Exploiting DHS data from 235 regions in 29 Sub-Saharan Africa coun- tries, we ¯nd that the combination of low levels of malnutrition together with dramatically high rates of mortality, encountered in Kenya's Lake Victoria territory, is unique for Sub-Saharan Africa. This paper explores the causes of this paradox for the Kenyan context. Our identi¯cation strategy consists of two parts. First of all, we apply multilevel regression models to control simultaneously for family and community clustering of the observed malnutrition and mortality outcomes. Secondly, to address unobserved but correlated factors, we exploit information from GIS and malaria databases to construct variables that capture additional compo- nents of children's geographic, political and cultural environment. Our analysis reveals that bene¯cial agricultural conditions and feeding prac- tices lead to the observed sound anthropometric outcomes around Lake Victoria. In contrast, high mortality rates rest upon an adverse disease environment (malaria prevalence, water pollution, HIV rates) and a policy neglect (underprovision of health care services). Nonetheless, a signi¯cant e®ect of the local ethnic group, the Luo, on mortality remains