Wanja N'gang'a is not a wretched, hollow-eyed child of the sort that has shamed the world into rushing relief food to Africa. On the contrary, she eats every day, coaxes piggy-back rides off her older brothers and plays peek-a-boo in her mother's skirts.
Her photograph would not provoke enough pity to be useful in fund-raising advertisements for the starving of Africa. And yet Wanja is, by international standards, severely malnourished. Her growth has been arrested. She is 18 months old and weighs 17.6 pounds. In the United States or among well-fed infants in Kenya's capital of Nairobi, 97 out of 100 girls her age weigh more.
Wanja is growing up at a rate that doctors say is somewhere between pathologically stunted and adequate. Since she was weaned a year ago from an exclusive diet of breast milk, she has been sick constantly. Her chest infections, diarrhea, malaria, hookworm, eye and ear infections leech away energy that nutritionists say she cannot replace in her twice daily meals of corn-and-bean porridge.
If her diet does not improve, there will be other costs when Wanja goes to school. She likely will become what local primary school headmaster Johnfriend Nyaga calls a "hungry child who is dull, who cannot concentrate." She will join the millions of ill-fed students who drop out of school at a rate that the U.N.'s Educational, Scientific and Cultural Organization (UNESCO) says is higher in Africa than in any region of the world.
This article and the others in this series examine the life offered Wanja, and millions of other mainstream African children like her, on the world's poorest continent -- where in normal, non-famine times, 4 million children under age 5 die every year, where during the past two years a coup or coup attempt occurred nearly every two months, where most rural African families are poorer today than they were a quarter century ago.
It examines the impact on children of Africa's towering foreign debt, its rapidly growing population, its shrinking farmlands, and its chronic violence, all of which conspire to leave the children hungry -- despite strides in agriculture and medicine.
"Children are always the ones who suffer most," says Dr. Arnfried A. Kielmann, a world-renowned specialist in Third World child nutrition. "Kids are the best barometers of the economic and social conditions on a continent. They are the first to die, the first to be neglected, the first to recover if things improve."
Africa has the world's youngest population. Nearly half of the 391 million people in 45 sub-Saharan countries are under 15 years of age, according to the U.N. Children's Fund (UNICEF).
Many more children are on the way. Africa south of the Sahara has the fastest growing population in world history, with a growth rate of 3.2 percent. According to U.N. predictions, the region's population will more than triple within 45 years to about 1.5 billion.
With recent bountiful rains across much of Africa, acute shortages of food now affect only a small percentage of the continent's children, according to UNICEF. Most of them are in parts of Ethiopia and Mozambique and in isolated pockets in a few other countries. The immediate solution for their problems is simple: emergency food.
But for most African children, the cures are not so straightforward as truckloads of wheat.A Search for Reasons
Doctors, nutritionists and social scientists agree that there is no one reason why an estimated 25 to 30 percent of Africa's children are stunted, why school enrollment has declined in many growing countries, or why child mortality in Africa is far higher than in other developing regions of the world.
These specialists say, however, that any attempt to understand why little girls like Wanja N'gang'a are hungry and sick up in the green hills of Kenya must begin with an understanding of the food and financial squeeze affecting most of the continent.
The World Bank's most recent report on the future of sub-Saharan Africa says it is the only region since World War II to have "suffered retrogression over a generation. . . . As a result, low-income Africa is poorer today than in 1960."
While it has been making babies at a record pace and getting poorer at the same time, Africa's per capita food production fell 32 percent in the 1960s and 1970s, according to a UNICEF report on Africa's children.
The U.N. Food and Agriculture Organization says most African countries adopted anti-rural policies that gave farmers little incentive to grow more food than their own families could eat. Instead, these policies lured many farmers, the backbone of poor African economies, to cities. There, they stopped farming and started eating imported food, purchased with over-valued currency and foreign-aid money. In those years, food imports rose 10-fold.
Governments supported their profligacy in the 1970s by borrowing extensively from private western banks (then flush with petrodollars) and from multilateral lending agencies (which directed much of the money into large, prestigious projects). The loans bought airports and factories, sports stadiums, hospitals and highways, universities and many corrupt politicians.
