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The Guardian - UK

Health

‘My baby went to sleep and didn't wake up’: young lives lost to Ghana's silent killer

A child looks out from a corn flour processing shop in Nyanyano, Ghana Photograph: Adam Walker/UBELONG

There is no war or famine in Ghana, and the economy is growing, yet malnutrition remains a silent killer that accounts for one-third of all child deaths in the country.

Although mortality rates are slowly starting to come down across the west African country, Ghana is struggling with high levels of stunting, a condition caused by chronic lack of nutrition in pregnancy and early childhood that permanently affects a baby’s mental and physical development.

One in five babies born in Ghana are stunted, which has been calculated to cost the economy $2.6bn (£2bn) a year, about 6.4% of the country’s GDP.

In Bentum, Apprah and Nyanyano, rural communities in Ghana’s Central region, about an hour from Accra, more than 35% of children under five suffer from severe malnutrition.

Kate Afful, 40, at home with her mother in Nyanyano, telling the story of how one of her daughters died at age two — Kate Afful, 40, at home with her mother in Nyanyano, tells the story of how one of her daughters died aged two. Another of her six children died during childbirth. Since her husband died 10 years ago, she has struggled to find work and take care of her four children, who are malnourished and often get ill. ‘God took my two-year old daughter. She was not feeling well so I put her to bed. Later that evening there was a bad storm. The sky was loud and angry. I heard an explosion in the clouds. When I went to check on my baby, she was dead. I believe the thunder killed my baby’ Photograph: Nick Parisse/UBELONG

Kate Afful (above, right), 40, at home with her mother in Nyanyano, tells the story of how one of her daughters died at the age of two. Anotherof her six children died during childbirth. She worked as a fishmonger for her husband up until his death, about 10 years ago. Since then, she’s struggled to find work and take care of her remaining four children. Her children are malnourished and often get sick – they only eat “banku”, a fermented corn and cassava dough. “God took my two-year old daughter,” she says. “She was not feeling well so I put her to bed. Later that evening, there was a bad storm. The sky was loud and angry. I heard an explosion in the clouds. When I went to check on my baby, she was dead. I believe the thunder killed my baby.”

Nana Agya Kwao, chief of the farming community of Bentum in Ghana — Nana Agya Kwao, 76, has been chief of the farming community of Bentum for 35 years. He has spent most of that time fighting claims for the lands that have been assigned to him in his role as a local leader. Two years ago, the chief, who says he has two wives and 35 children, sold most of the farming land in the area to a developer. As a result, most villagers lost their livelihoods and now struggle to feed their families. ‘I am very proud to be the chief. It’s not easy. No one will take my land. I know my people in Bentum cannot farm anymore. But whatever you do for food, is on you’ Photograph: Nick Parisse/UBELONG

Nana Agya Kwao (left), 76, the chief of the farming community of Bentum, has two wives and says he has 35 children. As chief, a position he has held for 35 years, he owns the land and has the right to sell or rent it out. Two years ago, he sold most of the farming land in Bentum to a developer. As a result, the majority of villagers lost their livelihoods and now struggle to feed their families. “I am very proud to be the chief. It’s not easy. No one will take my land. I know my people in Bentum cannot farm anymore. But whatever you do for food, is on you.”

A family outside their home in the fishing village of Nyanyano, where more than a third of children are estimated to be malnourished. The lack of proper sanitation or a waste management system compound the problem of malnutrition Photograph: Adam Walker/UBELONG

Early morning in the fishing village of Nyanyano, which has no waste management system. As in many villages across Ghana, the lack of such a system leads to many public health problems Photograph: Joey Rosa/UBELONG

Ama, in her 20s, with her two children at home in Nyanyano — Ama, who is in her 20s, with her two children at home in Nyanyano. Her husband is a fisherman, and she sells fried food on the street. Her children are both malnourished, and the eldest has had an eye infection for two years. ‘People talk about my children being sick and malnourished but I don’t care what they say. A lot of children die in this village. But there is nothing I can do because I can’t afford to take my children to the hospital or to give them the food supplements the nurses recommend. The food sachets from the nurses made my children better but they cost too much money’ Photograph: Roseanne Furniss/UBELONG

