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    - AN ARTICLE FOR YOU, FROM ECONOMIST.COM - Dear ujeni, Don and Cathy Weber (weber@elite.net) wants you to see this article on Economist.com. The sender also
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      Study on nutrition's effect on learning ... Malawi

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      Jul 29th 2004

      Global hunger is on the wane but it is still hampering the growth of
      people, and of economies

      THERE are not enough classrooms at the Msekeni primary school, so half
      the lessons take place in the shade of yellow-blossomed acacia trees.
      Given this shortage, it might seem odd that one of the school's
      purpose-built classrooms has been emptied of pupils and turned into a
      storeroom for sacks of grain. But it makes sense. Food matters more
      than shelter.

      Msekeni is in one of the poorer parts of Malawi, a landlocked southern
      African country of exceptional beauty and great poverty. No war lays
      waste Malawi, nor is the land unusually crowded or infertile, but
      Malawians still have trouble finding enough to eat. Half of the
      children under five are underfed to the point of stunting. Hunger
      blights most aspects of Malawian life, so the country is as good a
      place as any to investigate how nutrition affects development, and vice

      The headmaster at Msekeni, Bernard Kumanda, has strong views on the
      subject. He thinks food is a priceless teaching aid. Since 1999, his
      pupils have received free school lunches. Donors such as the World Food
      Programme (WFP) provide the food: those sacks of grain (mostly mixed
      maize and soyabean flour, enriched with vitamin A) in that converted
      classroom. Local volunteers do the cooking--turning the dry ingredients
      into a bland but nutritious slop, and spooning it out on to plastic
      plates. The children line up in large crowds, cheerfully singing a song
      called "We are getting porridge".

      When the school's feeding programme was introduced, enrolment at
      Msekeni doubled. Some of the new pupils had switched from nearby
      schools that did not give out free porridge, but most were children
      whose families had previously kept them at home to work. These families
      were so poor that the long-term benefits of education seemed
      unattractive when set against the short-term gain of sending children
      out to gather firewood or help in the fields. One plate of porridge a
      day completely altered the calculation.

      A child fed at school will not howl so plaintively for food at home.
      Girls, who are more likely than boys to be kept out of school, are
      given extra snacks to take home. So are orphans, who are plentiful in
      Malawi because so many adults have died of AIDS.

      When a school takes in a horde of extra students from the poorest
      homes, you would expect standards to drop. Anywhere in the world, poor
      kids tend to perform worse than their better-off classmates. When the
      influx of new pupils is not accompanied by any increase in the number
      of teachers, as was the case at Msekeni, you would expect standards to
      fall even further. But they have not.

      Pass rates at Msekeni improved dramatically, from 30% to 85%. Although
      this was an exceptional example, the nationwide results of school
      feeding programmes were still pretty good. On average, after a Malawian
      school started handing out free food it attracted 38% more girls and
      24% more boys. The pass rate for boys stayed about the same, while for
      girls it improved by 9.5%.

      Better nutrition makes for brighter children. Most immediately,
      well-fed children find it easier to concentrate. It is hard to focus
      the mind on long division when your stomach is screaming for food. Mr
      Kumanda says that it used to be easy to spot the kids who were really
      undernourished. "They were the ones who stared into space and didn't
      respond when you asked them questions," he says.

      More crucially, though, more and better food helps brains grow and
      develop. Like any other organ in the body, the brain needs nutrition
      and exercise. But if it is starved of the necessary calories, proteins
      and micronutrients, it is stunted, perhaps not as severely as a muscle
      would be, but stunted nonetheless. That is why feeding children at
      schools works so well. And the fact that the effect of feeding was more
      pronounced on girls than on boys gives a clue to who eats first in
      rural Malawian households. It isn't the girls.

      On a global scale, the good news is that people are eating better than
      ever before. HOMO SAPIENS has grown 50% bigger since the industrial
      revolution. Three centuries ago, chronic malnutrition was more or less
      universal. Now, it is extremely rare in rich countries.

      For an illustration of how quickly some nations and their diets have
      grown richer, step into a crowded lift in a Japanese corporate HQ.
      Etiquette dictates that the most junior employees stand at the front
      and press the buttons, while the oldest and most senior stand at the
      back. What is striking, is how much shorter those at the back are. In
      only a single generation, high-speed economic growth has added
      centimetres to the national stature. Nutritionists think this kind of
      thing could happen anywhere.

      In developing countries, where most people live, plates and rice bowls
      are also fuller than ever before. The proportion of children under five
      in the developing world who are malnourished to the point of stunting
      fell from 39% in 1990 to 30% in 2000, says the World Health
      Organisation (WHO). By 2005, this figure is projected to fall below
      26%. And the UN's Food and Agriculture Organisation (FAO) estimates
      that 17% of people in the developing world were undernourished in
      1999-2001, a slight drop from 18% in the mid-1990s. The absolute number
      of undernourished people rose slightly over that period, however, from
      780m to 798m.

