How giving every child basic nutrition may provide a starting point for tackling Africa’s other challenges..

Reuben Kyama | Sept/Oct 2009 issue

 
Touching down in Eldoret, a rural town about 185 miles (300 kilometers) from Nairobi near the Ugandan border in western Kenya, everything seemed calm and peaceful. The countryside is lush; indeed, most of the residents are farmers, growing wheat, coffee and tea as well as rearing dairy cattle. Suddenly, there was a commotion outside the airport and a loud, rhythmic chanting started. It turned out to be for Selina Kosgei, the runner from Eldoret who recently won the Boston Marathon. She’d just returned home and was greeted by a throng of supporters.
Kosgei is one of the few things the people of Eldoret have to celebrate. In January of last year, violence erupted in Eldoret and throughout Kenya after disputed elections. In Eldoret alone, hundreds of people were killed in tribal skirmishes, while thousands of others were displaced. Howard Schiffer had come to Eldoret to fight another killer: malnutrition. As founder and president of the non-profit Vitamin Angels, Schiffer has so far helped distribute 400 million nutritional supplements to needy children in more than 40 countries. Schiffer and other Vitamin Angels staff members had traveled to this remote Kenyan town to launch Thrive to Five, a program that provides daily doses of essential supplements to local people, especially children. “Essential nutrients save lives,” says Schiffer, a tall, bespectacled man who has been involved with nutrition for more than 30 years. “It is measurable, it is scalable and we don’t need to spend a penny on research or 10 years trying to find the cure. We only need to make the decision that these children are worth it.”
Schiffer’s philosophy, and the guiding principle behind Vitamin Angels, is that vitamins and other nutritional supplements are crucial to the health of young children and pregnant and lactating mothers. Supplements containing selected vitamins and nutrients—particularly vitamin A, iron, iodine, folate and zinc—mitigate the effects of undernutrition and malnutrition, Schiffer says, and dramatically reduce the likelihood of low-birth-weight babies. Low birth weight is a key indicator of chronic malnutrition, and low-birth-weight infants are at greater risk of dying from simple infections and common childhood illnesses. According to the British medical journal The Lancet, chronic malnutrition is responsible for a third of all maternal and child deaths every year.
Schiffer’s approach to the problem is backed by the World Bank, which argued in a 2006 report: “Investments in micronutrients have greater returns than those in trade liberalization, malaria, water or sanitation. No other technology offers as large an opportunity to improve lives at such a low cost and in such a short time.” An example of how effective supplements can be, Schiffer says, is that two vitamin A capsules given to a child every year increase survival rates by 23 percent. Schiffer hopes the Thrive to Five program will help children under 5 not just survive but thrive, both physically and cognitively.
And Kenyan kids need all the help they can get. Infant and maternal mortality rates in Kenya are among the highest in the world. Of the country’s 37 million inhabitants, some 58 percent live on less than $1 a day. Tourists wonder at Kenya’s spectacular wildlife and stunning beaches, but most Kenyans are subsistence farmers with no running water, electricity, reliable transport or proper food. Diseases that are all but eradicated in the West—spina bifida, malaria, TB—kill about 2 million Kenyans a year altogether. About 300 people, predominantly children and adults under 35, die of AIDS every day. In the past 20 years, life expectancy has dropped from 54 to 47.

Schiffer started his career as a midwife, becoming involved in childbirth education, maternal health and the homebirth movement. That led him into the natural products industry. But after 14 years and a fair amount of commercial success, “I was honestly bored,” he says. “I kept thinking, There has got to be something else I could do with all of these connections.” He launched Vitamin Angels in 1994.
Vitamin Angels‘ standard operating procedure is to “find organizations within a country that are doing good and help them do better,” says Schiffer. Vitamin Angels piggybacks on other educational or maternal and child health projects in a given country and adds a nutritional component. Vitamin Angels staff members then work with the partner organizations to distribute the vitamins. This keeps costs low and logistics efficient. The cost for vitamin A supplements, including everything from transport to education to administration, is 25 cents a child per year.
At Alupe Hospital in the Teso North district of western Kenya, where Vitamin Angels is also active, emaciated pregnant women cram into a tiny maternity ward. A single nurse tends to them. Mary Goretti Amoit, a 19-year-old primary school dropout, is among the patients. Pregnant with her first baby, she’s being treated for chronic malnutrition. Her husband is a casual laborer who hardly earns enough for medical care. “At home, we don’t have enough money to get the kind of food a pregnant mother is required to eat,” Amoit says. “We just survive.”
Most of the inhabitants of this hilly, semi-arid and sparsely populated region are nomads. They move from place to place tending their cattle, goats and sheep, always in search of water. Poverty is widespread. Most girls marry in their early teens. Very few, if any, make it to secondary school.
Lydia Anyokort, 15, has just had her first child, a boy delivered by Caesarian section. Caesarians are common here; malnutrition can make it difficult to carry a baby to term. “I was in school and had to drop out when I realized I was pregnant,” Lydia says. Lydia’s 40-year-old mother, who has 10 other children, sits by her bedside. “It means I have to take care of her little son, then send her back to school,” she adds. “We live by the grace of God. We can’t afford a decent meal. That’s why we always appreciate the vitamin supplements.”
Vitamin Angels serves some 10 million needy children and mothers worldwide. Next year, Schiffer wants to reach 15 million or more. “I want to get past vitamin deficiency diseases and start reaching women pre-conception, so the day children are born they have the opportunity to reach their full intellectual and structural capacity,” he says. “We don’t get to choose when a disaster will strike but we always get to choose how we will respond. We have it within our sights to see extreme poverty, malaria, TB, vitamin A deficiency and chronic malnutrition eliminated.”
Kenya, and Africa as a whole, has a lot of problems. Schiffer is trying to fix just this one—malnutrition—in the hope that this will provide a starting point for tackling the continent’s other challenges. If Schiffer could write a global constitution for children, he says, it would start with, “Every child has a right to basic nutrition.” Thanks in part to Vitamin Angels, that truth is starting to become self-evident.
Reuben Kyama is a journalist based in Nairobi, Kenya.