DISINFECTANT and crying wafted across the Angolan hospital ward where 2-year-old Fernanda Afonso slept in the lap of her mother near an empty intravenous bag that had been used to fight her malnutrition.
It’s the same affliction that killed all five of her siblings as toddlers and scars Africa’s second-biggest crude oil producer with the world’s highest rate of child mortality under the age of 5: 167 deaths per 1,000 live births, according to the United Nations Children’s Fund (Unicef). That’s one in six.
“I’d like to go to a private clinic but how can I afford that if I can barely eat,” Fernanda’s mother, Lourdes Afonso, a 37-year-old who sells bottled water on the streets of Luanda, the capital, said in an interview at the city’s Bernardino Pediatric Hospital.
Counting the number of children who don’t live to see their fifth birthday is a broad indicator of social and economic development, according to Unicef.
In Angola, sub-Saharan Africa’s third-biggest economy, Porsche dealerships and Armani shops cater to members of the elite under President Jose Eduardo dos Santo’s 35-year rule while two-thirds of the nation’s people live in slums or impoverished rural settlements, often without running water and electricity.
Sub-Saharan Africa hosts all 12 countries where more than 10% of children die before their fifth birthday, according to UNICEF. Sierra Leone is second, followed by Chad, Somalia and Central African Republic (CAR). Nigeria, which has the region’s largest economy and population with about 170 million people, is ninth.
Angola is by far the richest country among African countries with the highest child mortality, with gross national income per capita of $5,170 in 2013, according to the World Bank. Nigeria, which pumped 2.1 million barrels of oil a day in March compared with Angola’s 1.84 million, earned $2,710 per person two years ago.
In Somalia income per person is just $150. The figures for Chad, Central African Republic and Sierra Leone are all less than a fifth of Angola’s wealth.
Malnutrition stunts growth and causes about half of child deaths under 5, according to Maria Futi Tati, head of nutrition at Angola’s Ministry of Health. The country wants to cut chronic malnutrition to less than 10% of children under 5 in a decade, Tati said in a phone interview. The latest government information from 2007 puts the rate at 29%, she said.
“It is not due to lack of food,” Tati said. “The problem resides in poverty and lack of meal diversification. You can’t be healthy when you only eat rice and funge and a lot of families just have one meal a day.”
For about two-thirds of Angolans living on less than $2 a day, according to the World Bank, funge is a staple often made from cassava roots that have few nutrients.
“Cassava is indeed next to nutritionally useless,” Stephen Foster, a doctor who runs a private hospital in Lubango, about 1,000 kilometers (621 miles) south of Luanda, said by e- mail.
About 30% of children in the southwest African country are stunted because of malnutrition, according to a 2007 government survey.
The figure may be higher now because there are fewer aid agencies following the end of a 27-year civil war in 2002, Fernando Trabada, an agronomist who heads cooperation at the European Union delegation in Angola, said by phone.
“Nutrition should be the first priority of the government because a child’s mental development suffers most from malnutrition during their first two years and it costs the country in learning disabilities and earning power,” Trabada said.
The EU is funding 114 million euros ($127 million) over the next five years in agriculture, water and sanitation to reduce child stunting by 35 percent in project areas, Trabada said.
The mortality rate has fallen from more than 200 per 1,000 live births in 2000, UNICEF figures show.
The formerly communist government’s five year plan to 2017 targets reducing under-5 mortality to 127 per 1,000 live births, the Health Ministry says on its website. Other goals include cutting the number of women dying in childbirth to 415 per 100,000 by increasing the number of births attended by skilled health professionals to 70%. Life expectancy in Angola is 51.
Women such as Afonso spend their days on the street selling whatever they can to make a living, leaving their children for other youngsters to tend in a nation where 43% of the population of 19 million are under the age of 15, according to U.S. Census bureau data.
“We have to do door-to-door education campaigns,” Tati said. “There is malnutrition disorder at all levels.”
A 40% fall in oil prices since June has forced Angola to chop its budget by a quarter this year and investment spending by a third compared with initial plans in December.
Health spending is forecast to decline 15% to 270 billion kwanzas ($2.47 billion) this year, according to the Finance Ministry. The 2015 budget allocates 847 billion kwanzas for defense and security.
Among the I-V tubes and glum faces, Afonso appeared as weary as her child.
“My only child is dying in this bed and I’m powerless to help,” she said. “This is more like a cemetery for poor kids like mine.”