Top image: A family outside their home in the village of Nyanyano; middle image: Nyanyano has no waste management system; bottom image: Ama with her two children at home in Nyanyano

Ama’s husband is a fisherman, and she sells fried food on the street in Nyanyano. Both her children are malnourished, and her oldest child has had an eye infection for two years without medical treatment. “A lot of children die in this village. People talk about my children being sick and malnourished, but I don’t care what they say. There is nothing I can do because I can’t afford to take my children to the hospital or to give them the food supplements the nurses recommend.”

Nyanyano, Ghana. October 9, 2016 Hannah Abekah, 23, at her home in Nyanyano, surrounded by the yellow buckets of rainwater she collected the night before. Hannah never attended school, and started working at a very early age as a fishmonger. She is married to a fisherman, and they have two young children who suffer from malnutrition. Her husband is often away for weeks. 'I just want my children to become great people' — Hannah Abekah, 23, at her home in Nyanyano, surrounded by the yellow buckets of rainwater she collected the night before. Abekah has never attended school, and started working at a very young age as a fishmonger. She is married to a fisherman, and they have two young children who suffer from malnutrition. Her husband is often away working for weeks at a time. ‘Without my husband, I struggle to support my family. My kitchen is empty. I have no food. My children don’t even eat the little food I give them. I don’t know about malnutrition. I just want my children to become great people’ Photograph: Adam Walker/UBELONG

At her home, Hannah Abekah (left), 23, is surrounded by the yellow buckets of rainwater she collected the night before. She has never attended school, and started working at a very early age as a fishmonger. She is married to a fisherman, and they have two young children. Her husband is often away for weeks. “My kitchen is empty. I have no food,” she says. “My children don’t even eat the little food I give them. I don’t know about malnutrition. I just pray my children become great people.”

In Nyanyano a young girl prepares food for her family using pots and pans covered in flies — In Nyanyano, a young girl prepares food for her family using pots and pans covered in flies. Children in Ghana often share the responsibility of meal preparation Photograph: Nick Parisse/UBELONG

A young girl in Nyanyano prepares food for her family

Rebecca, 17, with her two children in Nyanyano. Her children are malnourished and frequently ill — Rebecca, 17, with her two children at home in the fishing village of Nyanyano. Malnourished and frequently ill, her children receive cheaper over-the-counter medical remedies from the local store in lieu of professional healthcare at the hospital. Like many women in Nyanyano, she doesn’t receive much support from the father of her children: ‘He doesn’t take care of us as he should. He says he doesn’t have money but I know he is not honest.’ Rebecca feels she has nowhere to turn: ‘Women don’t support one another here, it’s not something we do’ Photograph: Raul Roman/UBELONG

Rebecca (above) has two children who are regularly ill. They receive medicine from the local store instead of professional healthcare at the hospital. Rebecca, 17, doesn’t receive much support from the children’s father. “He doesn’t take care of us as he should. He says he doesn’t have money, but I know he is not honest.” She feels she has nowhere to turn. “Women don’t support one another here, it’s not something we do.”

Inside a typical home in the fishing village of Nyanyano, where most households spend less than $10 a week on feeding an entire family — Inside a typical home in Nyanyano, where most households spend less than $10 a week on feeding an entire family Photograph: Raul Roman/UBELONG

Exhausted from the heat, an elderly woman seeks shade from the sun in Nyanyano. Collecting rainwater is the only source of water for local villagers, who use it for drinking, bathing, and washing — Exhausted from the heat, an elderly woman seeks shade from the sun in Nyanyano. Rainwater is the only source of water for local villagers, who collect it for drinking, bathing, and washing Photograph: Nick Parisse/UBELONG

