The Washington PostDemocracy Dies in Darkness

This book on child malnutrition will change the way you think about health interventions

Wearing a dress that celebrates International Women’s Day, Elyse Musandji teaches a community how to produce milk from peanuts in the Democratic Republic of Congo in 2012. (Russell Watkins/ <a href="">Department for International Development</a> )

We try not to pick favorites in the African Politics Summer Reading Spectacular, but I’ve failed this year with this week’s book, “The Riddle of Malnutrition: The Long Arc of Biomedical and Public Health Interventions in Uganda” by historian Jennifer Tappan.

Why was it my favorite? I’ve learned a lot and enjoyed reading all of the books in this summer’s series. But Tappan’s excellent and deeply researched book reads almost like a novel: At the end of each chapter, I needed to keep going to learn what happened next.

Tappan’s book is part of Ohio University Press’s “Perspectives on Global Health” series. In a post asking what Africans actually think about public health interventions from afar, we featured two books from the series last summer: Melissa Graboyes’s “The Experiment Must Continue” and Lydia Boyd’s “Preaching Prevention.” Like these earlier books in Ohio’s series, Tappan’s is an accessible book that studies an important public health intervention: childhood malnutrition.

Millions of children around the world continue to suffer from malnutrition. In her book, Tappan shares the grim statistic that in 2011, undernutrition accounted for over 3 million deaths in children under the age of 5 — accounting for 45 percent of worldwide infant and child mortality. Tappan’s book is a history of responses to malnutrition, but its implications are important today, especially as 20 million people are at risk of starving to death.

“The Riddle of Malnutrition” traces childhood malnutrition — and responses to it — in Uganda for over a half century. Tappan examined archival material, including the personal papers of doctors who worked on childhood malnutrition in Uganda in the early post-colonial period. She also interviewed Ugandan and expatriate scientists and physicians who worked on malnutrition. These materials drive the human story Tappan tells of response to childhood malnutrition that government reports and scientific articles omit.

Tappan also conducted oral histories with elderly men and women who lived in an area surrounding the Luteete Health Center, the first rural extension of Africa’s first nutrition rehabilitation program, Mwanamugimu. (Mwanamugimu is the first word in a Luganda proverb, Mwanamugimu ava ku ngozi, which Tappan translated as “A healthy child comes from a healthy mother.”) These elderly respondents reflected on their memories of the Mwanamugimu program as it was experienced by communities the program intended to benefit.

Tappan provides important details about the broader Ugandan political context as she outlines the evolution of response to childhood malnutrition. For example, she writes about a scientific debate in the colonial period questioning whether childhood malnutrition in Africa was due to a protein or mineral deficiency. While this debate may seem technical on its surface — it also has a political dimension: It is one thing for children in British colonies to have a diet lacking in newly discovered vitamins or minerals but it was something completely different for those children to have a diet deficient in one of the major food groups. As Tappan writes, “Protein malnutrition pointed to the poverty of colonial populations.”

Ultimately, Tappan’s book offers an exemplar case of health intervention. While she documents many of the serious blunders undertaken in the name of improving children’s health, she also documents how the Mwanamugimu program came to be successful. She is not overt in connecting Mwanamugimu’s successes to the shift in seeing malnutrition as a disease to seeing it as a preventable condition and to Mwanamugimu’s involvement of the community in designing and implementing programming. But Tappan’s mass of evidence and clear writing make it difficult to miss that connection.

This book could change the way you think about health interventions. The period in Uganda when (predominantly Western) scientists and doctors were looking for a magic bullet to deal with childhood malnutrition was not just frightening for children and their parents — it was deadly. When researchers and health providers changed their approach to combine the promise of biomedical advances with locally appropriate feeding practices, perceptions of Mwanamugimu changed.

Even through periods of political violence and waning donor support, Mwanamugimu persisted. Tappan writes, “The nutritional rehabilitation program became a truly local and sustainable public health initiative, dependent on local adoption and advocacy more than on national institutions and international donor funds.” Her history of response to childhood malnutrition is an important reminder for those who design health interventions — especially from afar.