On the outskirts of Bamako, the capital of Mali, Tenindie Samake is making the rounds of the Yirimadio neighbourhood. In the courtyard of a concrete-block house, she measures the arm diameter of a thin child, determining that he is borderline malnourished. In another compound, housing 11 families, the kids look scrawnier still. One has an eye infection, so Samake advises treatment with eucalyptus leaves or expressed breast milk. In a third house, where there are no obvious health problems, she talks generally about monitoring symptoms, such as fever or diarrhoea, and asks the mother discreetly about contraceptive arrangements. These recommendations look rudimentary, but their impact has been nothing short of astounding. In the seven years since these interventions started, deaths of children under five have plummeted from 148 per 1,000, among the worst in the world, to seven — almost identical to the US. The key is Samake and hundreds of community health workers like her. A local re...

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