Appendix D

Potential Breakthroughs in Child Nutrition

As in the three previous appendixes, we report here innovations relating only indirectly to Africa's cereals. Once again, these seem of notable significance to the continent as well as to the future of the traditional grains. In this case, the potential breakthroughs are of great humanitarian significance - no less than a means by which Africa may at last put behind it the horrors and heartbreak of childhood malnutrition.

WEANING FOODS

In most parts of the world, baby foods are commonplace. In North America, for example, supermarkets may carry whole aisles of liquefied and semisolid concoctions carefully created from cereals, vegetables, and fruits. Through these foods, a child gets a diet that is easily digested, rich in energy, and balanced in protein, vitamins, and minerals. Such foods help the child make the complex and otherwise life-threatening transition from mother's milk to adult fare.

The tragedy for Africa's millions of malnourished children is that comparable bridging foods are unavailable to, or at least far beyond, a family's financial reach. A child in Africa, therefore, faces a cataclysmic change from a balanced and hygienic liquid diet of mother's milk to an unbalanced solid adult food that is often very unwholesome. Although the young milk-fed bodies are basically unprepared for such a switch, they must start digesting foods of alien consistency and inferior quality. Moreover, they often must do this while battling new and numerous intestinal infections introduced through unclean hands and utensils as well as through inadequate cooking.

This situation constitutes the gravest emergency facing children today. As UNICEF's executive director, James P. Grant, has pointed out: "The period of weaning, during which a young child becomes accustomed to the change from a diet consisting solely of his or her mother's milk, to one totally devoid of it, may take a year or more, and in much of the world this is perhaps the most dangerous period of the child's life. Many will not survive it. Of those that do, too many will be stunted in body, and perhaps in mind, and never be able to attain the full promise of their birth."

Today this hazard falls heaviest on Africa's children. Perhaps in the future centrally processed weaning foods will, as in North America, serve the children's needs. However, at present the cost of such products and the inability to distribute them throughout the rural regions makes this impractical. The only answer for the moment, then, is weaning foods that can be prepared either in the home itself or at least in nearby locations in the rural districts.

Given the extent of present malnutrition, one could be forgiven for concluding that household weaning foods are an impossibility for rural Africa - that appropriate ingredients must be unavailable, or that the people cannot make foods appropriate for children. But a number of knowledgeable nutritionists and food technologists believe that bridging foods for the critical nutritional years of each new generation can indeed be produced locally and cheaply. And, in their view, it is the traditional native grains - sorghum and finger millet, in particular - that are the key to this vital and life-saving possibility.

The reason for this is unexpected but understandable.

Those who, in the past, blamed malnutrition exclusively on the lack of certain nutrients in the foods were largely wrong. The local cereal products are not as poor in nutrient quality as was (and is) generally claimed. Today's nutritionists increasingly blame the low quantity of solids (what they call the "nutrient density") in the foods used for feeding the very young.

Africa's traditional weaning foods are watery gruels based on boiled cereal. These may have the right consistency for a child whose sole diet has been milk, but they are just too dilute. A gruel whose consistency is acceptable to a one-year-old contains merely one-third the food energy of a typical Western weaning diet. A child simply cannot consume enough to meet its energy and other nutrient requirements. Even when stuffed with gruel to its limit, a small stomach contains too little solid to keep its owner fed for very long. And most of the children must get by on only two feedings a day because mothers who work in the fields have no time to boil batches of gruel throughout the day. The children therefore get fed only in the morning and evening when the rest of the family's food is prepared.

A tragic irony is thus becoming apparent. Although the gruels are too thin, the porridges the mothers are cooking for the rest of the family would be satisfactory except for one fact: they are too thick to be swallowed by an infant. A stiff porridge is useless to anyone who cannot eat solids.

What can be done? The answer, the nutritionists now say, is to take a small part of the adults' thick porridge and change its consistency so any child can "drink" it. How? By the age-old African methods of malting or fermenting (see Appendix C). Both procedures break up boiled starch so that it collapses into smaller saccharides, including sugars, and releases the water that keeps it thick.

For the rest of the world, malting and fermenting are not everyday household operations, but in Africa they are. Indeed, these two processes are probably better known at the household level in Africa than anywhere else in the world. Both techniques require only a minimum of equipment and appear to be good ways to turn stiff starchy porridges into liquid weaning foods.

MALTED FOODS

Given what is currently available in an African village, probably nothing can compare with malting as a means for carrying rural babies across the nutritional abyss between mother's milk and adult foods. The previous appendix discussed malted grains and the potential they offer in and of themselves. Here, however, we discuss another side of these versatile materials: their use as culinary catalysts for modifying starchy foodstuffs. This is a process all but unknown to most people' but it is by far the biggest use of malted grains and is conducted all over the world. It is, in short, the vital first step in making beer and whisky.

Perhaps because of this association, malting has been saddled with a somewhat seedy reputation. But it is a simple, safe process that produces no alcohol and should be more widely used and better known to cooks everywhere.