In the 1980s, however, the flow of foreign money all but stopped as petrodollars ran low and investors woke up to Africa's anemic capacity to pay back what it had borrowed. As a result, Africa now has the lowest foreign investment rate of any developing region, a rate too low to "provide for new productive capacity or even to maintain and rehabilitate existing capacity," the World Bank said this spring.The Squeeze on Resources
The debts of the 1970s now are due. Recent outpourings of emergency assistance from the West have not come close to covering the debt-borne flight of hard currency from the continent. While $3 billion in emergency aid flowed into black Africa last year, $12 billion flowed out to foreign creditors, UNICEF says.
What all this dismal high finance means to Africa's 191 million children, according to the World Bank and UNICEF, is that many African governments are choosing to trim spending, pay debts, and discipline their national economies by cutting back in services that prop up the health and education of children and mothers.
While Africa's children probably have never heard of "structural adjustment," millions are feeling its pinch.
Immunization, the most cost-effective way of keeping children alive and healthy, has declined in Zambia, Tanzania, Ghana and Uganda, and has stalled in many other financially strapped African countries, says the World Health Organization. WHO reports that child immunization levels in Africa are the lowest in the world. The agency says only 35 percent of children are immunized against measles, a disease doctors call a "disaster" for even mildly malnourished children.
The most celebrated and, on the surface, the most successful economic adjustment has occurred in Ghana, a West African nation that for 20 years propelled itself into a classic African economic tailspin, complete with near-destruction of the once-lucrative cocoa industry.
In 1983, Ghana began taking the free-market economic medicine prescribed by the International Monetary Fund and the World Bank. Since then, the adjustment package has guaranteed high prices to farmers, boosted exports, slashed inflation and triggered strong economic growth. Ghana's program has been hailed by the West as a "blueprint for Africa."
For some of Ghana's children, however, the program has been a blueprint for death. UNICEF reports that debt repayments and fuel bills have forced drastic cuts in health, education and water supply budgets. Forty percent of the country's water supply systems have broken down for lack of money to buy spare parts, the UNICEF report said. It is estimated that 80 percent of Third World disease is spread by bad water. UNICEF added that schools have inadequate supplies, and hospitals are chronically short of drugs.
"In Ghana, the infant mortality rate, which had steadily declined over the past 15 to 20 years to approximately 100 deaths for every 1,000 live births, now appears to have increased to about 120 to 130 per 1,000," says a recent UNICEF field report. "The rate is as high as 250 per 1,000 in some areas. . . . and probably one-third of all children do not live to the age of five."
Martin Forman, head of the U.S. Agency for International Development's Office of Nutrition in Washington, monitors whether international lending agencies like the IMF are taking child health and nutrition into account in their attempts to rebuild the tottering economies of sub-Saharan Africa. Forman's verdict:
"It is not formally happening . . . While agencies like UNICEF are calling for so-called adjustment with a human face, it hasn't made any difference in the thinking of the people who are pressing for paybacks," he said.
To find out what else is squeezing the children of Africa, one should go to lunch here at the highland farm of Josphat and Madris N'gang'a.
It was 2:30 on a hot weekday afternoon. Wanja N'gang'a, the baby who doesn't look underweight but is, along with her father and five of her older siblings, were sitting down in the shade outside the family's mud-and-thatch hut for their first solid meal of the day.
Wanja climbed onto her mother's lap and was spoon-fed a thick porridge made of corn and beans. With the porridge were some boiled greens, leaves of cow peas that Wanja's mother had picked earlier in the day.
There was nothing nutritionally amiss in Wanja's lunch, according to David Alnwick, a UNICEF nutritionist who monitors feeding projects in 18 countries of eastern and southern Africa.
"It is not that farm kids are getting the wrong food. The balance of nutrients is roughly okay. They are just not getting enough of it," Alnwick says.
The porridge that Wanja ate for lunch, a staple in much of East Africa and the same warmed-up stuff that Wanja would eat for supper, is bulky and low in calories. Alnwick says many children "simply cannot get enough of it into their stomachs" during the typical two meals a day to avoid malnutrition.
"If the mother could feed her children five times a day that would solve the problem," Alnwick says. "But in order for a mother to do this, she must give up something else that might endanger her ability to provide for the family."
Like most African women, Wanja's mother does not have time to feed her kids five times a day.Family Life
Her husband, Josphat N'gang'a, 43, is typical of many African farmers in that he concentrates his attentions on cash crops -- tobacco and coffee -- while his wife takes care of planting, weeding, harvesting and cooking the food that keeps him and his children alive.
