SUMMARY

Project Fight child malnutrition in 4 regions in Mauritania by providing capacity building for community management of acute malnutrition and prevention of malnutrition. Intervention areas: Brakna, Gorgol, Assaba, Guidimakha Background: In Mauritania 75% of households foods needs are imported. Population is facing vulnerability du a lack of food and prices crises. Infant and children practices are not appropriate amoings children that are early affected by malnutrition. Acute malnutrition rates are high at the lean period in a recurrent manner, notably in the 4 regions. Starting date: Once funds are transferred to Mauritania country office Duration: 24 months General Objetif: Contribute to progres towards Millennium Developpement Goal #1 and #4 by improving nutritional status of children under five in five vulnerable regions (Brakna, Assaba, Gorgol, and Guidimakha). Specific Objetifs Health facilities and local partners capacities in the regions are strengthened in order to improve coverage of the treatment of acute malnutrition and of prevention interventions. Results R1. Health facilities in the intervention zones of the project are reinforced in order to improve the response time of the screening, prevention and treatment of malnutrition; 70% of health personnel should receive specific training. R2. Behaviour change in infant and children feeding practice has been promoted in 40% of women Budget: 400.000 Euros

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NEEDS ASSESMENT
The Islamic Republic of Mauritania, located in West Africa, maintains the Sahara Desert as its western border, also sharing a northeast border with Algeria, southeast with Mali and southwest with Senegal; this large country possesses a surface area of 1,030,000 km; its western border is the Atlantic Ocean, the coast totalize 600 km. Situated between Sub-Saharan Africa and North Africa, Mauritania has encompassed a crucial role in commercial trade in the Saharan region. Desert makes up 80% of the land and only 0.2% of the soil is fertile. The country only has one permanent waterway, the Senegal River, which forms the natural border with its neighboring nation, Senegal. In 2011, there are an estimated 3.255.777 inhabitants. Nearly half of the population (46%) lives in rural areas. The population density is 2,9 individuals/km. 44% of the population is made of individuals younger than 15 years (18.5% of these are less than 8 years), and only 6% of the population is older than 60 years of age. The male to female ratio is 100:116. The entire population is Muslim and is composed of Arabs, pulaars, soniks and wolofs. Mauritania has experienced rapid transformations, going from being a traditional nomadic society to being a society in which more than half of the population is living in urban areas. Even so, the contrast between the moderately developed sector and the traditional sector still strongly exists. The main portion of the resources of Mauritania is obtained through commercialism (mining and fishing). With a GDP per inhabitant of $280 in 2002 and 43% of the population living on less than $1/day, Mauritania pertains to the group of the least developed countries. Situation analysis on women and children was done in 2010 in the country focusing in an equity approach. In Mauritania, poverty remains, beside periods, a predominantly rural phenomenon in that 59% of the rural population lived below the poverty line in 2008, against 21% in urban areas. The distribution of the incidence of poverty across regions is still very unequal. According to data from the EPCV 2008, can be grouped into 3 sets Wilayas: The poorest, with an incidence greater than 60%: Tagant, Gorgol, Brakna; The moderately poor with an incidence between 30 and 60%: Hodh El Charghi, Adrar, Guidimagha; Assaba; Hodh El Gharbi, Trarza Inchiri; According to the Human Development Index (2010), Mauritania was ranked number 136 of the 169 nations. In the education sector, the registration rate is 85%, with a boy-girl of 75%; less than 57% of the population can read and write. The literacy rate is 68% in boys and 58% in girls. Access to adequate medical care is inefficient and unfairly distributed, as only 67% of the population lives within 5 km of a health center. The only establishments that are actually counted in this fact are those that maintain a fixed location, correctly equipped with the proper physical and human resources. This particular situation significantly influences the utilization of necessary services and therefore halts the progression of quality healthcare rates. The main rates in the health sector, particularly those referencing children and women, have seen limited progression over the past 10 years. The maternal mortality rate has reached 930 of every 100,000 births; (1995) 747/100,000; (2000) (DHSM Demographic Health Survey in Mauritania) 686/100,000; (2007) (MICS Multiple Indicators Cluster Survey). The synthetic fertility rate is higher than that of the sub region (4.7 in 2000), which is higher than
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in 1995 when it was 6.5. The rate of child mortality (>5) has increased to 122 deaths per 1000 children, of which 77 die within the first year, according to the MICS survey in 207. In this way, infant mortality rates (for children >1 year) and child (>5 years) have gone from 75 to 125 per 1000 births in 2000 (EDSM), 78 to 123 per 1000 in 2004 (Survey of infant mortality rates and malaria), and 77 to 122 per 1000 in 2007 (MICS). The recent regression is very slow, only 4% per year. The main causes include: (i) Acute Respiratory Infections, (ii) Diarrhea, (iii) Malaria, (iv) Malnutrition and (v) Measles for children >5 years old. The neonatal morality rate is half of the infant mortality occurrence in Mauritania, with leading causes including asphyxia, neonatal infections, low birth weight (premature birth, hypertrophy) Neonatal care has not been a priority over time and is only gradually making its way into the priority of intervention work (communal medical care). Nutrition situation In 2008 REACH-Renewing efforts against child hunger Initiative was piloted in Mauritania and in a early stage REACH working groups compiled key information to analyse nutrition situation and actors mapping. Largely surrounded by the Sahara (the Sahel region), Mauritania has been in crisis since 1990, as child survival has been an issue due to the poverty and nutritional situation in these areas. Things improved during the last 5 years, but this was broken in 2007. The nutritional status of children under 5 years is now precarious, due to poor and inappropriate feeding habits of children, threatening their survival and growth, also due to the access to basic health care and social services, particularly for the most vulnerable groups. For example, the practice of exclusive breastfeeding went down by 20% from 2000-2001 and by 11-14% between 2007 and 2008. Children under 5 years old in Mauritania have been most vulnerable during food and nutritional crises in recent years, due to a diminishing supply of food in homes as well as droughts and emergency situations; this has also occurred due to an increase in the occurrence of infectious diseases like malaria, respiratory infections, intestinal parasites and, most-commonly, diarrhea. Mauritania only produces 30% of the food products they need and therefore depend on imports and exterior aid. The increase in the price of food is most prevalent in imported products and has perpetuated the lack of access to these products, which in turn increases nutritional insecurity, especially for families with small children. This situation was made worse when tourism took a fall in December 2007, when the nation became most unstable and also during the recent political tension that has resulted from two consecutive changes in power in March and July of 2008, following a coup in August 2009. At a national level, the prevalence of global acute malnutrition is 12,5% during the lean period and 6,8% in post harvest. This date differs, depending on the geographical region. The highest rates of acute malnutrition during the lean period 2010 were found in Gorgol (19,9%), Guidimakha (19,8%) and Brakna region (18,4%). During lean periods in 2009, five regions has prevalence upper the 15% of WHO emergency threshold. Chart. Evolution of the prevalence of severe acute malnutrition between 2000 and 2009 (Reference NCHS)

