N'DJAMENA, 4 January 2008 (IRIN) - With a massive aid operation under way in the east of Chad, where armed conflict has displaced hundreds of thousands of people, little attention is being paid to the west of the country which has the highest chronic malnutrition levels.

"Kanem [a region in the west] has the worst chronic malnutrition [in the whole country]," the UN Children's Agency (UNICEF) nutrition project officer in Chad, Simeon Nanama, told IRIN.

The non-governmental organisation (NGO) CARE had projects in the region but with the conflict in the east "we made a policy decision to shift from development to crisis [projects]," the head of CARE in Chad, Nicolas Palanque, recently told IRIN. "We are talking about restarting in Kanem," he added. "It would be our priority if we were to get more funds."

Chronic malnutrition - as against severe malnutrition - occurs gradually over a person's lifetime and is the consequence of an inadequate diet. Children who suffer from chronic malnutrition are more likely to die prematurely, to contract infection and to have their growth stunted, according to Save the Children.

Reliable statistical information for Kanem is hard to come by but UNICEF nutrition project officer in Chad Simeon Nanama said: "It is quite possible that [malnutrition] levels there are increasing… Certainly the situation doesn't look like it is resolving itself."

Nutritional experts say chronic malnutrition has been high for at least 30 years in Kanem Region, where estimates of the population range from less than 300,000 to as many as 800,000.

Reasons for malnutrition

Experts give various reasons for the high levels. Many farmers in the arid region do not have access to land or the means to exploit it, the NGO Action contre La Faim (ACF)'s Carole Dubrulle told IRIN.

But she and other experts say inadequate food is just one of the causes. "We need to help people change their eating habits and improve sanitation," Nanama said. "We need to encourage mothers to breastfeed more and not start giving their babies water until they are six months old."

Children in Kanem aged 6-29 months have higher malnutrition levels than those over 30 months, Dubrulle of ACF said. "This is due to weaning practices as well as inadequate supplementary feeding."

Projects abandoned

Some NGOs had set up projects in Kanem to try to rectify the causes of the malnutrition but in recent years many NGOs have abandoned their projects.

ACF had a therapeutic feeding centre for malnourished children in four different towns in Kanem. They were handed over to the government in 2007 but the centres have since stopped functioning, Dubrulle said.

UNICEF does maintain some feeding centres in the region but these are not going to solve the problem, Nanama said. "We don't really have [NGO] partners to work with in the area," he said, adding that even if they did, "it's the old story of how to put in place structures that are sustainable."

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