Globally, we have made significant progress in reducing child mortality and increasing school enrollment. The deaths of children under age five declined from circa 12 million to less than 7 million between 1990 and 2011. Similarly, the number of children enrolled in primary school is up by 40 million worldwide.
However, if unchecked a lack of investment in early childhood development could erode these gains. And President Yoweri Museveni gets it! In the foreword to Uganda’s Nutrition Action Plan, Museveni writes, “Malnutrition affects millions of Ugandans in various ways, but it is particularly devastating to women, babies, and children. Malnutrition also impairs educational achievements and economic productivity, costing the government and families enormous amounts of money to treat related illnesses”.
About 40 percent of children in sub-Saharan Africa are stunted. Stunted children often endure painful and debilitating cycles of illness, depressed appetite, insufficient food and inadequate care. Children who survive carry long-term deficits in cognitive capacity. Stunting is a devastating early-life growth failure.
A recent study reported by Save the Children shows that compared with normal children, stunted children: score 7 percent lower on math tests; are 19 percent less likely to be able to read a simple sentence at age 8, and 12 percent less likely able to write a simple sentence; and, are 13 percent less likely to be able to be in the appropriate grade for their age at school.
In a survey of 350,000 children in Kenya Uganda and Tanzania, Uwezo, an education advocacy organization found that 2 out of every 3 children in grade 3 failed to pass basic tests in English, Kiswahili or numeracy set at the level of grade 2. The study also revealed that children from poor households perform worse on all tests at all ages.
Invariably, children are the most visible victims of undernutrition. Undernutrition magnifies the effect of every disease, including measles and malaria. The estimated proportions of deaths in which malnutrition is an underlying cause are roughly similar to diarrhea (61 percent), malaria (52 percent), pneumonia (52 percent) and measles (45 percent). Malnutrition can also be caused by diarrhea, which reduces the body’s ability to convert food into useable nutrients.
Malnutrition, as measured by stunting affects nearly 40 percent of children in Africa. In many cases their plight began even before birth, with a malnourished mother. Under nutrition among pregnant women in developing countries leads to 1 out of 6 infants born with low birth weight. This is not only a risk factor for neonatal deaths but also causes learning disabilities, mental retardation, poor health, blindness and premature deaths.
Extensive epidemiologic studies have suggested that adult disease risk is associated with adverse environmental conditions early in development. The molecular basis for these apparently non-genetic trans-generation effects is not known. One hypothesis is that it involves epigenetics. Epigenetics is the process by which patterns of gene expression are modified in a heritable manner by mechanisms that do not involve alterations in gene sequence.
The Dutch Hunger Winter provides developmental biologists a rare opportunity for understanding differences associated with prenatal exposure to adverse environmental conditions. The Dutch Hunger Winter was occasioned by the German imposed food embargo in the western part of The Netherlands close to the end of the World War II in the winter of 1944-45. Studies have shown that Dutch babies whose mothers were exposed to famine during early gestation grew up to have higher rates of obesity than those born before or after the famine.
Hundreds of millions of hungry mothers in Africa live on less than 400–800 calories per day, equivalent to the rations Germans limited the Dutch to. Recent estimates show that the number of hungry people in Africa grew from 175 million to 239. Nearly one in four people are hungry in Africa.
Given the prevalence of poverty, hunger and malnutrition it is highly likely that a majority of children entering school have critical early-life growth failure, which constrains learning ability and hence their potential to be healthy and economically productive citizens. Studies estimate that early-life growth failure could lead to earning deficits of up to 66 percent in adulthood.
Programs like free primary education must go hand in hand with robust interventions in early childhood development to forestall early-growth failure. And there is such a thing as quality of citizens and our country ranks very low.