A new therapeutic food that can be used safely at home, combined with community-based treatment, is saving children in Malawi, Niger, Haiti and Sierra Leone and could save the lives of many of the world’s 20 million children under five who are suffering from severe malnutrition. This new approach has improved survival rates for severely malnourished children so dramatically during emergencies in Congo, Ethiopia, Malawi and Niger that international agencies want to see the approach used more generally. One doctor says the new therapeutic food is like an antibiotic for hunger.
The new evidence shows that about 75% of such children – traditionally treated in hospital with special milk-based diets - can be treated at home using highly-fortified, ready-to-use therapeutic foods (RUTFs) that can be eaten by children over six months of age. RUTFs do not need to be mixed with water, do not need refrigeration, and could be produced in all countries with high levels of severe acute malnutrition. So far, the only RUTF being produced locally is Plumpy’nut, developed in 1998 by Nutriset, the French company that has worked on humanitarian nutrition for two decades, and Dr. Briend of the Institut de Recherche pour le Développement. Local production is underway in Congo, Ethiopia, Malawi and Niger through franchises granted by Nutriset, and more requests are pending from other parts of Africa and the world.
In June 2007, the World Health Organization (WHO), World Food Programme (WFP), United Nations Standing Committee on Nutrition (SCN) and UNICEF jointly endorsed RUTF as the new standard for treatment of severely malnourished children worldwide. Implementing community-based interventions on a large scale, combined with strengthening of referral facilities for severely malnourished children with medical complications, could transform the lives of millions of children, says WHO.
Project Peanut Butter is a therapeutic feeding program for malnourished children in Malawi and Sierra Leone, founded by Dr. Mark Manary, a pediatrician at St. Louis Children’s Hospital and professor of pediatric medicine at Washington University School of Medicine. Dr. Manary, a world authority on severe childhood malnutrition, conducted the first clinical trials of RUTF, an energy-dense lipid paste similar to commercial peanut butter, but with added vitamins and minerals, powdered milk, vegetable oil, and sugar. RUTF, administered at home, offers a 95% recovery rate for severely malnourished children, compared with 25%-40% for the milk-based formulas, which required hospitalization. An estimated 200,000 children were treated with RUTF last year
Project Peanut Butter operates a factory in Blantyre, Malawi that produces several metric tons of RUTF each week. The factory uses machinery that efficiently mixes, grinds and packages ingredients into reusable 275g jars which are returned for cleaning and repackaging. Ingredients are obtained locally, except for vitamins and milk, which must be imported; WFP and UNICEF provide some of these ingredients. RUTF can be stored in large plastic drums, unrefrigerated, for months without spoiling.
The model Dr. Manary developed for RUTF production and distribution is efficient, cost effective and greatly benefits the local economy. Project Peanut Butter is primarily focused on Malawi, where 70% of all children are malnourished because they are fed a low-nutrient diet of corn paste, the only food available in rural Malawi most of the year. Until recently, 23% of Malawi’s children died before their fifth birthday. Project Peanut Butter’s factory now produces enough RUTF to feed two-thirds of Malawi’s severely malnourished toddlers, and the project is starting operations in Sierra Leone, which has the world's most devastating child mortality rate, at 28%.
RUTF, known locally as Chiponde, is carried by medical teams in Land Rovers to rural villages and other sites around Malawi. Local health service assistants encourage mothers to bring their ill children to the sites, where they are weighed, measured for height and arm circumference, and given a two week ration of RUTF if found to be moderately or severely malnourished. Teams return in two weeks’ time to check the children again. Generally, 95% of malnourished children recover on this formula within six to eight weeks, and maintain this recovery at a rate of 98% during the ensuing six months after-treatment; 96% maintain recovery over the course of a year. Project Peanut Butter trains local health service workers to assess pediatric malnutrition levels, encourage local participation and assist teams of medical professionals on site visits.
Médecins Sans Frontières (MSF) began using Plumpy'nut in Niger in 2004 and successfully treated more than 150,000 children for moderate and severe acute malnutrition by 2006; that region went from having Niger's highest malnutrition rate in 2004 to its lowest in 2006. MSF listed the successful new treatment as one of the 10 most under-reported humanitarian stories of 2006. “While continued efforts to address the underlying causes of malnutrition are critical, it is possible today to offer simple and effective curative treatment to tens of millions of children facing a high risk of death,” said MSF. Dr. Milton Tectonidis, MSF's chief nutritionist, says if the United States and the European Union were willing to spend part of their food aid on such RUTFs, more companies will start making them. "Even by taking a miniscule proportion of the global food aid budget, they will have a huge impact, huge impact!" he told CBS.