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Chronic malnutrition is not related to seasons, but is directly linked to poverty and the lack of access to regular and diverse nutrition (which includes all essential nutrients). In 2000, 2001 and 2009, the prevalence of global chronic malnutrition has decreased considerably, by 50%. However, this improvement is not accurate in every region, and leaves some in a vulnerable nutritional situation. This global improvement could be due to nutritional interventions (preventative and curative), carried out by governments and their collaborators. Another reason could be the improvement in data collection and information, as the gravity of the situation can be determined, as well as those areas that do not have reliable official documents providing information. Figure: Evolution of underweight (Reference NCHS) A phenomenon of temporal tendencies is highly noticeable in underweight. This type of malnutrition is strongly linked to the time in which the surveys were conducted, which was during periods of cultivation, while the crops were most accessible. This situation presents external elements which influence the nutritional state of children, putting them at risk for suffering malnutrition, including some of the following aspects: a) Price tendencies of basic food materials: In February 2011 the overall index FAO food prices reached a record level exceeding that of 2008, year of global food crisis. In terms of cereals, the increase in international prices is particularly sensitive for wheat (+85%) and maize (+76%). Wheat prices in Nouakchott increased 40% compared to last year with the same period. Other commodities of first need (Including maize, sugar, oil, rice) also recorded significant increases in prices. This increase in food prices coincided with the resumption of crude oil prices, favored by
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the recovery of the global economy. b) Innapropiate infant and child feeding pratices. Although there is a positive evolution in exclusive breasfeeding practice (45,9% in 2010), efforts should continue to increase the number of children receiving exclusive breastfeeding between 0 and 6 months of life to hav a huge impact in malnutrition reduction. One major problem, as nutrition data shows is the lack of diversity of complementary feedin ans the low percentage of the minimum adequate diet (frequency and diversity), which is 20.7% in 2010. The KAP-Knowledge, Attitudes and Practices of February 2009showed that some behaviors do not correspond with the practice of proper nutrition: a. one third of mothers give birth at home, sometimes because of lack of access to health facilities, sometimes for cultural reasons; b. In the rural sites, especially among first time mothers, they rely on a nurse to feed the baby sometimes up to several days; c. The tradition of giving water and other sweetened liquids is very strong. It often occurs at home after a delivery in a health facility (which way the water could be d. Half of pregnant women were told that the child "in need of drinking water"; e. Many Mauritanian mothers do not use an optimal position or put the child at the breast during a feeding; f. The grandmother serves as a conseulor and is often next to the new mother during the first 45 days while the stepmother is often present throughout the life of the child. c) Beyond dietary behavior, other underlying causes are the Mauritanian context. These are (i) low access to care and basic services (health and education), (ii) a high prevalence of childhood diseases in a restrictive environment and (iii) a precarious hygiene.

