Of the many countries in Africa, the Gambia, on the bulge of West Africa, is one of the smallest. Most Gambians live in small villages, and the one in Fig. 2 is typical. The houses are made of mud bricks and have roofs of corrugated metal or grass. The major cash crop and the main source of dietary protein for the villagers is groundnut. This rapid description of the village is what a tourist or any casual visitor would see.
Reality is, however, much more harsh.
Subsequently, we have shown that by two years, two-thirds of surviving children would also be considered malnourished by international standards. These are not unusual statistics. Similar values have been obtained in many parts of Africa where careful assessments have been made. The age when marasmus becomes a serious clinical problem is one to two years, but for every child who reaches this sad state, there are many more who are seriously underweight. Figure 5 shows the percentage expected weight and height of the children, on the basis of WHO standards, at different ages.