Rachel Edifile, 18, with her two children at her home in Nyanyano, where she works as a fishmonger. Her youngest child is underweight and malnourished, and she relies on help from her grandmother to pay for medical costs — Rachel Edifile, 18, with her two children at her home in Nyanyano. She works as a fishmonger, but struggles to provide food for her children. Her youngest child is underweight and malnourished, and she relies on help from her grandmother to pay for medical costs. ‘I am not happy. I do not want to sell for other people. I want to own my business to make more money to take better care of my children, send them to school and buy good food’ Photograph: Nick Parisse/UBELONG

Top: inside a typical home in Nyanyano; middle: an elderly woman is exhausted from the heat; bottom: Rachel Edifile with her children

Rachel Edifile, 18, works as a fishmonger in Nyanyano but struggles to provide food for her children. Her youngest child is underweight, and she relies on the help of her grandmother to pay for medical costs. She cannot send her older child to school. “I am not happy,” she says. “I want to take better care of my children, send them to school and buy good food.”

Nevertheless, more children are attending school in the area as private schools have been springing up. Some of the schools provide feeding programmes, so pupils can expect to get at least one meal a day.

A student sleeps at the only school in the farming community of Apprah. Most students at school are malnourished, and many fall asleep during the day or have problems concentrating in class Photograph: David Taylor/UBELONG

In most circumstances, the only meal children receive for the entire day is at school. Here children take a break from learning to enjoy their lunch — Usually, the only meal children receive during the day is at school. Here, children take a break from lessons to enjoy their lunch Photograph: Raul Roman/UBELONG

Beatrice Amponfi (right) and Joy Glii (left) are in charge of the childcare and malnutrition unit at the Kasoa clinic — Beatrice Amponfi (right) and Joy Glii (left) are in charge of the childcare and malnutrition unit at Kasoa clinic, the main centre for malnourished children in the area. Amponfi says only 20% of malnourished children are taken to the clinic. ‘Women with malnourished children have problems that they cannot openly discuss with friends or family. There is a stigma associated with having a malnourished child. So we mostly identify malnutrition cases by talking to neighbours … The most important part of our job is to provide a safe environment to counsel mothers about their children’ Photograph: Joey Rosa/UBELONG

Beatrice Amponfi (right) and Joy Glii (left) are in charge of the childcare and malnutrition unit at Kasoa clinic. The clinic, the largest run by the government in the city of Kasoa, serves the people of Bentum, Apprah and Nyanyano, but it can involve a journey of up to three hours to get there. According to Amponfi, only 20% of malnourished children are taken to this clinic, mostly extreme cases. Fifteen nurses work at the clinic, serving a catchment area of about 100,000 people. There is also a nutrition officer in the district who visits the clinic four times a month.

The room where women give birth, at the small health clinic in Nyanyano Photograph: Adam Walker/UBELONG

A clinic on the outskirts of Kasoa. In Ghana, health services lack the resources they need to tackle widespread malnutrition, and the majority of malnourished children never get treated Photograph: Nick Parisse/UBELONG

“There is a stigma associated with having a malnourished child. So we mostly identify malnutrition cases by talking to neighbours. Besides, mothers of malnourished children are lonely and they don’t feel supported by their husbands. Our most important job is to provide a safe environment to counsel them about their children, so that they don’t feel embarrassed about bringing them here. But our effort is just a drop in the ocean.”

Charity Essel, 29, with her two-year-old daughter Tiffany, at the farm in Bentum where she worked until the land was sold two years ago — Charity Essel, 29, with her two-year old daughter Tiffany, at the farm in Bentum where she used to work before the chief sold the land to a developer two years ago. Since then, food has been scarce in this isolated community. Charity’s daughter has struggled with malnutrition since she was born and only started to put on weight and improve after a local non-profit organisation diagnosed malnutrition and provided her with dietary supplements. ‘My daughter used not take any food. When she lay down, I could see all her ribs. My child would have died without the help of this non-profit’ Photograph: Rosanne Furniss/UBELONG

Charity Essel, 29, used to work on a farm in Bentum before all the farming land was sold to a developer by the local chief two years ago. The land is now surrounded by a 9ft wall, built by the villagers who have lost their farms, and food is scarce. Since birth, Charity’s daughter Tiffany has struggled with malnutrition but Charity says hospital staff never explained what was wrong with her daughter. The child only started to put on weight and improve once a local non-profit organisation diagnosed malnutrition and provided her with dietary supplements, she says. “My daughter used not take any food. When she lay down, I could see all her ribs. My child would have died without the help of this non-profit.”