The N'gang'a children are luckier than many in Africa because their father lives at home. He says he turns over all the earnings of his cash crops -- about $125 from tobacco last year, he says -- for clothing and school fees for the children.
There is strong evidence across Africa that the workload of many women -- estimated at between 60 and 80 percent of farm work -- and the consequent malnutrition of their children is growing because African men have left home, lured to cities by prospects of high wages.
UNICEF reports in Kenya that "slightly over one-fourth of rural smallholdings are headed by women . . . Male earnings are not automatically -- and in some cases are never -- used for family welfare." Reports from UNICEF officials in Sudan, Uganda, Tanzania, Zambia and Botswana indicate the problem is similar across much of eastern and southern Africa.
The N'gang'a children also have escaped two other major social developments in Africa that have worsened the nutritional status of millions of children in the past two decades.
One is the shrinking size of farms due to rapid population growth. In many parts of Africa, especially Kenya, which has recorded the highest national population growth rate in history (4.1 percent per year), farms are shrinking with the inheritance of each new generation.
The average family in Africa has nearly seven children. In Kenya, the average is eight. In western Kenya, households with 10 to 14 children are common. In some areas, farmers, mostly women, are trying to feed their children on farms that average three-fifths of an acre.
Kenya has been more successful than most countries in Africa in lowering its infant mortality rate, which at 80 deaths per 1,000 live births is still about seven times higher than in the United States. Reasons for Kenya's success include widespread child immunization and strong economic growth throughout much of the past quarter century. In the western part of the country, however, child health is sliding back. Children there appear to be paying a high price for their swelling numbers.
Between 1977 and 1982, the percentage of stunted children in a densely populated district near Lake Victoria nearly doubled, from 20 to 38 percent.
"As farm holding areas decline, without concurrent increases in employment, more households fall below the level at which their own resources can sustain them," according to a report by the Cornell Nutritional Surveillance Program. "It is clear that more and more households in western Kenya must be at increasing risk of malnutrition. . . . "Urbanization's Toll
The rapid growth of cities also has caused the quality of the food many children eat to deteriorate. The U.N. Center for Human Settlements reported this spring that while Africa is the world's least urban region, its cities are growing faster than anywhere else. Twenty years ago there were three African cities with more than one million inhabitants. Now there are 28. The report said urban growth in Africa will accelerate throughout this decade.
Many children in African cities have poorer quality diets and often have more health problems than those who remain in rural areas, according to Dr. Arnfried Kielmann, the Nairobi-based nutritionist and physician. He says mothers often stop breast feeding earlier in cities, children often are left alone or with young siblings while their mothers work, water quality is often worse than in the countryside and the availability of fruits and vegetables is severely limited.
Putting aside the estimated 3 percent of African children who are victims of severe food shortage due to drought or war, UNICEF nutritionist Alnwick concludes: "The nutrition situation for most of Africa's children is bad, and there are lots of reasons to believe it is worse now than ever."
None of this means that Wanja and her siblings -- whose hunger is undramatic, almost invisible -- are hopelessly disadvantaged. Nutritional research has found that only the most severely malnourished children under two years of age, such as some of the stick-like infants of Ethiopia's famine, suffer irreversible brain or organ damage. Researchers across the Third World also agree that growing up stunted, due to the combined effects of hunger and illness, does not in itself damage intellectual potential.
Dr. Ernesto Pollitt, a world-renowned nutrition and child development specialist at the University of Texas, said researchers have been surprised by the capacity of children to bounce back from years of hunger.
But Pollitt and other nutritional scientists who have worked in Africa agree that the hunger of children like Wanja N'gang'a steals the energy they need to concentrate, to play, to learn.
"Early malnutrition and poor nutritional status among students can and will have significant adverse effects over school progress, and contribute significantly to school wastage," concludes Pollitt in a UNESCO paper summarizing scientific findings on nutrition and educational achievement.
When they reach the age of 6, the children of Josphat and Madris go off to school with a breakfast of tea and milk. They do not eat anything solid until 2:30 p.m. They are quiet, passive students.
At school, according to local headmaster Johnfriend Nyaga, "there is something wrong inside the hungry ones. They are not happy. They are not champions."
NEXT: Zimbabwe -- Hunger amid plenty