Nairobi — Although she is five years old, Rose Nduta is about the same height as a 20-month-old toddler. Pale, spindly-limbed and severely underweight, the Kenyan girl suffers from chronic malnutrition.
North of here, in refugee camps near Kenya's border with neighboring Somalia, children like Rose are huddled in tarpaulin tents under the spotlight of international news organizations. The region's worst famine in decades has focused African and global attention on both Somalis and Kenyans in the most-affected areas. But Rose, who lives in Kenya's capital, is one of the often-invisible sufferers of urban hunger.
"She was very weak. I was scared she was going to die," said her mother, Alice Nduta, as she tried to rock Rose to sleep at their home in Viwandani slum. "For a span of one week, I had sleepless nights due to her constant crying. She had lost a lot of weight, and that prompted me to seek medical attention."
Her mother managed to get at least temporary help for Rose. She is being treated with a high-energy therapeutic food known as 'Plumpy Nut,' which is normally given to starving children in emergency feeding centers.
But the family continues to struggle with hunger. Nduta said there are days when the family has no food. "When we are lucky enough, my children and I subsist on one meal a day, one that may only consist of some ugali (a staple made with maize meal) and cabbage or even just a cup of black tea," she said.
A Creeping Crisis
Rose is one of thousands of malnourished children in this city, where food prices escalate daily. Despite a wide-spread assumption that severe malnutrition only occurs in drought-stricken or rural areas, researchers report escalating hunger in urban centres, especially in sprawling, congested slum settlements such as those where about half of Nairobi's population live.
Malnutrition scientist Jay Berkley says the affliction is often misunderstood. He said these children don't die from lack of food per se; they succumb because their severely weakened bodies are vulnerable to other threats. Up to half of all childhood deaths is attributed to this slow decline.
"Malnutrition kills by promoting common infections and underlies much of childhood mortality in Kenya, said Berkley," who is based at the Kenya Medical Research Institute, KEMRI-Wellcome Trust Research Programme, in Kilifi on the Kenyan coast.. "Studies indicate high estimates of malnutrition-attributable death, ranging from 30 to 50 percent of childhood deaths."
Even for the survivors, the costs of persistent hunger is high. Berkley said that severely malnourished children often suffer brain impairment or compromised cognitive development, which contributes to poor academic performance. If they reach adulthood, they are also less productive workers.
The Kenya Service Provision Assessment of 2004 estimates that malnutrition, which not only occurs due to a lack of food but also from a lack of essential food nutrients in the body, is an underlying factor in about 70 percent of the illnesses that kill children under five in Kenya.
"There are high levels of malnutrition in the slums, especially the [type] that results in child stunting, due to poverty and chronic food insecurity," said Dr. Elizabeth Kimani, a specialist on child health issues and malnutrition at the African Population and Health Research Center. Macro-nutrient malnutrition occurs due to lack of food, while micro-nutrient malnutrition occurs due to lack of essential micro-nutrients and vitamins in the body.
For Lack of Basic Nutrients...
Kimani said that about half of children aged five and under in Nairobi's slums are stunted. This is because many infants are being weaned by age one, and may not be receiving proper nutrients. They are also more likely to get diarrhoeal infections, which lead in turn to increased malnourishment.
According to the World Health Organization, Vitamins A and C, iron and iodine form the most important micro-nutrients in global public health terms, especially for children and pregnant women in poor countries. Zinc is also important.
Vitamin A deficiency affects more than half of all countries, especially in Africa and Southeast Asia, and is the leading cause of preventable blindness in children. Low levels of the vitamin also increase the risk of disease risk and death from infections.
"Lack of Vitamin C, which is important for the absorption of other nutrients, in a child's diet leads to bleeding gums while iodine deficiency results in mental retardation and lowered cognitive development. Children who lack iron become susceptible to anaemia and get stunted," said Kimani.
Low-Cost Lifesaving
Part of the reason malnutrition in slums gets relatively scant attention is that it rarely reaches the level of a recognized emergency. Thresholds for emergency response to malnutrition in rural areas differ from the indicators applicable to poor, urban settlements. Large numbers of people packed into tight spaces - often without clean water and sanitation - multiply the risks of infection.
People living in slums are also especially vulnerable to food price changes, because so much of their income is spent on food. In addition, the lack of regular employment makes planning and saving difficult. "Food Prices - From Crisis to Stability" is the theme of this year's World Food Day, which is observed on Sunday.
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Public health experts see little prospect that urban hunger will attract the kind of international attention that acute famines command. But they say that a number of low-cost interventions can save and change the lives of large numbers of children.
Kimani acknowledges that providing children with sufficient food is challenging for poor families. But she says that educational programs in public maternal-and-child health facilities can teach mothers how to feed children a more nutritious diet, even when food is scarce.
She also says lessons in hygiene practices, include hand washing, would "go a long way in preventing diseases and curbing malnutrition." Communicating to mothers that breastfeeding minimizes the risk of malnourishment, as well as of infection from unsafe water, would help as well. The Global Alliance for Improved Nutrition says that the "lack of immediate and exclusive breast feeding causes an additional 1.5 million" childhood deaths above those directly attributed to malnutrition itself.
And public health programs that provide even minimal nutritional support could yield dramatic results. Researchers estimate that just providing Vitamin A to children aged six months to five years every four to six months could reduce childhood mortality worldwide by 23 percent.
