One in every five children in Kenya has irreversible damage to their growing brain, affecting their ability to do well in school and earn a good living, making it harder for the child and their family to rise out of poverty.
This is the harsh reality staring at the children who can never learn or grow like their peers because they lacked proper nutrition during the first 1,000 days of their life.
The first 1,000 days — the period between conception and a child’s second birthday — are crucial and it turns out the greatest barrier to college education or higher wages and social mobility is not high school fees, but the skills children have before they first enter kindergarten. As per the concept conceptualised by the World Health Organisation (WHO), the first 1,000 days of a baby’s life are categorised into three stages: The 270 days of pregnancy, 365 days of baby’s first year and 365 days of baby’s second year.
According to Unicef, lack of iron is the most common nutritional deficiency in the world and women who are pregnant need to take folic acid, which is essential for proper physical and neural development of a foetus.
A report published in the journal Paediatrics says maternal iron deficiency or conditions that increase foetal iron demand (such as maternal diabetes) may lead to newborn iron deficiency and associated long-term cognitive deficits.
Foundation for Brain Development and Learning reveals that during the first 1,000 days, the baby’s brain grows more quickly than at any other time in a person’s life. Therefore, a child needs the right nutrients at the right time to feed his/her brain’s rapid development.
Dr Thomas Ngwiri, chairperson of the Kenya Paediatrics Association, agrees, saying that getting children into school has long been a gauge of successful development. But, ensuring brain development in the first 1,000 days so children are actually capable of learning once they get to school, has been largely ignored.
He adds that when a mother fails to offer a child the proper diet, then they are automatically set back not only on physical health, but also intellectual growth. “These 1,000 days have a long-term effect on the growth and development of a child. Mothers need to pursue a balanced diet before conception, during the pregnancy and when the child is lactating to ensure that they start off well,” he says.
Dr Ngwiri adds that the foundations for optimum health and development across the lifespan are established during the two years and that the right nutrition and care during the 1,000-day window determines not only whether the child will survive, but also his or her ability to live a successful life. “Given the statistics, then you can see that it contributes to society’s long-term health, stability and prosperity,” he says.
When parents fail during this time, it causes irreversible damage because the children will never meet height averages that match their age, will have brain damage that causes issues such as low IQ, and illness later in life.
The world’s greatest unexploited resource, he says, is not oil or gold, but the minds of hungry children.
So crucial is this diet for children that missing out on the recommended nutrition, according to WHO, leads to stunting, wasting and malnourishment.
Globally, stunting is now recognised as the main indicator of malnutrition because it shows long-term, cumulative effects of inadequate nutrition and poor health status, thus, it gives a broad representation of the nutritional status of a country. Despite this, malnourished children are not a priority, so children are stunted in ways that will hold back the country for many decades to come.
Dr Bernard Thuo, a nutrition officer, says stunting is preventable by employing good feeding practices such as exclusive breastfeeding and complementary feeding during a child’s first two years of life. He says once a child is identified as not having met height averages that match their age, it results in brain damage.
“The cognitive development, performance and productivity of a child in school will not be optimal if stunting is not identified and corrected before they turn two. Once a child is screened for malnutrition and promptly helped with supplements, it can be reversed before 1,000 days,” he says.
Dr Thuo adds that fortifying foods with iron, zinc, iodine and vitamin A is transformative.
That stunting affects a child’s performance in school is reiterated by WHO which states that on average, stunted children lose between six and 10 IQ points and miss approximately a year of school as the result of sickness.
“Children experience more sicknesses such as pneumonia and diarrhoea from extended malnutrition, as well as being more likely to die of severe illness from a weakened immune system,” says WHO.
Later in life, affected children are more likely to suffer from chronic diseases such as hypertension. They also earn lower wages, earning around one-fifth less than their non-stunted peers, says WHO.
The nutritional tragedy in the country is the biggest obstacle and the first 1,000 days pose the greatest inequality.
At a time when fancy foods are available, studies show that there is hidden hunger: A form of malnutrition caused by a lack of vitamins and minerals in the diet such as vitamin A, iron, zinc, folic acid and iodine.
Dr Rahma Hassan, a paediatrician, says there are key players in hidden hunger that could lead to malnourished children especially in the first 1,000 days. She says children who do not have enough iron in their lives, for example, end up being slower because the lack of these minerals makes it hard to achieve their physical and mental potential.
“Because we need these essential nutrients in small amounts, they are called micronutrients. At very little cost, micronutrients can be added to staple foods such as rice, oil and wheat or maize flour, as well as condiments, such as salt,” she says.
She adds that when children fail to get enough iron in their food, they are slower to acquire language, struggle with short-term memory, have poor attention spans and ultimately don’t do as well as their peers in school.
Globally, an estimated 47 per cent (293 million) of all preschool-aged children and 42 per cent (56 million) of all pregnant women are anaemic, and approximately half of these cases are attributable to iron deficiency, says Unicef.
Once a baby is born all health practitioners advise exclusive breastfeeding since it provides nutrients, growth factors and types of cells not found in infant formula. In Kenya, 61.4 per cent of infants under six months are exclusively breastfed.
Dr Thuo says a mother’s milk is often sufficient for the child until six months when the development of the baby depends on the body getting all the nutritional building blocks it needs. “During this time, mothers are advised to provide an alternative to breast milk and not just focus on one type of food. The type of foods introduced to the child at six months must include at least six food groups,” he says.
The food suggested by Unicef includes whole grains, fruits, vegetables, pulses, eggs and chicken soup to provide proteins, vitamins, minerals and carbohydrates.
Dr Ngwiri says at this point it is important to consult a professional who will advise you in order to ensure proper development of the baby’s bones. “When mothers visit clinics, they should ask what more they can do and what is needed for the proper development of bones and to avoid the risk of rickets in babies,” he says.
Kenya still experiences a malnutrition burden among its under-five population. The national prevalence of under-five overweight is 4.1 per cent. The national prevalence of under-five stunting is 26.2 per cent, which is greater than the developing country average of 25 per cent. Conversely, Kenya’s under-five wasting prevalence of 4.2 per cent is less than the developing country average of 8.9 per cent.
Stunting levels are higher among boys (30 per cent) than girls (22 per cent) and higher among children whose mothers reported they were very small at birth (43 per cent) than among those who were average or larger at birth (24 per cent).
Among rural children, stunting is higher at 29 per cent than urban children (20 per cent). At the regional level, Coast (31 per cent), Rift Valley and Eastern (each 30 per cent) have the highest number of stunted children, while Nairobi (17 per cent) and Central (18 per cent) have the lowest.
Stunting in children generally decreases with education of the mother, according to reports. Children of mothers who did not complete primary school (34 per cent) or who have no education (31 per cent) are more likely to be stunted than children of mothers with a secondary or higher education (17 per cent).
According to Unicef, at least 200 million children in developing countries fail to meet their developmental potential. While there are other factors that can be attributed to this such as infectious diseases, environmental hazards and violence, under-nutrition is the one aspect that can be controlled.