HARARE, 17 August 2007 (IRIN) - Malnutrition is accelerating among Zimbabwe's children, their access to healthcare is declining, and one in 10 in the capital, Harare, is suffering from kwashiorkor, a condition caused by an acute lack of protein, according to new reports released by the government.

The 2005/06 Zimbabwe Demographic and Health Survey (ZDHS), compiled with the assistance of the Central Statistical Office (CSO), found that 29 percent of children under five were stunted, a condition in which a child is shorter than the average for his or her age because of the cumulative effects of chronic malnourishment. The previous ZDHS survey, in 1999, found that 27 percent of children under five years old were stunted.

"Thirty-one percent of stunted children are found in rural areas, while 24 percent live in urban areas," the report said. "At the provincial level, more than one-third of the children in Mashonaland Central and Manicaland are stunted, with the former recording an increase of 38 percent."

The survey, compiled from interviews and the investigation of 9,285 households, found that in other provinces, stunted growth among children reached 27 percent in Mashonaland West, 29 percent in Masvingo and 35 percent Manicaland.

Low body weight, which determines whether a child is underweight for his or her age and can also indicate malnutrition, has also risen. According to the survey, 17 percent of children nationwide were underweight, compared to 13 percent in 1999.

In Bulawayo, Zimbabwe's second city, and Harare, as well as Mashonaland Central, Mashonaland East, Midlands and Masvingo provinces, the incidence of underweight among children increased by at least 28 percent, the report said.

"Midlands, Harare and Bulawayo have all seen at least a 70 percent increase in the level of children who are malnourished," said the report. There were slight decreases in underweight in Mashonaland West, Matabeleland South and Matabeleland North, while in Manicaland there was no change from the previous survey.

Wasting - in which a child is considered too thin for his or her age due to acute or recent malnourishment - stood at 6 percent nationwide, and was unchanged since the 1999 survey.

In a provincial breakdown, Mashonaland Central recorded a 6 percent incidence of wasting among children, in line with the national average, but in Mashonaland East it climbed to 11 percent, in Mashonaland West to 9 percent and in Masvingo to 7 percent.

There were increased levels of wasting in Manicaland (4 percent), Matabeleland South (6 percent) and Bulawayo (1 percent), while the condition among children in Matabeleland North (6 percent) and Harare (4 percent) remained constant.

The report was sponsored by the US Agency for International Development (USAID), with technical support from the health ministry, the Zimbabwe National Family Planning Council (ZNFPC), USAID, the UN Development Programme (UNDP), UNICEF, the UK Department for International Development (DFID) and the National Microbiology Reference Laboratory (NMRL).

The World Health Organisation (WHO) stipulates that basic immunisation coverage should comprise doses of BCG, DPT and polio vaccines, but the ZDHS noted that access to child healthcare was declining, and only 53 percent of children aged between 12 and 23 months had been immunised, compared to 75 percent in 1999.

Throughout Zimbabwe, cases of anaemia, an indication of iron deficiency, have risen in the age group 6 months to 59 months, with 58 percent of children now affected.

Kwashiorkor affects one in 10 children

A recent report by the Harare City Council's health department showed malnutrition was on the rise in the capital, with 10 percent of children suffering from kwashiorkor in 2006. Case numbers were particularly high in the poor, populous suburbs of Dzivaresekwa, Kuwadzana, Mabvuku and Mbare.

"Acute under-nutrition or wasting ... increased during 2006, compared to the previous year. The number of kwashiorkor cases increased by 43.7 percent," the report said. "The findings may be due to the harsh economic situation being felt throughout the country by the majority of Zimbabweans."

Of the cases of malnourishment reported among minors at Harare's public clinics, 91 percent occurred among children younger than five years, and 9 percent among those aged 5 to 15.

In June 2007, the United Nations Children Fund (UNICEF) representative in Zimbabwe, Festo Kavishe, said the organisation was "deeply concerned" about the negative impact of the economic crisis.

"Every day in Zimbabwe the basic elements required for a healthy and happy childhood - affordable education, three meals per day, clothing and shelter - are being pushed out of reach for people," Kavishe said.

Since 2000, when President Robert Mugabe launched his fast-track land-reform programme, which redistributed white-owned commercial farmland to landless blacks, the country has been in its worst recession in 27 years of independence from Britain.

Inflation has topped 13,000 percent, according to independent analysts; the economy has contracted by about a third, unemployment levels are at 80 percent and shortages of basic commodities, fuel, water and electricity have become commonplace.

The UN World Food Programme, which is currently feeding about 1.1 million Zimbabweans - including nutritional support for malnourished children and orphans via school feeding schemes - said in its country fact file that about 45 percent of the population was malnourished. International donor organisations expect that more than a quarter of the population will require emergency food aid later this year.

The Famine Early Warning System Network (FEWS NET), in its August update on Zimbabwe's food security, blamed the ZANU-PF government's price control clampdown, which forced businesses to cut the prices of commodities by 50 percent, fuelling food shortages.

"Recent attempts by the government to arrest the rampant increases of basic commodity prices by introducing price controls only exacerbated the already out-of-reach cost of basic necessities," FEWS NET said.

"Quickly, commodities affected by price controls became unavailable in markets, either because they had immediately sold out at controlled prices, or simply became uneconomical to sell at the set prices." As a result, "the food access of poor households continues to diminish at an alarming rate, especially in urban areas."

The winter wheat harvest, which relies mainly on electrically powered irrigation, was ruined by numerous power outages; food shortages, already serious, are expected to become more severe.

Food short for employed and unemployed

Esther Shereni, 28, of Hopley Farm, a settlement established in 2005 for Harare residents displaced by Operation Murambatsvina, a government campaign that demolished informal housing and business stalls, leaving about 700,000 people without shelter or income, is one parent among many unable to provide enough food for their children.

"Before Operation Murambatsvina, I ran a tuckshop in Glen Norah [township in Harare], in which I also slept, but when it was razed down I became homeless," said Shereni, a single mother who survives by selling flowers to mourners at a graveyard.

She was pregnant at the time, and "because I no longer had a steady source of income, I failed to feed myself adequately and when the child was born, she was underweight and my inability to feed her has continued to this day and she is always falling sick," she told IRIN.

Her two-year-old daughter has an extended belly, an unusually big head and thin limbs - a clear indication of malnutrition. Sherini said it was always a struggle to get the medicines her child needed; the public clinics rarely had any, and she could not afford to buy from private pharmacies.

Shereni's home is a shack made of plastic sheeting, she fetches water from a borehole that is used by thousands of other people, and the settlement has no sanitation or electricity.

"My dream was to have a bouncing, healthy baby, for that is what every mother looks forward to but, because of poverty, that has not been possible. I just pray that my little daughter will not die," she said.

"The breast milk was scant ... and now that I have weaned her off, she invariably eats sadza [maizemeal porridge, the staple dish] and the fish that I buy by the roadside."

But having a job is no guarantee that the children will be adequately fed. Samukheliso Sigodo, 30, a personal secretary at a Harare consultancy, cannot feed her six-month-old baby exclusively on breast milk because of work commitments, and leaves the child with a caregiver. "That means I have to give the child formula milk and porridge, but the tragedy is that you cannot get these from the shops," she told IRIN.

"While there has always been scarcity, and I have had to rely on traders who buy it from South Africa, the situation is now worse because the shops have completely run out of the products and the informal market has also dried up."

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