NUTRITION STRATEGY IN MAURITANIA

In Mauritania the problem of malnutrition is complex and multisectoral causes. Despite many nutritional interventions on the part of government with the support of all its partners - more than 30 actors are involved - most activities are very fragmented and only implemented some small scale. REACH reverses this trend by setting a global goal, the needs of children, and focusing on how each partner can contribute to reducing malnutrition.

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Multisectoral Nutrition National Plan The national plan aims to accelerate progress towards MDG-F #1 and elimination children malnutrition. The selected interventions in the national plan, focus on five priority areas that target the direct causes and underlying causes of malnutrition: improve breastfeeding and complementary feeding; increase the intake of micronutrients; improve the treatment of diarrhea and parasite control; improve the treatment of severe and moderate malnutrition; improve household food security; National protocole of acute malnutrition In 2007, alerted by acute malnutrition situation (MICS survey in 2007 showed 4 regions with a emergency prevalence of acute malnutrition and 3 regions below the alert threshold) a national protocole to care acute malnutrition children was adopted and the programme was scaled up to all regions. The management of acute malnutrition initially focused on launching the program planning and processes i.e. development of tools, early procurement of equipment, and on the training for trainees. Since 2008, the focus was put on the implementation of the management of acute malnutrition Protocol and at raising national interest in the project and at raising self awareness in the regional and national health services. Also, nutrition integration in the health information system was started. The constraints were coverage and the quality of the treatment. Mobile units introduction along with the strengthening of field interventions were possible through technical assistance inputs that innovated the health structures. Additionally, an increased interest and presence of international NGOs in some areas led to the better quality of assistance provided by partners. Since 2007, there has been a progressive introduction and scaling up of effective nutritional interventions to manage severe and moderate acute malnutrition in Mauritania. The program has been organised and managed by National Government with the assistance of many different International agencies and non-governmental organisations. Community health workers or volunteers can easily identify the children affected by severe acute malnutrition using simple coloured plastic strips that are designed to measure midupper arm circumference (MUAC). In children aged 659 months, a MUAC less than 110 mm indicates severe acute malnutrition, which requires urgent treatment. Community health workers can also be trained to recognize nutritional oedema of the feet, another sign of this condition. Once children are identifi ed as suffering from severe acute malnutrition, they need to be seen by a health worker who has the skills to fully assess them following the Integrated Management of Childhood Illness (IMCI) approach. The health worker should then determine whether they can be treated in the community with regular visits to the health centre, or whether referral to in-patient care is required. Early detection, coupled with decentralized treatment, makes it possible to start management of severe acute malnutrition before the onset of lifethreatening complications. In some context, the majority of children who have severe acute malnutrition are never brought to health facilities. In these cases, only an approach with a strong community component can provide them with the appropriate care.

