? Is the child is still breastfed? 1. exclusive breastfeeding 2.mix(breast milk + something else) |____| 1. Yes 2. No (if yes, go to Q47) |____| |____|____ Duration of breastfeeding in months | 1. too much work to do, too busy or tired 2. the baby was big enough, he no longer needed Why did you stop 3. I was advised to stop breastfeeding because I breastfeeding? was pregnant Do not read list 4. Other, specify: ............................................ ................... . |____| At what age (months) did your child start having complementary foods (food - liquids in addition to breast milk)? |___|___| Since yesterday at the same time that now, did he / she (child) have one of the following : Simple water 1.yes |____| 2.no |____| How many times? |____|____| Sugar water 1.yes |____| 2.no |____| How many times? |____|____| Herbal tea, tea, infusion 1.yes |____| 2.no |____| How many times? |____|____| Fruit juice 1.yes |____| 2.no |____| How many times? |____|____| Fruits 1.yes |____| 2.no |____| How many times? |____|____| Natural milk 1.yes |____| 2.no |____| How many times? |____|____| Animal protein (meat, eggs, fish) 1.yes |____| 2.no |____| How many times? |____|____| Plant protein (beans, cowpeas, etc.) 1. yes |____| 2.no |____| How many times? |____|____| Vegetables 1.yes |____| 2.no |____| How many times? |____|____| Artificial milk, dairy products 1.yes |____| 2.no |____| How many times? |____|____| Animal fats 1.yes |____| 2.no |____| How many times? |____|____| Cereals (solid food) 1.yes |____| 2.no |____| How many times? |____|____| Family porridge 1.yes |____| 2.no |____| How many times? |____|____| Weaning porridge 1.yes |____| 2.no |____| How many times? |____|____| Other________________________________ How many times? |____|____| Q4 9 Q5 0 Local name Composition Preparation Cooking time Consistency Local name Composition Preparation Cooking time Consistency What infant porridge did you give to your child? What weaning porridge did you give to your child? Q5 1 How often do you give food supplement? 1. 1 times 2. 2 times 3. 3 times 4. 4 times more | ____ | Characterization of food consumption patterns in southern Mali (Sikasso) Interview guide of the focus group: women of childbearing age Specific objectives of the study 1. Assess the basic knowledge on nutrition; 2. Describe the characteristics of households’ food consumption; 3. Identify the food habits and food preparation mode; 4. Monitor food availability and accessibility in households; 5. Determine the diversity and food consumption scores in households; 6. Describe the existing food diversity and the parts for cereals, vegetables, animal products. Theme 1: Identification: village, participants Topic 2: Basic nutrition knowledge on  Malnutrition (symptoms, causes, prevalence, consequences, treatment, prevention mode);  Balanced diet, the diet of pregnant women, children under 5 years, adolescents, elderly people, sick people;  Vegetables consumption;  Hands and water hygiene. Theme 3: family recipes, recipes of infant and weaning porridge (local name, composition, method of preparation) Theme 4: Proposals for enhanced vegetable consumption in households.  Highlight the ways and means to improve vegetables consumption;  Source of funding for the proposals;  Natural and legal persons to participate in funding proposals. Thank you for your cooperation 72 Characterization of food consumption patterns in southern Mali (Sikasso) Interview guide of the focus group: heads of families Specific objectives of the study 1. Evaluate the basic knowledge on nutrition, 2. Describe the characteristics of households’ food consumption 3. Identify the food habits and food preparation mode 4. Monitor food availability and accessibility in households 5. Determine the diversity and food consumption scores in households 6. Describe the existing food diversity and the parts for cereals, vegetables, animal products Theme 1: Identification: village, participants Theme 2: diversity of local products available for food for the study period (local name, characteristics) Theme 3: accessibility of food in households (local production, purchase, exchange, income source) Theme 4: work and responsibilities sharing agreement between women and men in relation to the nutrition of the family (decision-making, men spending for nutrition, women spending for nutrition, women vegetables gardens, self-consumption, male involvement in vegetables production) Theme 5: Proposals for greater vegetable consumption in households.  Highlight the ways and means to improve vegetables consumption  Source of funding for the proposals  Natural and legal persons to participate in funding proposals Thank you for your cooperation Characterization of food consumption patterns in southern Mali (Sikasso) List of participants of women of childbearing age’s focus group Aged.................................. Village........................ Date............... N° Names Age Level of Occupation First name education 1 2 3 4 5 6 7 8 9 10 11 12 Total 74 Characterization of food consumption patterns in southern Mali (Sikasso) List of participants of women of childbearing age’s focus group Aged.................................. Village........................ Date............... N° Names Age Level of Occupation First name education 1 2 3 4 5 6 7 8 9 10 11 12 Total