      In recent years, such improvements have stemmed largely from swift
      economic growth in China and, to a lesser extent, India. Most of the
      world's malnourished children are still in Asia, but the average
      Chinese enjoys a third more calories today than he did two decades ago.

      Africans are doing less well. A third of Africa's people are
      undernourished, a figure that barely changed between the mid-1990s and
      the turn of the millennium. In central Africa, which has been thrown
      into confusion by the war in Congo, the proportion of hungry people
      rose from 53% to 58% between 1995 and 2001. More peaceful parts of
      Africa did much better: and malnourishment is on the retreat in such
      places as Nigeria, Angola, Ghana, Malawi and Madagascar.

      Even those who have never experienced it know that hunger is a bad
      thing. But can the harm it inflicts be measured? Up to a point, yes.
      Malnutrition is the largest single contributor to disease, according to
      the UN's standing committee on nutrition. Hunger weakens the immune
      system. At the same time, disease can aggravate malnutrition. This may
      be direct--for example, when infection leads to appetite loss, or
      impedes the absorption of nutrients into the bloodstream--or indirect,
      say when a peasant is too sick to work, and so grows less millet.

      Inadequate nutrition of mothers and young children alone is responsible
      for 9.5% of the global burden of disease (see chart). Underweight
      infants are much more likely to succumb to diarrhoea, malaria or
      pneumonia. And, by some estimates, more than half of the 10m annual
      deaths of young children are directly or indirectly attributable to
      malnutrition. Furthermore, the interaction of hunger and AIDS
      aggravates matters. HIV infection progresses more quickly to full-blown
      AIDS in a body weakened by hunger. And hungry women are more likely to
      sell their bodies to buy food.

      Obviously, what hungry people need first and foremost is more food. But
      they also need better food. The most basic kind of malnutrition is
      called "protein energy deficiency". In other words, a diet that is
      lacking in energy because of a deficit in all the major
      macronutrients--such as carbohydrates, fats and proteins. Typically,
      though, such a diet will also be deficient in many micronutrients. As a
      consequence many lives are blighted for want of tiny amounts of iodine,
      iron, vitamin A and zinc. Micronutrient deficiencies are ranked eighth
      among the top ten risks to health worldwide by the WHO.

      Take iodine. Nearly 2 billion people consume less of this mineral than
      they should--usually because the water and soils where they live lack
      it. The most visible sign of iodine deficiency is a swelling of the
      thyroid gland called a goitre. The most important effect, though, is on
      the brain, which cannot develop properly without iodine. Each year,
      says the UN, some 20m children are born mentally impaired because their
      mothers did not consume enough iodine. The worst affected suffer
      cretinism, the symptoms of which include severe mental retardation and
      physical stunting.

      Iron deficiency, meanwhile, is the most common nutritional deficiency
      in the world, affecting some 4.5 billion people. Iron is essential as
      it forms the molecules that carry oxygen in the blood. Symptoms of
      deficiency include fatigue, shortness of breath and lethargy. A lack of
      iron damages productivity and cuts GDP by 2% in some countries says the
      WFP. Researchers Sue Horton, of the University of Toronto, and Jay
      Ross, of the Academy for Educational Development in Washington,
      estimate that lost productivity due to iron-deficiency anaemia costs
      Bangladesh 7.9% of GDP each year.

      Worse, perhaps, is that iron deficiency impedes cognitive development.
      Some 40-60% of children in developing countries are impaired in this
      way. Nevin Scrimshaw, a nutritionist at the United Nations University
      in New Hampshire, says that iron-deficient children are retarded by the
      equivalent of five to ten IQ points.

      Meanwhile, vitamin A deficiencies compromise the immune systems of a
      large proportion of those under five in poor countries--increasing
      their susceptibility to infectious diseases, and ultimately causing 1m
      infants to die each year. Deficits also cause hundreds of thousands of
      children to go blind each year, says the Micronutrient Initiative, a
      lobby group based in Ottawa. Finally, insufficient zinc appears to be
      linked to a higher risk of dwarfism, diarrhoea and pneumonia.

      Of course it is difficult to disaggregate the effects of deficiencies
      in micronutrients from hunger more broadly. Both hungry and
      mineral-deficient people tend to be weaker, more prone to illness and
      less intelligent. This must in turn make them poorer. Weak manual
      labourers produce less, and so earn less. Clever workers tend to earn
      more. Thus, malnourishment is not only a consequence of poverty, it is
      also a cause of it. Only the poor are hungry, and their hunger tends to
      keep them poor.

      Masautso Fraxon, a 13-year-old Malawian boy, dropped out of school last
      year after his parents died and he was no longer being fed. He supports
      himself and his grandmother by doing odd jobs in other people's fields.
      A full day's toil can pay up to 100 kwacha ($1), but if Mr Fraxon has
      not eaten, he can only put in 20 kwacha-worth before he has to stop,
      exhausted. He then comes home, spends his paltry wages on food, and
      rests for the remainder of the day. At the best of times, his wages buy
      only slightly more calories than he expends to earn them.

