Ben Farmer Africa Correspondent

A couple of years’ malnutrition for a tiny child can echo for a lifetime.

If children are starved of nutrients while growing in the womb, or as infants and toddlers, they can grow up not only shorter, but also less mentally developed.

Studies have found that means they are more likely to do worse at school, earn less money, end up in poverty and be more prone to sickness in later life.

The physical impact of this early malnutrition is particularly clear in scans of infants’ brains.

A well-fed child’s brain is a bushy network of fibres starting to fill the skull, while a malnourished child has a smaller network full of gaps.

After a young age, the damage can be irreversible.

This impaired growth and development is called stunting and can come with not just a personal cost to the child, but a huge economic cost to the country.

Ending it has long been a global public health goal, but it is still thought to affect nearly a quarter of children worldwide, and after decades of progress, the decline is stalling, the United Nations said last year.

Part of the solution to this problem could now come in bottles of cheap pills.

After decades of gathering evidence, advocates for pregnancy vitamin and mineral supplements called Multiple Micronutrient Supplements (MMS) say it is now clear these can have a big effect on stunting and work far better than commonly-used iron and folic acid pills (IFA).

A recent review published in the American Journal of Clinical Nutrition of 19 previous studies found that a UN-approved MMS formulation containing 15 different supplements reduced stunting at birth by nine per cent compared to IFA.

It reduced underweight births by 13 per cent and the prevalence of small head circumference – a sign of poor brain development – by 12 per cent.

The effect only got stronger with time, and at three months there was 14 per cent less stunting and a 16 per cent reduction in small head circumference compared with IFA.

Worldwide, these percentages represent huge numbers of children.

After decades of slowly gathering research, advocates for MMS believe the supplement’s time has now come, with more than 30 countries so far declaring they will switch from IFA.

“There are certain things that are easy wins and MMS is an easy win,” says Liezel Engelbrecht, a nutrition expert with South Africa’s Hold My Hand accelerator, a public-private partnership with the government.

“It’s a low hanging fruit with relatively high return on investment at a very biologically sensitive time [in a child’s life].”

A broad approach to stopping stunting also needs to look at other factors like income, the cost of food, breast feeding, and alcohol consumption, she said.

But if MMS was not a “magic bullet”, it was “a quick win that is not going to cost a lot and that we should definitely be backing”.

The growing adoption of this medicine is in no small part due to the efforts of Spencer Kirk, a businessman-turned-philanthropist who has sunk $220m into the project over a quarter of a century.

The UN first drew up the formulation, called UNIMMAP MMS, in 1999, but it has taken years to reach a point where he says MMS is now really taking off.

“We weren’t ready for prime time before. We are ready for prime time now,” he told the Telegraph by phone from his headquarters in Salt Lake City, in Utah.

The 65-year-old made his fortune building a company that made modems for laptops and by the late 1990s had retired.

But around 25-years ago he read a self-help book called Half Time about how high achievers who had spent a career chasing success and money often wanted something more significant in later life.

With a businessman’s head for figures, he asked a humanitarian friend to identify where his money would have the biggest return on investment to improve people’s lives in the developing world.

He was told the number one area was providing clean water and the second was improving maternal nutrition.

As a father of  four healthy children, and being one of 10 siblings born to an obstetrician father, he said he felt guilty that many women around the world had not had the same advantages.

So since then he has devoted his life and his Kirk Humanitarian foundation to making the case for  UNIMMAP MMS.

He said adoption had been slow at first because two hurdles had to be overcome.

Firstly studies had to clearly show that MMS was not only safe, but effective. Secondly the price had to come down so that MMS would be at least as cheap as IFA.

He said: “We needed the science to be proven that it was safe and superior to IFA. We needed the product to be affordable.”

The key milestone was to be able to produce a bottle of 180 pills for $2.22 (£1.66), which with years of investment, bulk buying and order planning, they have now managed to do.

He said: “Awareness is starting to build, but the most important place where it’s starting to build is ministries of health in low and middle income countries.”

“People are not aware that there are things that can be done to save human lives and to improve the human condition.”

The foundation has donated prenatal vitamins to 3.8m women in Afghanistan in the past two years, and 3.75m women in Pakistan.

Earlier this year in his state of the nation address, South Africa’s president, Cyril Ramaphosa, vowed to end child stunting by 2030.

The crucial time to do that is in a child’s first 1,000 days, from conception to their second birthday, say nutrition experts.

MMS supplements given to the mother while the child is growing in the womb have an outsized effect on the rest of their lives.

Ms Engelbrecht explained: “The first 1,000 days from conception until a child is two years old, that is the most biologically sensitive time of a child’s life.

“Approximately 80 per cent of a child’s development happens in that time. If a child is at a disadvantage in utero, then the child is starting off life at a big disadvantage physically, and cognitively and then the 24 months after is the biggest gap for catch up.”

Giving a child the best start in the womb can have an impact on the rest of their lives, says Mr Kirk.

“If we can get the birth right, we can have a significant impact on the trajectory and hopefully prevent a lot of stunting.

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