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Evidence shows that about 80 per cent of children with severe acute malnutrition who have been identifi ed through active case fi nding, or through sensitizing and mobilizing communities to access decentralized services themselves, can be treated at home. The treatment is to feed children a ready-to-use therapeutic food (RUTF) until they have gained adequate weight. In some settings it may be possible to construct an appropriate therapeutic diet using locally available nutrient-dense foods with added micronutrient supplements. However, this approach requires very careful monitoring because nutrient adequacy is hard to achieve. In addition to the provision of RUTF, children need to receive a short course of basic oral medication to treat infections. Follow-up, including the provision of the next supply of RUTF, should be done weekly or every two weeks by a skilled health worker in a nearby clinic or in the community. With modern treatment regimens and improved access to treatment, case-fatality rates can be as low as 5 per cent, both in the community and in health-care facilities. Communitybased management of severe acute malnutrition was introduced in emergency situations. It resulted in a dramatic increase of the programme coverage and, consequently, of the number of children who were treated successfully yielding a low case-fatality rate. In 2010, two major evaluations (Community Mamangement of Acutre Malnutrition UNICEF experts (1) and FANTA-2 (2)) were carried out at the beginning of 2010. Somme recommandations were: For Inpatient Therapeutic feeding centers (OTF-CRENI) - Ensuring a screening in external consultation and emergency room - Harmonize admission and exit criteria including MUAC (Middle Upper Arm Circunference) tools to be used. - Tracking sheet and register - transfer reference card: harmonized and translated into French - Arabic tools - using the F75 phase 1 - OTF list available in all structures (OTF, InTF) applying decision - Children monitoring for discharge - tracking sheet and register available For Outpatient Therapeutic feeding Centers (InTF-CRENAS) - Training, evaluation and supervision strategies enhancement - Reinforcing community sensibilization (WFP, local NGO) - Available tools in arabic and french, available drugs for systematic treatment - Scale-up mobile teams of acute malnutrition management For Nutrition Service and regional nutrition respondents - Supplies management improved (logistics, stock..) - Single country in integrating nutrition in health information system - Improvement of retro information to structures and DRAS - Assure link with hospitals data base and SNIS data base Improving supervision (quality and tools) The results of these two important evaluations were applied in the revision of the national protocol to improve the quality and coverage of acute under-nutrition treatment. Mauritania programme is focused on:

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1. Adopting and promoting national policies and programmes that: Ensure that national protocol for the management of severe acute malnutrition have a strong community-based component that complements facility-based activities. Achieve high coverage of interventions aimed at identifying and treating children in all parts of the country and at all times of the year through effective community mobilization and active case fi nding. Provide training and support for community health workers to identify children with severe acute malnutrition who need urgent treatment and to recognize those children with associated complications who need urgent referral. Establish adequate referral arrangements for children suffering from complicated forms of severe acute malnutrition so they can receive adequate inpatient treatment. Provide training for improved management of severe acute malnutrition at all levels, involving an integrated approach that includes community- and facility-based components. 2. Providing the resources needed for management of severe acute malnutrition, including: Making RUTF available to families of children with severe acute malnutrition through a network of community health workers or community-level health facilities. Ensuring funding to provide free treatment of severe acute malnutrition because affected families are often among the poorest. 3. Integrating the management of severe acute malnutrition with other health activities, such as: Activities related to the Integrated Management of Childhood Illness at fi rstlevel health facilities and at the referral level. Preventive nutrition initiatives, including promotion of breastfeeding and appropriate complementary feeding, and provision of relevant information, education and communication (IEC) materials. National Strategy on Infant and Young Children Feeding The aim of the national strategy is to improve the nutritional status and health, the growth, development and survival of infants and young children Mauritania through the promotion of breastfeeding and appropriate practices supplementary feeding. The strategy provides the tools to improve nutrition status through prevention. The objectives of the national strategy, which will be completed by 2015, are: Increase and maintain the proportion of newborns breastfed within time after delivery; Increase the percentage of newborns who are not breastfeed (tea, water, fruit juice, milk, animal etc.) Increase and maintain the percentage of infants under six months exclusively breastfed Increase and maintain the percentage of infants aged 6-9 months breastfeed and who receive appropriate complementary feeding Increase the percentage of children who are still breastfeeding at age 20-23 months Promote the use of appropriate complementary foods maximizing the use of local products Breastfeeding promotion targets a national coverage taking into account the 5 components for success of the IYCF: Strategic action at national level: policy, legislation, planning, budget, monitoring and evolution. Organization of the health system.
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Community level intervention. Communication for behavior change; and IYCF in difficult situations (e.g. emergencies, HIV).

