Mommy, I'm hungry.

As non-governmental organization (NGO) in consultative status with the United Nations Children's Fund (UNICEF), and being associated with the United Nations Department of Public Information, ACEI receives a good deal of material in the mail each month that pertains to the well-being and protection of children. Recently, I received a copy of "The State of the World's Children 1998," a report that UNICEF publishes each year to focus universal attention on the plight of children. This year's report looks at childhood malnutrition and the far-reaching impact this terrible disease has on the lives of children and entire societies.

I think many of us have no true comprehension of the harsh conditions under which a great many children in the world live, nor of the staggering number of deaths each year that are attributable to largely preventable causes. Having spent nearly a year-and-a-half in Vietnam during the war, I saw firsthand how children elsewhere lived. Some were orphaned, others were obviously in poor health and hungry, and still others lived in houses that were little more than the "play forts" that my friends and I built as kids. It was sad. This was my first experience away from home, and I was somewhat naive and unprepared for what I saw. I learned later, when I returned home, that it was not even necessary to travel outside the U.S. to find similar conditions.

I read in an earlier report that of the top 20 industrialized nations, the United States has the highest rate of child poverty. The rate, in fact, is nearly double that in those other countries. I still find this hard to believe. I mention this because malnutrition is usually directly correlated with poverty. It is estimated that, each day, over 13 million children in the United States alone do not get the food they need for proper growth and development. In developing countries, the number is much, much higher.

Malnutrition refers to the condition, or syndrome, that results from the combination of frequent infections, along with an inadequate intake of protein and vitamins. Malnutrition is far more prevalent than most of us realize - one out of every three children worldwide is affected, according to the report. Each year approximately 12 million children trader the age of 5 die, and over half of these deaths are either directly or indirectly attributable to malnutrition. For comparison, the mortality rate for children younger than 5 in the United States is eight per 1,000, compared to 320 per 1,000 in Niger.

Many suffering from malnutrition display no obvious signs or symptoms. Indeed, three-quarters of all those who die of malnutrition-related causes are only mildly or moderately malnourished. In more advanced cases, those affected show signs of severe wasting, called marasmus, or they have the condition known as kwashiorkor, marked by skin and hair changes and significant swelling of the arms and legs. Measuring height and weight is the most common way to assess malnutrition. Malnutrition also affects the physical and mental development of children and it has a huge impact on future economic productivity.

Most of us think that satisfying hunger is the solution to the problems of malnutrition or malnourishment. It is not that simple, however. In its most basic form, malnutrition is the consequence or result of inadequate dietary intake, as well as disease. Protein energy malnutrition and deficiencies in micronutrients, such as iodine, zinc, iron, and vitamins (like vitamin A, B complex, and vitamin c) are other forms of malnutrition. Discrimination and violence against women can also involve and lead to malnutrition. To complicate matters, many children suffer from multiple types of malnutrition.

Micronutrient deficiencies are particularly serious for young children and for women during pregnancy. All of the minerals, and nearly all of the vitamins, that the body needs must come from the food that we eat or from dietary supplements. Vitamin A deficiency alone affects over 100 million children worldwide, often leading to blindness or reduced resistance to disease. The World Health Organization estimates that 51 percent of the children in developing countries are anemic (iron deficient) - one more example of the seriousness of the problem.

In summary, the nutritional health of children depends on the complex interplay of many factors, such as the mother's social or economic status, access to food, caring practices (including breastfeeding), disease, availability of safe water and good sanitation, and access to basic health services. Good nutrition is a basic human right, and one that has been articulated in several international doctrines, including the Declaration of the Rights of the Child in 1924, the 1978 Convention on the Elimination of All Forms of Discrimination Against Women, and, more recently, the 1989 Convention on the Rights of the Child, which ACEI strongly supports. Article 24 of the Convention specifies that State Parties (i.e., the countries that have ratified the international treaty) must take "appropriate measures" to provide children with adequate, nutritious food and safe drinking water, in order to reduce infant and child mortality and to combat disease and malnutrition.

The well-being and protection of all children worldwide depends on sound nutrition. Clearly, a great deal more attention must be focused on malnutrition and the impact of this pervasive killer. For more information about UNICEF, NGOs or United Nations programs, visit their Web site at www.unicef.org.