September 20, 2010 | By Roger Thurow

For a Better Tomorrow

In Rwanda earlier this summer, I visited a rural project with the lyrical name, IBYIRINGIRO.  It means “hope” in Kinyarwanda, and trumpets this slogan: “that in which we have faith for a better tomorrow.”

The “that” in which Ibyiringiro puts its faith is better nutrition.  Better nutrition for a better tomorrow.  It is a message carried by neighborhood health workers and put into practice through community-based nutrition education, the promotion of vegetable gardens and cooking demonstrations that draw big, curious crowds.  It began as a program for people living with HIV/AIDS, but the Ibyiringiro philosophy spreads through entire communities.

“We were finding households with enough food but the children were malnourished,” said Erisa Mutabazi, the manager of the Ibyiringiro project for World Vision in Rwanda.  “They might have a lot of food, but they didn’t know how to balance it.  They would eat only one type of food during a season.”

“More often than not here,” he said, “food insecurity is not caused by lack of food but poor utilization of available food.”

This important revelation will appropriately be at the center of next week’s deliberations on reducing poverty and hunger when the United Nations’ examines the progress – or lack of it – on achieving the Millennium Development Goals by the target date of 2015.  It will particularly be the focus of Tuesday’s special U.S.-Irish initiative to highlight undernutrition as one of the world’s most serious but least addressed problems.

That event, hosted by U.S. Secretary of State Hillary Clinton and Ireland’s Minister for Foreign Affairs, Micheal Martin, will launch “1000 Days: Change a Life, Change the Future – Partnering to Reduce Child Undernutrition.”  It is intended to lead a movement to improve child nutrition through programs targeted at the 1,000 days window of opportunity beginning with a woman’s pregnancy and continuing until a child is two years old.

These early days of a child’s development are crucial in combating physical and mental stunting.  Development agencies have built an amazing network of school feeding programs in the poorest countries; these programs ensure that school-aged children get at least one hot meal a day, and they provide encouragement for parents to enroll their children in school and incentive to local farmers to grow food for the school meals.  But nutrition programs for pre-school children have been less widely developed.

The malnutrition that results from a lack of vital micronutrients – vitamin A, iron, zinc and many, many others – is often called Hidden Hunger, because it may not be manifested so clearly as hunger from a lack of food.  Still, this Hidden Hunger has left 150 million children under the age of five stunted from malnourishment, which means they likely never will reach their full potential, physically or mentally.

Global map of stunting in children under 5 years of age

Global map of anemia prevalence in pregnant women

Part of the hidden nature of malnourishment is that it is often overlooked in the talk of food security.  The emphasis has usually been on boosting production of food, not necessarily on improving the nutrition of that food as well.  Unfortunately, food and nutrition have often been decoupled: food being the realm of ministries of agriculture; nutrition the realm of ministries of health.

This separation hindered the treatment of HIV/AIDS in Africa; the continent sits at the deadly crossroads of the highest prevalence of AIDS and the highest prevalence of chronic hunger.  The early efforts to combat AIDS focused on the need to get affordable medicine into Africa; the provision of nutritious food to compliment the medicine was nowhere to be found in the international AIDS treatment protocol.  That only began to change when doctors in the field (most notably in the AMPATH program in Kenya, which is featured in our book ENOUGH) began noticing that some patients weren’t responding as well as they should to the HIV/AIDS medicine.  It turned out they didn’t have enough food to eat; unable to work their fields, isolated from their families, they were chronically hungry.

African ministers of health appealed to international donors to begin funding food and nutrition programs as well as supplying medicine.  They argued that giving such drugs to hungry people was like washing your hands and then drying them in the dirt.  What good did it do?

In the past couple of years, nutrition has become an important component of HIV/AIDS treatment.

Likewise, in all the attention on food security, an increase in food production won’t be victory enough.  There must also be improvement in the variety of crops, and the nutritional value of the food, as well.

This dual necessity is at the heart of Ibyiringiro.  The program is funded by the U.S. Agency for International Development and PEPFAR (the President’s Emergency Plan for AIDS Relief begun by President George W. Bush) and implemented by a consortium of humanitarian agencies including Catholic Relief Services, World Vision, Africare, ACDI/VOCA and Adventist Development and Relief Agency.

Some of these agencies were monitoring child growth patterns five years ago and found that malnutrition rates were running up to 45% among children under five in the area.