Christy Ansah, 32, with her youngest daughter near the farm in Bentum where she used to work before the land was sold — Christy Ansah, 32, with her youngest daughter near the farm where she used to work in Bentum before the land was sold. Now the community is plagued by poverty and child malnutrition. ‘No one here can access the farms. But I am not angry with the chief. It’s his land and it’s his right. I was able to feed my four children before, but there is no food any more and no jobs in this village. I struggle to earn a quarter of what I made before’ Photograph: Nick Parisse/UBELONG

Christy Ansah, 32, has also struggled since the farmland in Bentum was sold. As a result of the village chief selling all the farming land in the community to a local company, “no one here can access their farms”, she says. “I was able to feed my four children before, but there is no food any more and no jobs in this village. I struggle to earn a quarter of what I made before.”

Men relax in the middle of the day in Nyanyano. Most work as fishermen and when they are not working they rarely help with household chores — Men relax in the middle of the day in the fishing village of Nyanyano. The majority of men in Nyanyano work as fishermen and when they not working, they rarely help with children or any household chores Photograph: Raul Roman/UBELONG

In Nyanyano, a local fishmonger covered in scales prepares fish caught earlier that morning. Protein is rare in Ghana and usually reserved for consumption by male household heads Photograph: Nick Parisse/UBELONG

Mary Essil, 27, at home in Bentum, holding a bottle of glucose that she fed her malnourished son until he died at two months of age — Mary Essil, 27, at her home in the farming community of Bentum, holding the bottle of glucose that a nurse gave her at the clinic to combat the malnutrition symptoms of her newborn baby. She could not breastfeed her son, who was very small at birth. Following advice from the nearby clinic, she gave glucose to her baby until he died six weeks later, at just two months old. ‘My baby went to sleep and did not wake up.’ Local tradition mandates that when a baby dies of malnutrition, the baby is taken away. Mary and her husband were not allowed to attend their son’s funeral Photograph: Nick Parisse/UBELONG

Mary Essil, 27, at her home in the farming community of Bentum, holds the bottle of glucose that she gave her son when he was sick. She could not breastfeed her newborn, who was small at birth. Her baby died when he was two months old. “My baby went to sleep and did not wake up,” she says. Local tradition mandates that when a baby dies of malnutrition, the baby is taken away. Mary and her husband were not allowed to attend their son’s funeral.

NGOs in the area are supporting women like Charity, Mary and Christy. The Cheerful Hearts Foundation, in Kasoa, runs a nutrition programme in the area, conducting workshops in schools for children, and home visits for mothers, led by volunteers.

Nana, chief of Nyanyano, says he is powerless to solve problems like malnutrition and trafficking in the community — Nana Obeng Wiavo V, the chief of Nyanyano, at his palace. As a traditional leader, he is responsible for overseeing political and ethical issues revolving around the fishing community. ‘Fishermen leave women pregnant and then they run away. Mothers are left to fend for themselves and support their children alone. My people are starving. Mothers are desperate – many sell their children to fishermen to get some cash and food. The government does nothing about it. So many people look to me for answers, but I am only one man. I wish I could help them, but I have no power’ Photograph: Joey Rosa/UBELONG

Nana Obeng Wiavo V, the chief of Nyanyano, at his palace. As a traditional leader, he is responsible for overseeing political and ethical issues in the fishing community. “Fishermen leave women pregnant and then they run away. Mothers are left to fend for themselves and support their children alone. My people are starving. Mothers are desperate … The government does nothing about it. So many people look to me for answers, but I am only one man. I wish I could help them, but I have no power.”

The land the chief sold to developers two years ago is now lying idle. There is some animosity towards him from the community for selling the land, but most people say they felt powerless to do anything to stop the sale. Since then, some families have moved away in search of new opportunities.