      Mr Fraxon's ambition, he says, is to set up his own business buying and
      selling fish. He says he has trouble reading and writing, but is good
      at sums. Your correspondent asked him what six times six was. He
      replied: "22".

      Western experts tend to tiptoe around the issue of how malnourishment
      makes people less intelligent, but local experts sometimes do not. "If
      your brain is stunted when you are young, that affects the decisions
      you make in later life. If you can't do simple arithmetic, you won't
      invest wisely. The cost of that will be very high," says Tomaida
      Msisika, a consultant on food security in Malawi.

      Sam Chimwaza, an analyst for Malawi's Famine Early Warning Systems
      Network, says that the reasoning ability of people in rural areas has
      been affected by malnutrition and it is hard for them to execute simple
      instructions. "They can work as servants in the city for two or three
      years and still not figure out how to adjust the temperature on an
      iron," he says.

      Several pieces of research have shown the broader economic effects of
      these problems. A study on Zimbabwe found that children exposed to a
      drought completed on average nearly five months less schooling (and
      were 2.3cm shorter than expected). It estimated that this resulted in a
      loss of 7-12% of lifetime earnings. At a somewhat larger scale, the
      World Bank estimates that in low-income countries, the net present
      value of causing children to be born of normal rather than low weight
      would be about $580 per child. That is more than a year's average
      income in a typical sub-Saharan African country.

      Sadly, the battle against hunger is harder to win than it should be.
      Food shortages tend to occur in countries with callous, despotic
      rulers. That is why a 14-year-old male North Korean refugee is on
      average 25cm shorter than his South Korean peer. In the long term,
      economic growth and improved agricultural technology offer the surest
      cure for malnutrition. In the meantime, there are several quick, cheap

      Iodine deficiency, for example, can be eliminated at minimal cost by
      iodising salt. Progress in this area has been rapid. Since 1990, after
      sustained efforts by many governments, the proportion of household salt
      that is iodised has risen from less than 20% to more than 60%. But
      there is no good reason why it should not be 100%.

      Similarly, iron deficiency can be tackled by fortifying flour with
      iron. And although it is better to get one's vitamins from normal food,
      pills can help. In places where vitamin A deficiency is rife,
      supplements can reduce child mortality by 23%.

      Some of the harm caused by malnutrition is irreversible, and this is
      especially likely if it occurs in the womb or during the first two
      years of life. So it is crucial to get good food into infants early and
      often. Breastfeeding is the best way to do this, unless the mother is
      HIV positive. By one estimate, exclusive breastfeeding in the first six
      months of life, followed by more breastfeeding between six and 11
      months, could reduce the number of deaths of children under five by
      1.3m a year, or 13% of the global total.

      Educating women is also important. As more women go to school, fewer of
      their children end up malnourished. A study of 63 countries by Lisa
      Smith and Lawrence Haddad, of the International Food Policy Research
      Institute in Washington, found that improvements in women's education
      and life expectancy relative to men's helped to reduce the proportion
      of children who were malnourished by 50% between 1970 and 1995.

      Many mothers, however, still know too little about nutrition to make
      the best use of the food that is available to them. Poor people are
      often tremendously knowledgeable about the environment in which they
      live, but they are also usually reluctant to try anything new.
      Malawians, for example, have an attachment to NSIMA (maize porridge)
      that strikes outsiders as nearly religious in its intensity. Ask a
      Malawian if he has eaten today, and if he has not eaten NSIMA, he will
      probably say "no".

      Patricia Saukila, who works for the WFP in Lilongwe, the Malawian
      capital, says there is a lot of resistance to dietary change. People do
      not rear enough chickens and goats, she says, and even if they do they
      tend to sell them to buy maize rather than eat them. The result is a
      great deal of protein deficiency, visible in the swollen limbs of so
      many of the children.

      One way to tackle dietary conservatism is to concoct tasty new recipes.
      Aid workers in Zambia--another southern African country with a
      maize-porridge fixation--have fooled street children into eating
      vegetables by dicing them and mixing them with maize porridge. The WFP
      has even come up with ways to make the "fortified blended foods" it
      doles out more palatable. Maize-soya porridge can be pepped up with
      mangoes, tamarind or tomatoes. Blended flour can be baked into cakes
      and sweetened with bananas or molasses.

      Many of the things that would ease hunger are worth doing anyway.
      Policies that promote economic growth or better education would be
      desirable even if they had no impact on nutrition. Democracy and
      freedom of speech are attractive in and of themselves. But it is also
      worth noting that rich, well-educated countries never go hungry, and
      that no democratic country with a free press, no matter how poor it may
      be, has ever suffered a famine. Unfettered reporters provide early
      warnings, and accountable governments know they have to respond to
      emergencies. The recent crushing of the independent media in Zimbabwe
      is one reason why the WFP expects trouble this year.

      In other places, the battle against hunger is steadily being won.
      Better nutrition is making people cleverer and more energetic, which
      will help them grow more prosperous. And when they eventually join the
      ranks of the well off, they can start fretting about growing too fat.

      See this article with graphics and related items at http://economist.com/science/displayStory.cfm?story_id=2963282

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