Children Survival and development communication strategy This strategy was developed on the basis of a qualitative research carried out in 2009.UNICEF translated it into an integrated communication plan linked with National Strategy of Children Survival with four main messages to encourage healthy behaviors and improved knowledge, attitudes and practices and participation of families, individuals & communities, as in below: (1) Promotion of exclusive breastfeeding for < six months and adequate complementary feeding; (2) Promotion of hand washing with soap; (3) Promotion of long lasting impregnated bed nets; (4) Control of diarrhea.

FIELD COORDINATION
The REACH initiative started as a pilot project in Mauritania with the support of the United Nations system (UNICEF, WHO, FAO, WFP) in May 2008. This is a multi-sectoral partnership between government, the UN, civil society and the private sector to foster the strengthening of coordination and promotion of joint programs for nutrition and food security. This initiative is leading efforts to (i) support the immediate causes of malnutrition (individually), focusing on increasing micronutrient intake and improved feeding practices infant and young child, (ii) the management of underlying causes (at Community), which focuses on increasing the availability and accessibility to food and basic health services and interventions preventive. REACH is based on the definition of a multisectoral package of interventions tailored to the specific context of the country and with the extension of coverage will have an impact on reducing malnutrition in children. These combined interventions have shown an efficacy rate of 60% in reducing malnutrition. Thereafter, reaching a coverage of at least 80% of each of these interventions would significantly reduce the "burden"of malnutrition among children under 5 years (Lancet Nutrition Series, 2008).

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REACH initiative is used as a coordination platform at the national level of actors on nutrition. This nutrition coordination is now also stablished in some regions with the support of International NGO, as Gorgol and Guidimakha. Its a multisectoral coordination that allows to harmonised approach and to improve analyse and availabillty of prompt information. In the humanitarian domain, a national Emergency Coordination Forum is leaded by the Resident coordinator of the UN System in Mauritania in tight collaboration with government. This forum has developed a humanitarian mapping and gets quick information of situation to share it amongst stakeholder and to initiating decision and action in a possible response. During the last 3 years this forum has largely contributed to help nutrition community in the response in lean periods to localised emergency nutrition situation (acute malnutrition rates below 15%).

OPERATIONAL FRAMEWORK
Title Project: Fight child malnutrition in 4 regions in Mauritania by providing capacity building for community management of acute malnutrition and prevention of malnutrition. Malnutrition Location The project will be implemented in 4 regions, Brakna, Gorgol, Guidimakha and Assaba

Duration 24 months Target population Indirect: All children population in those 4 regions will be target by project: 218.456 under five children. Direct: Focus in 49.595 under two year old children. The projet will touch 108,000 women. Children suffering from acute malnutrition (see table with estimations)

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Estimated numbers of direct and intermediary beneficiaries Interventions Direct beneficiaries In-patient therapeutic Feeding centres for Treatment of sever acute under-nutrition with complications Out-patient therapeutic Feeding Centres for treatment of Acute under-nutrition without complications* Adult women (15 and older) receiving information on exclusive breast feeding, complementary feeding, hand washing, ITN and diarrhoea control** Intermediary beneficiaries Programme managers at local level, non-government and UN agencies Front-line Service providers (health workers, Personnel of NGOs and teachers of university and school health)***** Supplementary feeding centers for treatment of moderate acute under-nutrition 40 500 200 50 600 200 20 1800 108 000 30 2000 110 000 Year 1 Year 2

Totale ASSABA GORGOL BRAKNA GUIODIMAKHA TOTAL 314,478 315,057 320,632 230,677 1,180,844

Children 0-59 58,178 58,286 59,317 42,675 218,456

Children 0-24 22,013 22,054 22,444 16,147 82,659

Children Severe acute malnutrition 252 556 720 814 2,341

Children moderate acute malnutrition 4,991 10,050 9,457 7,322 31,820

Table: indirect target based on estimations from 2010 acute malnutrition prevalence.

