[Happy Fathers’ Day! My dad is the only 50-something-year-old guy I know who cares enough about pediatric nutrition to stand and carefully examine the baby food aisle every time we go to the grocery store. In his honor, I’ve been taking some pictures and notes on pediatric food options here.]
During our first week here, my mother asked me what I was eating. I dodged the question. Luckily, we’ve since figured out where to get food other than rice, bread, peanut butter, and nsima, but finding nutritious food sources is still an issue for many people, particularly children, in the outlying areas.
Growth faltering is a delay in the onset of the childhood growth phase (measured by height for age) at the end of the breastfeeding period. Growth faltering is worst around 18-24 months, and if you haven’t intervened by then, you may have lost the opportunity. [1]
WHO statistics indicate that in 2010, 70.7% of rural Malawian children under
the age of 5 showed stunted growth– meaning that they were two or more standard
deviations below the reference for height by age. [2]
The potential irreversible damages of poor fetal growth or stunting during the first two years of life are marked by shorter adult height, decreased offspring birth weight, lower attained schooling, and reduced adult income. In the US, the government prevents this by providing formula for children under 2 whose parents can’t afford it. [1] Here, where kids aren’t yet in school, there’s no good way to distribute to that crucial age range.
Kwashiorkor is caused by sudden food deprivation. It’s more lethal than marasmus because it opens children
up to infections and tends to occur in older children. Markers are pale sparse hair, enlarged liver, wasted muscles,
oedema, moon face, poor appetite, pale skin, and apathy. [3]
Other than the obvious (breastfeeding), the food options for children under 2 in the village are pretty minimal. In stores in Lilongwe, we saw a fair assortment, though it appears that Nestle dominates the market. In the village mart, Jey Jey, the two infant food shelves hold three flavors of Nestle baby cereal and a few cans of Nestle starter formula. Children of the relatively well off (workers at the hospitals, at nearby Namitete Technical College, at the furniture factory) can afford the Nestle. Children in the villages eat almost solely maize.
Some of the hospitals that we saw this week were “baby-friendly hospitals,” meaning that they strongly encourage breast feeding. There’s not really the same stigma about public breastfeeding that there is in the States–mothers nurse their babies everywhere. [4]
The formula costs 1,570MK (Malawi Kwacha) and the baby cereal is 1,320MK; by today’s exchange rate
that’s about $9.40 USD and $7.90 USD, respectively. In 2011, 74% of this country’s population lived below
the international poverty line ($1.25/day) and the average Malawian woman had 6 live births in a lifetime. [5]
We see the signs of malnutrition everywhere. During our first week here I remarked that I enjoyed being average height here. While my 5’2” stature is probably genetic [6], for many Malawians it’s the result of inadequate nutrition. We see kids with textbook kwashiorkor every time we go play with the local kids. It’s very hard to guess children’s ages because kids are much smaller here than they are in the US. Our second day in morning report, the pediatrics ward nurse reported an overnight death due to “anemia and hypoglycemia.”
The traditional diet relies heavily on different permutations of maize. Nsima, on the far right, is such a staple of the diet that,
as Sister Justa puts it, “in the villages, if the children take food but they do not take nsima, they think like they have not taken
anything at all.”
Like most progress indicators in Malawi, the malnutrition problem hasn’t gone without significant global aid efforts. The HIV/AIDS clinic at St. Gabriel’s gives out packets of Chiponde, a fortified peanut butter paste also known as Plumpy’nut, to all pediatric patients who have a BMI below about 16. [7] Other efforts in the country have been successful in reaching a 96% Vitamin A supplementation rate and 50% iodized salt consumption. [4]
Chiponde boxes and sachets at the HIV clinic.
There are still huge discrepancies between urban and rural nutrition access, though, and this issue is linked far too closely to poverty to be an easy fix. Instead, as with most of the seemingly impossible challenges here, I’m trying to see malnutrition through the quote my dad puts at the end his talk: “It is not incumbent upon you to finish the task. Yet, you are not free to desist from it.” [8] We can’t do everything. But maybe with consistent and diligent effort, we can do something.
[1]: GLHT 201 Lecture notes 9/6/12, that time my dad came to talk about global malnutrition. See, dad, I wasn’t just doodling!
[2]: Unfortunately, statistics like these are often inaccurate in low-resource settings. Expect an upcoming post about stunting metrics problems and BTB’s attempts to answer them.
[3]: Had to pull this part from the powerpoint. Okay, I may have been doodling a little bit.
[4]: We don’t have very many baby-friendly hospitals in the US because of the prevalence of formula.
[5]: UNICEF. Unfortunately, they didn’t have these statistics split urban/rural, but for the two friends of mine I know are wondering (you know who you are), check out the UN report on rural gender employment inequality.
[6]: Hi dad.
[7]: Plumpy’nut is its own very google-able story. It appears to be seeing some success in Malawi, but the outlook for a more global scaleup remains unclear.
[8]: Rabbi Tarfon: Ethics of the Fathers, Pirke Avot, Chap 2: verse 21