Can new maize variety tame Kwashiorkor in Africa?

BY DR. NELLY M’MBOGA
Published April 19, 2010

Last week I travelled to the United States of America to publicize my book, “A HEALTHY YOU: Tame Africa’s Child Malnutrition.” The programme involved a presentation of the book, explaining why I had written it, followed by a reading of excerpts from the book. This was followed by a discussion and questions. On my return to the Kibera clinic, we spared an afternoon for a discussion of my presentation with the clinic staff and interested members of the public. We had chosen Friday afternoon, and fliers were duly sent out to advertise the event. On the appointed day, I spoke to the Kibera audience about the American presentation:

“My presentation went smoothly. Americans were fascinated by the fact that in this day and age, people still consider that certain common diseases were attributed to ‘witchcraft’ or ‘taboos.’ I was asked two other questions: why does Western Kenya still grow predominantly white hybrid maize when better varieties of maize are available for consumption? The questioner then went on to educate me on the favorable qualities of ‘quality protein maize’ (QPM).

“According to her, studies in several centers have shown that QPM has almost twice the amount of protein as normal maize. And community studies done in Ghana (among other centers) had shown that children fed predominantly on QPM over a one year period had fewer illnesses, including fewer diarrheal episodes. They had better growth, including a reduction in stunting (growth failure in children is similar to ‘wasting’ in adults), a condition that is common in pre-schoolers.

“The next question that I was asked was why the ‘lake people’ (communities around Lake Victoria, a fresh water lake) have been documented for decades now to have a high burden protein of malnutrition in spite of the ready availability of fish. In Kenya, an example is often given of Busia District, where infant mortality approaches 200 per 1000 live births. What this means is that for every 1,000  children born alive, 200 die in their first year. This compares poorly to other districts, which post a figure of 50 to 70 deaths. When other causes of under-five deaths are added, it is evident that some populations are at risk of dying off.

“Before I address these two questions, let’s first revisit the cause of kwashiorkor. Kwashiorkor was first described in a Ghanaian child in 1935 as ‘the disease the deposed child gets after stopping mother’s milk.’ This description later came to be known as ‘protein energy malnutrition’ (PEM). What this description does not include is an acknowledgment of the micronutrients that are rich in breast milk for example, vitamins, minerals and trace elements. A child with protein malnutrition will therefore fair better on mother’s milk, but will not thrive on cow’s milk or formula which are poor sources of micronutrients.

“The reasons why a majority of Sub-Saharan Africans like to consume white hybrid maize (even when alternatives are offered) are discussed in my second book. When dealing with children who subsist predominantly on this hybrid maize, there are two main reasons why we must pay attention to their micronutrient needs:
1. White hybrid maize is a poor source of many micronutrients, especially vitamins A and Bs.
2. Because maize is digested poorly, its consumption is a common cause of diarrhoea, which leads to  further loss of micronutrients. In the past, many diets have been advocated to correct kwashiorkor, including the use of dry skimmed milk. These prove inadequate after a period of use. In determining a healthy diet for malnourished children, therefore, attention must be paid to their micronutrient needs and to protein quality and calories.

“This brings us to the two main questions I was asked at the presentation. To understand why African governments still feed their people on white hybrid maize, instead of better varieties of maize, one has to understand the global economic order which still shapes much of what goes on in Africa. For example, there is a large global market for white hybrid maize in such industries as the fodder and starch industries. Incentives to develop seed therefore depend on the ready availability of a market outlet for the crop. White hybrid maize is attractive, (especially to large commercial farmers) because there is a ready market outlet beyond human consumption.

“Yet that cannot be the whole explanation. Ideally, attempts should have been made to address the nutritional needs of peasant farmers whose families subsist mainly on maize. In Ghana, attempts have been made to bridge the nutritional shortfall through the research use of a variety of maize that is richer in protein, QPM. QPM is said to contain almost twice the amount of protein that ordinary maize has.

“From the community studies concluded in Ghana in the 1990s, the following verdict was reached: A strong case is made for the replacement of normal maize varieties with QPM in this country (Ghana), and in all other Sub-Saharan African countries that depend on maize as an important source of calories and protein in their diet. In Kenya, some work has been done with QPM but it is yet to be published. However, the development of QPM seeds by industry players and the private sector is alive. So QPM seed varieties suitable for Western Kenya are available in Kitale in Western Kenya. I suspect that individual initiative may be necessary to popularize the variety.

“As for why the lake region is more vulnerable to kwashiorkor in spite of the ready availability of fish, one has to revisit the micronutrient connection. Fish is a source of high quality protein; the lives of fishing communities tend to revolve around the fishing industry, often at the exclusion of farming. So although fish has most of the body building amino acids that the body needs, consumers lack the necessary micronutrients to process the protein in the body. In the absence of a diverse diet, the high quality protein then becomes a bigger metabolic burden on the body. This burden needs to be understood because, in part, it explains our high disease burden, especially among the middle class as they acquire richer diets.”

Dr. Nelly’s journal continues next week.

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