Despite two years of bumper harvests, malnutrition, partly a consequence of Malawi's famine in 2005, still lingers. "The scale of the malnutrition problem in Malawi is clearly very large and, given its consequences for economic development and child survival, calls for immediate and large-scale action," said Aida Girma, UNICEF Resident Representative.

"Micronutrient deficiencies, which are often referred to as hidden hunger, are also very high." Malnutrition is characterised by key indictors, such as the number of underweight children and levels of stunting, wasting and micronutrient deficiencies: stunting levels were at 46 percent, 19 percent of children up to 59 months were underweight, and wasting was 4 percent, the UN Children's Fund representative added.

After the drought

Malawi has turned the page on the 2005 drought that left about five million people in need of food aid. According to government estimates the 2007 maize harvest, the staple food, increased by 22 percent over the 2006 crop, and was 73 percent higher than the average for the past five years.

Mary Shawa, principal secretary in the Office of the President and Cabinet responsible for nutrition and HIV and AIDS, described malnutrition as a silent crisis. She called for a comprehensive study to establish whether the bumper harvests in the 2005/06 and 2006/07 growing seasons had had any impact on reducing malnutrition levels.

"We have started to see improvements in the food security situation in Malawi in the past two years [but] malnutrition is still a challenge," UNICEF's Nutrition Officer, Stanley Chitekwe, told IRIN.

He said malnutrition was caused by three underlying causes: the first, household food security, had shown improvement; the other two - care for children and women, and the availability of health services - were still inadequate.

"Malawi is heading in the right direction by meeting one of the three requisites for nutrition," he commented, but addressing the other issues would "require more investment in building capacity to improve care practices and health seeking behaviours", because "there is still more work required in promoting diversified crops rich in vitamins and nutrients, and in food processing and preservation."

HIV/AIDS also "undermines nutrition improvements by directly causing ill-health and eroding capacity at various levels - family and institutions - to care, produce food and provide services," Chitekwe added.

The hunger gap, a pre-harvest period when food from the previous crop was often depleted, meant that seasonal variations in household food availability still resulted in higher levels of malnutrition from September to March/April each year, he said.

Filling the hunger gap

A 2005 National Nutrition Survey found that 90 percent of children in Malawi were malnourished. Tapiwa Ngulube, principal nutritionist in the ministry of health, said since then the government had established 95 Nutrition Rehabilitation Units, where free food was given to malnourished children and mothers were trained to feed them correctly.

"Our aim is to ensure that the children are healthy and have gained weight by the time they leave rehabilitation units; children who are malnourished lose up to 11 centimetres in height if they are not treated for malnutrition and stunting," Ngulube noted.

Around 39,000 children are still being treated at rehabilitation centres throughout the country, but "our efforts are hampered by a shortage of medical personnel," Ngulube said.

UNICEF's Girma attributed micronutrient deficiency to the low nutrient content in local diets, which are based mainly on cereals, roots and tubers and said diets needed to be supplemented with micronutrient-rich foods like fish, meat, eggs, milk and dairy products.

But in a country where over half the people live on less than US$1 a day, most households struggle to come up with two meals a day.