Sector Nutrition, health, humanitarian action General Objetif: Contribute to progres towards Millennium Developpement Goal #1 and #4 by improving nutritional status of children under five in five vulnerable regions (Brakna, Assaba, Gorgol, Guidimakha and Nouakchott). Specific Objetifs Health facilities and local partners capacities in the regions are strengthened in order to improve coverage of the treatment of acute malnutrition and of prevention interventions. Specific Objetif Indicators Rates of global acute malnutrition Rates of global underweight 80% of acute malnutrition cases are detected and screened at the community level and refered to health facilities 60% of children with severe acute malnutrition admitted in the health care facilities are treated and cured.

Verification source SMART Nutrition Surveys

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Results and indicators Result1. Health facilities in the intervention zones of the project are reinforced in order to improve the response time of the screening, prevention and treatment of malnutrition; 70% of health personnel should receive specific training. Indicators: % of health personnel and agents trained involved in treatment and prevention of malnutrition % of children screened and monitored % of health facilities providing monthly information on acute malnutrition management program Result 2. Behaviour change in infant and children feeding practice has been promoted in 40% of women Indicators: Number and percentage of adult women (15 and older) receiving information on exclusive breast feeding, complementary feeding, hand washing, ITN and diarrhoea control Verification sources Register books from health care facilities Monitoring reports National Health information system tally monthly sheets Activities Result 1 Activity 1. Adoption of new protocole of acute malnutrition and editing of new tools Activity 2. Equipment of 50% health care facilities with anthopometric equipment and medicines Activity 3. Training of up to 600 health agents in the protocole of acute malnutrition management Activity 4. 50% of hard to reach localities are covered by mobile teams of acute malnutrition management Result 2 Activity 5. Interpersonal and group discussions (home visits, working with women's groups) to counseling on essential nutrition actions. Activity 6. Mass communication campaigns leaded by health agents at the community level target to women Activity 7. Training of health and community agents in the family essential practice (breast feeding promotion, complementary feeding, handwashinhg, etc,..) Activity 8. Develop communication materials to promote good practices

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Implementation chronograme
1 2 X X 3 X 4 X 5 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 6 7 8 10 9 11 12 13 14 15 16 17 18 19 20 22 21 23 24

A1 A2 A3 A4 A5 A6 A7 A8

Monitoring and evaluation - Impact: The twice yearly SMART surveys will gave thekey information of nutrition status of children and feeding practices o July survey: Malnutrition prevalence indicators in lean period o December survey: Infant and Young children feeding practices and malnutrition prevalences indicators in post harvest. - Monitoring: The consolidation of the nutrition and health information system. The four regions are equipped and assisted to integrate the indicators of acute under-nutrition treatment into Health Information System monthly. A semester report is also produced. - Monitoring: a community based M&E system will collecte information about BCC at the community level and mass campaigns.

RISKS AND HYPOTHESIS

In initiating the project, the reaching of the objectives directly depends on the state of the following criterion: 1. Political Instability: Proper and firm political relations for project development are necessary in order for the projects lasting impact. 2. Firm and lasting political relations are also necessary for all parties associated with the project (UN organizations, NGOs, civilians and beneficiaries). 3. The timely mobilization of financial and human resources. 4. Significant emergencies or natural disasters must not be present nor affect the health centers in the community. 5. Safety issues dealing with expat kidnappings can also negatively affect the impact of the projet