“It was a shock to see families that were food secure but still malnourished,” said World Vision’s Mutabazi.  “Traditionally they just ate beans or potatoes.  We would look in the houses and they would have carrots, onions, other vegetables, but they wouldn’t eat them.  They would sell them.”

In Ibyiringiro, they beseech the farmers not to sell all the vegetables, but to keep a variety of their crops in stock and eat them through the year, mixing them with the staples.  They teach a new technique of growing a variety of vegetables on a small piece of land near the house, called bio-intensive gardening.  And they organize cooking classes, about how to mix vegetables with the staple foods, and the importance of adding fish and other proteins to the diet.  The malnutrition rate among children in the area has fallen to 12%.

The day I visited, villagers gathered under a mango tree for a cooking demonstration.  The instructors displayed photos of various vegetables and their nutritional components.  In a big bowl, they mixed bananas, beans, sweet potatoes, cassava, collard greens, peanuts and vegetable oil.  It was the day’s lunch, served with tiny sardine-like fish from the local lakes.  For dessert there was pineapple, papaya and mango, all of which grow wild in the area.

How’s it taste?, I asked the group.

“Delicious,” came a loud chorus.

“I used to just make potatoes.  They are filling.  I didn’t know what was nutritious,” volunteered one woman.  “I didn’t understand.  I thought every type of food had all the nutrition.”

Not far from the mango tree, Frank Bitwayiki showed off his little garden right beside his mud-brick house.  He was growing onions, eggplant, carrots and cale.

“I never ate vegetables with regularity,” he said.  “I never planted any.”  He grew the staple crops: beans, potatoes, maize, cassava.  And he would rarely pick any of the tomatoes, onions and peppers that would grow wild in the fields.  When the Ibyiringiro instructors first came to his village to talk about gardens, he wasn’t interested.  “I thought it was a waste of time,” Frank said.

Then three years ago he planted his first garden and he grew convinced about the importance of vegetables as he saw his family’s health improve.  He says his two children, eight and five years old, have grown strong with more nutritious diets.

Do they like vegetables?

“Yes, very much,” Frank said, smiling broadly.

He is the president of the community association, and he leads by example.  He reported that of the 246 members, 170 have followed him in starting a kitchen garden.

The name of the association is “Let’s Look Forward.”


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Outrage and Inspire with Roger Thurow - Am I About to Lose My Second Child, Too?

The latest podcast in our ongoing series with Roger Thurow. Hear how even the best nutrition projects can be undermined by bad water, poor sanitation and hygiene, and lousy infrastructure.  From northern Uganda, we hear a mother’s agony when her healthy, robust child suddenly falls ill after a few sips of water…unclean water, it turned out.

Roger Thurow on SDG 2.2

Roger Thurow sat down with Farming First to talk about the individual and societal consequences of malnutrition. 




Digital Preview of The First 1,000 Days

In his new book, The First 1,000 Days, Council senior fellow Roger Thurow illuminates the 1,000 Days initiative to end early childhood malnutrition through the compelling stories of new mothers in Uganda, India, Guatemala, and Chicago. Get a first-look at photos and stories from the book in this new web interactive.

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» Order your copy of the book.


The First 1,000 Days

Roger Thurow’s book will tell the story of the vital importance of proper nutrition and health care in the 1,000 days window from the beginning of a woman’s pregnancy to her child’s second birthday.

The 1,000 days period is the crucial period of development, when malnutrition can have severe life-long impacts on the individual, the family and society as a whole. Nutritional deficiencies that occur during this time are often overlooked, resulting in a hidden hunger. It is a problem of great human and economic dimensions, impacting rich and poor countries alike.

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The Last Hunger Season

In The Last Hunger Season, the intimate dramas of the farmers' lives unfold amidst growing awareness that to feed the world's growing population, food production must double by 2050. How will the farmers, Africa, and a hungrier world deal with issues of water usage, land ownership, foreign investment, corruption, GMO's, the changing role of women, and the politics of foreign aid?

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Roger Thurow and Scott Kilman, award-winning writers on Africa, development, and agriculture, see famine as the result of bad policies spanning the political spectrum. In this compelling investigative narrative, they explain through vivid human stories how the agricultural revolutions that transformed Asia and Latin America stopped short in Africa, and how our sometimes well-intentioned strategies—alternating with ignorance and neglect—have conspired to keep the world’s poorest people hungry and unable to feed themselves.

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