“The success the world has had in protecting children’€™s rights and realising human potential is captured far more eloquently in flesh and bone than in concrete or steel, far more tellingly in the height of children than that of skyscrapers.”

These words are contained in the introduction of a Unicef report “The Progress of the Nations”, which reveals that 40% of children under age five in sub-Saharan Africa are stunted.

“Stunting does not come easy. It happens over time, and means that a child has endured painful and delibitating cycles of illness, depressed appetite, insufficient food and inadequate care,” the report said.

Many children do not survive such rigours, while many of those who do survive carry long-term deficits in mental capacity along with losses in stature.

Low weight at birth, insufficient feeding, inadequate care and nutrient depletion caused by repeated bouts of illness culminate over time in a child whose height is less than that of other children of the same age.

Such stunting is a standard marker of failure in early growth.

Deprivations in feeding and care that impair growth in the critical first years may also reduce a child’€™s cognitive development and learning ability, often leading to poor school performance and dropping out.

Some 39% of children under five in the developing world are stunted ‘€“ around 209 million children, with stunting rates highest in Asia and sub-Saharan Africa.

Inadequate feeding and repeated illness are the immediate causes of stunting in the young child. This vicious cycle is the result of poverty and the consequent inability of families to adequately care for their children.

A lack of clean water in a poor community, or a long distance between home and health clinic, for example, affects the level of care that can be given.

Stunting also occurs when babies are born underweight because the mother was poorly nourished or stunted.

Once established, stunting and its effects typically become permanent. Stunted children may never regain the height lost and most will never gain the corresponding weight. And when the window of early childhood is closed, the associated cognitive damage is often irreversible.

According to Dr Eva Perez of the Child Health Unit at the University of Cape Town, chronic rather than severe malnutrition is fairly common in South Africa.

“We find that the children usually don’€™t catch up (growth), achieve poor results in school, exhibit behavioral problems and usually come from poor families.”

Perez said researchers were increasingly investigating the possible link between malnutrition, poverty and the child’€™s relationship with the mother.

“Studies in the United States found that children who were severely malnourished performed well after being adopted. It was also found that malnourished babies that are massaged put on more weight,” she said.

Dorothy van der Spuy, head of the Dietetics Department at the Red Cross Children’€™s Hospital, said malnutrition affected brain growth in the very early stages.

Early studies revealed that the brain of a malnourished child was smaller than that of a healthy child. The malnourished child’s brain weight was lighter as it had less cells and a lower protein content.

“At that stage it was thought that these factors may affect later development, but that is being questioned increasingly. The question of catch-up is now being debated,” Van der Spuy said.

Verbal and non-verbal development could be affected as well as eye and hand co-ordination and visual-motor development.

But there is some glimmer of hope on the horizon.

A simple, cost-effective intervention has seen a huge decrease in the death rates of malnourished children in the Eastern Cape.

The “ten steps for recovery” protocol, designed by the World Health Organisation (WHO), has seen a dramatic drop in the mortality rate of malnourished children admitted to Mary Theresa (Mt Frere) and Sipetu Hospitals, located in one of the most under-resourced regions in South Africa.

Before the project started in 1998, Sipetu had a fatality rate of 28%, while at Mary Theresa Hospital it was 38%. With the WHO programme these numbers have been halved.

“The children were dying like flies,” said Nomthandazo Mdingazwe, the nurse in charge of Sipetu’€™s paediatric ward.

“There were huge staff shortages at night. You resuscitate a child if there is time, otherwise you just console the mother later,” she said.

A recent review found that many health services worldwide used discredited practices and that staff were unfamiliar with modern, effective guidelines for the management of severe malnutrition.

South Africa is considering enriching staple foods such as maize meal, bread flour and possibly sugar following the finding of a health department survey that one in five children between the ages of one and nine years is stunted. New laws could set minimum levels of vitamins to be added to staple foods.- Health-e News Service.