RESSOURCES
Total budget : 400,000 euros (see annex) Human ressources: a) UNICEF staff: 2 international nutrition staff and 2 national staff and 2 consultants (technical assistance) b) Ministry of Health: 3 staff in the National Nutrition Survey DRAS: 4 nutriton focal points in the regions Disctrict: 25 nutrition focal point in districts
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c) NGO: 4 international NGO working in the regions Material ressources Result 1 Protocole and gudelines, and tools (register books and mothly reports sheets) Training and manual materials Height boards and scales, MUACs Essential drugs dans RUTF. Vehicule to mobile teams

Result 2 Flip charts and posters. Househoulds monitoring tools (focus groups and home visits) Campaign monitoring tools Manual and training materials

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CROSS-CUTTING ISSUES
Gender More than half (59%) of women 15-49 are married and only 29% are single. A third of women do not have any education, as compared to 24% of men. The average level of education in rural areas is much lower than that of urban areas; 41% (urban) and 22% (rural) in women and 31% (urban) and 31% (rural) in men. According to the average resident, more than half of women live in rural areas and 46% in urban areas. Due to migrations, more men live in urban areas (56%). Mauritania possesses Arabic and Islamic populations, as well as black African groups, giving it a rich diverse cultural aspect. Gender relations continue to be influenced by cultural and historical aspects. The generation of the 1960 independence was very influenced by womens emancipation values. This womens rights defense should be brought to life in Islamic values, which are governing elements of current Mauritanian life. Since the time of independence until the 90s, women integration and development was a dominant focus of development work. In 1992, Mauritania created a Secretary of State of Womens Conditions. In this context, the situation of Mauritanian womens conditions has improved in the last few decades (primary education, employment, political participation). The national Assembly in 2002 adopted a law regarding the obligation of childrens education for ages 6-14 years. After ratifications made to the CEDAW and to the CDN (2001) in order to promote positive discrimination. The general statute is less valued for women than men. It is highly diverse: access to the second level and duration of studies, access to technical and scientific education, private employment, access to resources and production factors (faming, financial, etc.). The raising of awareness of the population (for men and women) regarding traditional practices and certain behaviors (matrimonial precautions, divorce, polygamy, etc.) constitutes a means to achieving gender equality. Realistically speaking, everything affecting womens health and nutrition are highly regarded because these women are the ones that make their own decisions (in the case of older women), apart from when there are implicit expenses or major decision, such as when they have a serious illness or complication. Men are generally interested, but stay away; their responsibility consists in ensuring that women are available to be responsible for the council of for women in troublesome situations. Societal perceptions and judgments regarding specific gender roles trigger the inequality of women. Gender Focus (UNICEF) Gender equality is one of UNICEFs principles in all areas of the world, and one of the mandate on which the Convention on Childrens Rights is based, the Committee on the Elimination of Discrimination against Women, CEDAW. This applies as much in humanitarian interventions, or development work, which UNICEF undergoes in 150 developing countries, as it does in awareness raising program, carried out in industrialized countries, through the National Committees, including the UNICEF Spanish Committee. Various issues are linked with transversal gender actions carried out by UNICEF, in which projects related to malnutrition prevention can be found, including the project being presented.
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These premises are also applied in UNICEFs work in Mauritania, in the understanding of gender equality; child development and access to basic services cannot be obtained without reaching gender equality, including development for the mothers of these children. UNICEF is committed to balancing its efforts with girls, teenage girls and women, ensuring that they have the same opportunities as boys. UNICEF works in Mauritania in order to guarantee the betterment of the lives of every boy and girl, through integrated care, the receiving of quality of education in order to prepare them for the future, keeping in mind the gender differences; all girls, teenage girls and women should have the necessary information and capacity to protect themselves against HIV, gender violence and all types of gender discrimination. Gender equality is a key issue in project design. In the analysis of a situation, the populations uncharted information is key. In every phase of the project, an active promotion of the participation of women has been included. Teams will be formed, including hired and volunteer workers, in efforts to obtain gender equality. Salaries will be equal (for men and women). A fundamental element to keep in mind is that women are also beneficiaries of the project, given that positive results cannot be obtained without also preventing malnutrition in women, which has been previously noted (women are the responsible parties for the health status of the family). In conclusion, we feel that this project promotes gender equalities in the communities in which it will be implemented, and will seek to fundamentally improve the lives of women. Enviroment Not envisage any negative impact on the environment.

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