Marc Bonenberger, MA


Marc Bonenberger  is currently a PhD-Student at the Swiss Tropical and Public Health Institute, which is associated with the University of Basel. The working title of his PhD project is „Supporting decentralised management to improve health workforce performance in Ghana “. Marc has a BA degree in History and Social Anthropology from the University of Basel and graduated in 2010 with a Master in African Studies. In addition to his PhD-Project he conducts short-term consultancies in the area of human resource development at Project Sino in Tajikistan.

MA Thesis

Malnutrition in Zanzibar – Prevalences, Determinants and Mitigation Strategies


Malnutrition is a global public health problem with more than 1 billion people affected by protein-energy malnutrition and up to 2 billion people affected by micronutrient deficiencies. Despite the strenuous efforts that have been made by the international community over the past decades to reduce the burden of the condition in Africa, sub-Saharan Africa remains the only region in the world where malnutrition is increasing. By using the Zanzibar archipelago as an example, this study was conducted to identify the causes of these high levels of malnutrition in an East African region. For this purpose, the “Conceptual Framework of Malnutrition” from UNICEF was employed, which recognises the basic, underlying and immediate determinants of malnutrition, including the environmental, economic, and sociopolitical contextual factors, with poverty having a central role. The underlying data of the study derived from surveys and studies conducted in Zanzibar over the past two decades, the District Health Information System of the Ministry of Health and Social Welfare, Zanzibar, and from the Tanzania Demographic and Health Survey from 2004/05. Some data were also used from own interviews conducted with mothers of malnourished children during a 3-months research period in Zanzibar.

The study shows that severe protein-energy malnutrition is a minor problem on the archipelago, but that mild-to-moderate forms of the condition are with up to 50% of all under-5-children highly prevalent. Also deficiencies in iron, vitamin A and iodine are widespread in this age-group. Although it can be expected that zinc deficiency is highly prevalent, no direct evidence has been found that this kind for deficiency occurs in Zanzibar. The study suggests that both inadequate dietary intake and infectious diseases are attributable to malnutrition in infants up to the age of 9 months, as exclusive breastfeeding is rarely practiced up to the age of 6 months and complementary feeding is introduced too early in life, leading to high rates of diarrhoea and pneumonia through reduced immunocompetence and contaminated liquids and foods. Because no direct evidence was found that inadequate feeding prevails in older children, the study suggests that infectious diseases are rather attributable to malnutrition in these children. However, the possibility that also inadequate nutrition partly contribute to the high rates of mild-to-moderate malnutrition could not be fully rejected. Evidence in this study strongly suggests that the major underlying determinants of malnutrition in Zanzibar are inadequate access to safe water and sanitation, and inadequate childcare as indicated by low educational levels of mothers. Moreover, evidence was found that inadequate access to food and health care is also attributable to malnutrition in Zanzibar. It is shown that poverty is the key factor affecting all underlying determinants.

Strategies to mitigate malnutrition and its immediate determinants, which are currently implemented in programmes of the Zanzibar health system, are the Integrated Management of Childhood Illness (IMCI), bi-annual mass administrations of vitamin A capsules and mebendazole tablets against helminth infections, and iodisation of salt through local salt producers. It is shown in this study that most of these programmes are implemented inadequately in the Zanzibar health system, as these are suffering from several constraints, which are most likely the result of a lack of sensitisation to the problem of mild-to-moderate malnutrition. To mitigate the underlying determinants, the Revolutionary Government of Zanzibar has launched the Development Vision 2020 in 2000, which has the primary goals to eradicate absolute poverty and to attain overall sustainable development by the year 2020. Within the framework of Vision 2020, the government aims at reforming the agricultural sector to increase access to food and at improving provision, affordability and accessibility to social services, especially in the areas of education, health, water and social protection programmes.


Marc Bonenberger
c/o Swiss Centre for International Health
Swiss Tropical and Public Health Institute
Socinstrasse 57,  P.O. Box
CH-4002 Basel, Switzerland