In Africa, malting has a special promise. Two of the native staples - finger millet and certain sorghums - are rich in the malting enzymes (amylases) that break down complex starches.

To liquefy even the thickest cereal porridges takes only a small quantity of flour from germinated sorghum or finger millet. When this flour and the porridge are heated slowly, the amylase enzymes hydrolyze the gel-like starch in the porridge so that it collapses and can no longer hold water.

In this way, sprouted sorghum and finger millet can turn a pasty porridge semiliquid in minutes.

Moreover, the food not only thins down, it becomes, to a certain extent, predigested so that it is easier for the body to absorb. In addition, the enzymes hydrolyze not only the starches but some of the proteins as well. They also reduce antinutritional and flatusproducing factors, improve the availability of minerals, and enhance some of the food's vitamin content. Further, the malting process imparts sweetness and flavor that makes for a tasty end product.

Considering the extent of malnutrition, it is more than ironic that individuals throughout Africa know more about this process than people anywhere else in the world. Indeed, throughout sub-Saharan Africa, millions of homes have a crock in the corner that contains malted grain.

A small sample of the contents would transform thick porridges into baby foods sufficiently liquid for children to consume and sufficiently nutrient-dense to keep them healthy. Tests have shown that adding a little germinated cereal while a porridge is being prepared doubles the amount of food energy and nutrients a child can ingest. However, at present the malt is used only to make beer, almost never to prepare weaning foods.

Experiences in Tanzania suggest that the concept of liquefying porridges for baby food is not an impractical dream. In the early 1980s, scientists at the Tanzania Food and Nutrition

Centre found that small quantities of flour from germinated sorghum or finger millet could be used to thin the traditional viscous porridges. They called their product "Power Flour." When a spoonful was added during cooking, porridges thick enough to hold up a spoon turned liquid within 10 minutes.

The researchers found that mothers in Tanzania's villages were only too willing to use Power Flour. Most of the mothers knew how to prepare germinated cereals for brewing but knew nothing about making foods for their children from them. However, because the procedure was already so well known, they quickly adopted it. Although it is ironic (even tragic) that malting is so well known across Africa, it is also an advantage. Using germinated cereal to improve weaning foods is simply a variation on an already widespread technology - not a strange foreign food or technique to be imposed by an outside authority.

Local, national, and international efforts to stimulate appreciation of this could see a new level of weaning foods sweep across Africa with little outside involvement. The key in many areas may be to educate village brewmasters to the potential of a second product from their ongoing malting operations.

Sorghum is the most widely available malting grain in Africa, and it has been used in most of the nutritional experiments so far. However, finger millet is a better choice: it has a higher amylase activity; it has no tannins; it develops no potentially toxic materials on germination; it is rich in calcium and methionine, both of which are needed for child growth; its malt has a pleasant aroma and taste; and, finally, it does not mold or deteriorate during germination.

Considering the fact that the technology and raw materials are common in most village situations, why has this immensely beneficial practice not been more widely used? For one thing, the process of germinating grain does take some time; mothers, already weighed down with burdensome work loads, tend to reject anything that takes up more of their day.

However, germinated flour need not be produced daily. Indeed, small portions can be set aside whenever a fresh batch of beer is begun. In addition, as in the case of Tanzania's

Power Flour, the malt could be made centrally and sold widely. Unlike the weaning foods themselves, it is a stable, concentrated material that is used only a pinch at a time.

FERMENTED FOODS

The fermentation of cereals by lactic-acid-producing bacteria has been discussed in the previous appendix. It, too, appears to be a way to prepare weaning foods. Like malting, fermentation is a householdlevel food technology that reduces the viscosity of stiff porridges (although not as much and not in minutes). It raises the levels and bioavailability of proteins, vitamins, and minerals. It enriches the foods through the synthesis of some B vitamins, and it adds flavor. On top of all that, it helps protect the foods from diarrhea-causing microorganisms.

As has been noted in Appendix C, lactic fermentation is practiced throughout the world to make pickles, sauerkraut, soy sauce, sourdough bread, and other popular foods, but it is especially well known in Africa. From Senegal to South Africa "sour" porridges are popular.

However, although still widely consumed, they are often overlooked as weaning foods.

But sour porridges seem to fulfill many of the characteristics required, and they also reduce the risk of pathogenic diarrhea - Africa's leading cause of infant death. They save time and energy as well, and might be very suitable for use during the day when a working mother has no time to cook.

A few fermented foods are already employed as weaning preparations. One example is ogi, a blancmange-like product that is one of Nigeria's most important foods. Ogi is created by fermenting a slurry of sorghum, millet, or maize. Adults eat it for breakfast, but some is kept aside and used as a weaning food.

There are possibilities, too, of combining fermentation and malting. Thus, fermented doughs, such as ogi or ugi (a similar product widely eaten in East Africa), might be liquefied with Power Flour into forms that weanlings can "drink." In that way children could ingest more, and the double processing would likely produce highly digestible foods, easy for any young, old, or sick bodies to assimilate.