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       THE RIDDLE OF MALNUTRITION

       PERSPECTIVES ON GLOBAL HEALTH

      Series editor: James L. A. Webb, Jr.

      The History of Blood Transfusion in Sub-Saharan Africa, by William H. Schneider

      Global Health in Africa: Historical Perspectives on Disease Control, edited by Tamara Giles-Vernick and James L. A. Webb, Jr.

      Preaching Prevention: Born-Again Christianity and the Moral Politics of AIDS in Uganda, by Lydia Boyd

      The Riddle of Malnutrition: The Long Arc of Biomedical and Public Health Interventions in Uganda, by Jennifer Tappan

       THE RIDDLE OF MALNUTITION

      The Long Arc of Biomedical and Public Health Interventions in Uganda

      Jennifer Tappan

      Ohio University Press

      Athens, Ohio

      Ohio University Press, Athens, Ohio 45701

       ohioswallow.com

      © 2017 by Ohio University Press

      All rights reserved

      To obtain permission to quote, reprint, or otherwise reproduce or distribute material from Ohio University Press publications, please contact our rights and permissions department at (740) 593-1154 or (740) 593-4536 (fax).

      Printed in the United States of America

      Ohio University Press books are printed on acid-free paper

      27 26 25 24 23 22 21 20 19 18 17 5 4 3 2 1

       Library of Congress Cataloging-in-Publication Data

      Names: Tappan, Jennifer, author.

      Title: The riddle of malnutrition : the long arc of biomedical and public health interventions in Uganda / by Jennifer Tappan.

      Other titles: Perspectives on global health.

      Description: Athens, Ohio : Ohio University Press, [2017] | Series: Perspectives on global health | Includes bibliographical references and index.

      Identifiers: LCCN 2017006596| ISBN 9780821422458 (hc : alk. paper) | ISBN 9780821422465 (pb : alk. paper) | ISBN 9780821445914 (pdf)

      Subjects: | MESH: Malnutrition—prevention & control | Infant | Child | Public Health | Preventive Health Services | Uganda

      Classification: LCC RA645.N87 | NLM WS 115 | DDC 362.1963/90096761—dc23

      LC record available at https://lccn.loc.gov/2017006596

       Dedicated to Wednesday, Oscar, and Sid

      CONTENTS

       List of Illustrations

       Preface

       Acknowledgments

       Introduction

       ONE. Diagnostic Uncertainty and Its Consequences

       TWO. Medicalizing Malnutrition

       THREE. The Miracle of Kitobero

       FOUR. In the Shadows of Structural Adjustment and HIV

       Epilogue: Remedicalizing Malnutrition and the Plumpy’Nut Revolution

       Notes

       Glossary

       Bibliography

       Index

      ILLUSTRATIONS

       Figures

       I.1. Marasmus

       I.2. Kwashiorkor

       1.1. “Bed for metabolic studies,” c. 1952

       2.1. Child treated for kwashiorkor at the MRC Infantile Malnutrition Unit, Mulago Hill

       2.2. “Kwashiorkor in a 17 month old Ganda boy, showing syringe feeding . . . through a fine polythene tube.”

       2.3. Label for milk packets

       2.4. Magalita at fifty-two weeks

       2.5. Petero at thirty-four weeks

       2.6. Waswa and Nakato at sixteen and a half months and their mother

       3.1 and 3.2. Women delivering therapeutic formula to malnourished children at Mwanamugimu, c. 1965

       3.3 and 3.4. Cooking demonstrations at Mwanamugimu

       3.5. Mwanamugimu Nutrition Rehabilitation Unit as seen from original entrance

       3.6. Staff of Mwanamugimu Nutrition Rehabilitation Unit, c. 1965

       3.7 and 3.8. Measuring using a handful and informal discussions

       3.9. June 1969 calendar

       3.10 and 3.11. Mwanamugimu certificates

       3.12. Weight chart

       3.13. Mother with her daughter during a follow-up visit two years after admission

       3.14. Mother with her severely malnourished daughter on admission

       3.15. Mother with her daughter and second child after three weeks at the unit

       3.16. Mother together with her subsequent children after five years

       3.17 and 3.18. Protected springs pictured during construction and following completion, Luka Mukasa seated on right

       3.19. Tusitukirewamu club

       3.20 and 3.21. Bwamaka bulungi and the “simple frame shelter,” Luteete Health Center in background

       3.22. Demonstrating how to prepare kitobero in rural area

       4.1. Deputy Minister of Health, Mr. S. W. Uringi, delivering a speech at the opening ceremony of the MRC Child Nutrition Unit’s Expansion in 1969

      

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