Jeanette is five years old but unnaturally tiny for her age. A year ago, she could not stand, play with other children, eat solids or talk. The thin monotonous wail that convulsed her scrawny frame drove her mother, Esperance, to desperation.
"I desperately feared that she might die," says the 45-year-old. "Her hair color changed. It turned orange."
Jeanette was suffering from kwashiorkor, a micronutrient deficiency that causes swelling in the hands and feet, tooth loss, distinctive rust-colored hair and a painfully distended belly. Her mother had reason to dread the worst. Left untreated, kwashiorkor can whittle a child away to practically nothing.
Esperance lost her eldest son in the 1994 genocide, but she believes that starvation -- not violence -- remains Rwanda's foe. "Malnutrition is the most dangerous because it kills unhurriedly," she says.
But malnutrition doesn't only kill, it stunts. If Jeanette is any indication, it isn't hard to see why. At the age of four, she weighed a mere 22 pounds. Today she is doing better but is short, spindly and developmentally lagging for her years. Even though she and her family are now receiving food aid, her long-term prospects remain ambiguous.
Although she has survived the worst, the little girl must now contend with the long-term consequences of prolonged malnutrition. These include poor motor and cognitive skills, anemia and an increased susceptibility to disease and chronic fatigue. Because her immune system is so damaged, vaccines are far less likely to be effective. This in turn increases the likelihood of developing a life-threatening infection.
Jeanette has plenty of company. According to UNICEF, as many as 200 million children under the age of five suffer from malnutrition. Recent data also shows that 130 million children are underweight. Twenty-four countries account for more than 80 per cent of the global burden of stunting, while low birth weight contributes to 60 per cent of all neonatal deaths.
Perhaps the only thing more tragic than the losses of these children and the diminishing of their potential is the fact that malnutrition is preventable. However, the political will to address this issue is often as anemic as the children themselves. Committed, long-term investment is critical.
According to Mariana Stephens, nutrition adviser for World Vision's Food Programming Management Group (FPMG), most donor and national budget allocations are earmarked for programs that last between 12 months and three years. "We need commitments of between five and 10 years. Only then can we measure a noticeable impact on stunting rates."
The potential impact is also notable in economic terms. In 2008, a panel of leading economists -- among them a handful of Nobel Laureates -- signed the Copenhagen Consensus, which highlighted nutritional programming as the best development investment based purely on a cost/benefit ratio of one to 100.
Each dollar spent on micronutrient programs targeting children aged less than two years means gains of more than $17 in terms of fewer deaths, better health and increased future earnings.
Although the benefits of nutritional programming take awhile to manifest, results can be startling. A recent study conducted in Guatemala by World Vision revealed that boys who received highly nutritious food supplements from birth to up to two years of age earn an estimated $0.67 per hour more than more disadvantaged peers -- an average wage increase of 46 per cent. According to the World Bank, eliminating childhood anemia in the worst-affected countries can result in a 5-7 percent increase in adult productivity, which in turn can nudge GDP up by 2 percent.
Last week, the United Nations General Assembly is meeting to discuss the Millennium Development Goals, including the goal to "eradicate extreme poverty and hunger" and "reduce child mortality." The international community is behind in reaching these goals and may not meet its deadline of 2015. If the lives of these individual children aren't sufficient motivation to muster the necessary political will, one can only hope that the economic benefits of a strong and healthy workforce will be.