In Northern Uganda, International Medical Corps began training women to make Plumpy’nut themselves in 2007. Previously, the product was imported from France and distributed in the camps for internally displaced persons. In Haiti, Meds & Food for Kids (MFK) is using “peanut butter medicine” (Medika Mamba) to combat childhood malnutrition.
"It is urgent that this approach, along with preventive action, be added to the list of cost-effective interventions being used to improve nutrition and reduce child mortality," says Dr. Margaret Chan, WHO Director-General. "With this new approach, we have the right product composition to save millions of young lives – this is an example of the new technology and capacity which bring us closer to achieving the first Millennium Development Goal,” says WFP Executive Director Josette Sheeran. Following an informal consultation in 2005, WHO has worked with UNICEF to develop a field manual on community-based management of severe malnutrition.
Plumpy’Doz, an innovative approach to prevent child malnutrition in Somalia
UNICEF has introduced an emergency food supplement to prevent malnutrition in over 100,000 of the most vulnerable children in Somalia, where the national average prevalence of acute malnutrition is 18.6% - well above the 15% emergency threshold which signifies a very critical situation.
Made of vegetable fat, peanut paste, sugar, milk powder and added nutrients, Plumpy’Doz is packaged in 325g (11 ozs) plastic containers, enough for a weekly ration for a child. Three teaspoons of Plumpy’Doz three times a day provides each young child with additional energy, including fats, high-quality protein and all the essential minerals and vitamins required to ensure growth and a healthy immune system.
Produced by the French company, Nutriset, which also produces Plumpy'Nut®, a ready-to-use therapeutic food designed for severely malnourished children, Plumpy’Doz is the latest generation of nutritious, safe, convenient, and ready-to-use food designed to satisfy the nutritional needs of children aged six to 36 months and supplement food distributions by partners such as the World Food Programme (WFP) as well as other home food sources.
Plumpy’Doz is being distributed to children through health facilities, mobile health teams and where possible, through special Child Health Days, a joint WHO and UNICEF programme to accelerate young child survival in Somalia where access is severely limited dure to ongoing conflict. Once registered, children will receive this supplement for eight months.
On 18 December, UNICEF and local health authorities provided Plumpy’Doz to over 9,000 children living in poor urban areas and camps for internally displaced persons (IDP) in Bosasso, northeast Somalia where the highest rate of malnutrition ever in Somalia was recorded. As of 31 December, Plumpy’Doz is also being introduced to children in central and southern Somalia, where 75% of the targeted child population is located. The next distribution will aim to reach over 40,000 children in the Afgoye IDP corridor, home to the most densely populated IDP camp in the world and critical malnutrition rates compounded by limited humanitarian access.
“This is the first time that Plumpy’Doz will be distributed on such a large scale. UNICEF is working with partners to take proactive action to not only treat but prevent malnutrition," said Christian Balslev-Olesen, said UNICEF Somalia Representative. “By adopting this new approach, we aim to reach children before they become malnourished.”
This will complement efforts to advocate for exclusive and continued breastfeeding for the first six months and quality complementary foods well into the child's second and third year of life.
“In the face of Somalia’s complex humanitarian situation, using Plumpy’Doz is an innovative way to assist a population at risk and at the same time address the nutrition situation where one in six children is acutely malnourished at any point in time,” he continued. UNICEF will continue optimizing the use of Plumpy’Doz to reach nutritionally vulnerable children in high-risk areas as well other areas where nutritional needs arise.
two British doctors, Steve Collins and Alastair Hallam, have created a not-for-profit company called Valid Nutrition to manufacture packets of the peanut butter supplement in Ethiopia. The BBC says the company already owns a factory in Malawi, and has also subcontracted local factories in Kenya and Zambia.
While day-to-day manufacturing is managed by industrialists with experience in food manufacturing in the world's largest companies, the board is made up of humanitarians who have worked for major NGOs such as ActionAid and Plan International.
The BBC reports that Dr Collins turned from medicine to food manufacturing after fears that rocketing global demand for Ready-To-Use-Foods could not be met by the French firm that owned the patent for the recipe, Nutriset, which sells its food under the brand name Plumpy'nut. As a result, Valid Nutrition has become one of a growing band of companies paying Nutriset a royalty to use its recipe.
Valid Nutrition's Malawian factory has firm orders for almost 11 million sachets so far this year, compared with just 88,000 three years ago, the BBC says. The Ethiopian Hilina Enriched Foods Processing Centre plans to expand Plumpy'nut production from Ethiopia into east Africa this year and the Norwegian manufacturer Compact for Life began manufacturing in India two weeks ago and plans to expand to countries where Nutriset has not patented Plumpy'nut, the BBC said.
For other stories about practical health care solutions in Africa, see:
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