MALNUTRITION: CHAD: Fighting malnutrition with “dysfunctional” health sector

MAO, 19 March 2012 (IRIN)

 Photo: Anna Jefferys/IRIN
A mother feeds her severely malnourished son at the feeding centre of Mao district hospital in Kanem, western Chad

Hovering at around 20 percent in some places, Kanem Region in western Chad is well-known for having some of the world’s highest continual severe acute malnutrition rates. “Emergency” aid agency malnutrition responses have continued year on year since the 1980s.
Part of the problem is due to chronic food insecurity and drought that has affected much of the Sahel this year: This year some 3.6 million Chadians are food insecure due to poor rains, according to the World Food Programme. Dangerous care practices also play their role: Giving babies dirty water instead of breast milk, burning their chests when they have diarrhoea, among others.
But unless something is done to improve the country’s “dysfunctional” health system (as described by half a dozen interviewees), these malnutrition rates are unlikely to change significantly.
IRIN spoke to Ministry of Health staff, aid workers, government officials and mothers to find out if anything can be done to wean Chad from its dependence on emergency nutrition interventions.

"What doesn't need fixing?"
Taking a tour of the district hospital in Mao - one of two in Kanem Region - it quickly becomes clear the structure is a hospital in name only: most of the rooms are empty, without equipment, and there are few health staff around, other than in the aid agency-supported nutrition wing.
This low capacity is region-wide. Kanem has just six doctors for 410,385 people, according to the health district’s nutrition focal point, Maina Mahamat Abakar Sadick; 65 percent of health clinics are not operational because they have no staff; over half are run by someone unqualified to do so; and 65 percent of them are made of non-durable materials. One in four has no cold-chain facilities and so cannot administer routine vaccinations. As one nutrition expert put it: “What doesn’t need fixing?”
Nutrition, as a sub-set of the health sector, is de-prioritized and poorly understood, according to Dallam Adoum, who runs the Ministry’s of Health’s Centre of Nutrition and Technology (CNTA), which covers everything from prevention to treatment of malnutrition, and was set up before 1960 but still has no budget.
According to him, there are just 15 nutritionists officially working in the Health Ministry - excluding those who have been trained by aid agencies.
Understanding of the causes of malnutrition is pretty low within the Ministry, said Adoum.
This was backed up by Céline Bernier, nutrition coordinator at Action Against Hunger (ACF), who said little nutritional surveillance takes place other than that carried out by aid agencies (such as ACF, UNICEF, Médecins Sans Frontières and Worldvision, among others.) “The government recognizes there is a problem but it doesn’t necessarily know how to fix it,” she told IRIN.

Things, not people
When the government does invest (5-6 percent of the annual budget is spent on health, according to UNICEF), it tends to focus on “things” rather than people and processes, several analysts told IRIN. “The main problem is human resources,” said Roger Sodjinou, nutrition manager for UNICEF in Chad. “There is no clear idea of the HR strategy of the government.”
Francois Ndoubalhidi who runs the ostensibly independent organization to monitor the country’s petrol resources (CCSRP), says the same is true for the estimated US$1.9 million of petrol funds that are, according to him, directed to the health sector each year.
“The government is more into concrete investments - building health clinics for instance - human resources is not a priority,” he told IRIN.
Building up pools of trained staff requires vision and planning, but most of the 22 regional governments have no nutrition or health plans, according to a nutrition expert at one large aid agency, and “even national plans are not very clear.”
Due to support from aid agencies, 261 health centres across ten regions are now treating acute and severe malnutrition according to UNICEF. But this number must double to reach the 127,000 children expected to suffer acute severe malnutrition over the next six months, said UNICEF head Bruno Maes.

Picking up the pieces
On the nutrition front, aid agencies for the most part pick up the pieces, treating acutely malnourished children all over the country’s Sahelian zone - though gaps remain in parts of several districts, according to EU humanitarian aid body ECHO. LINK
The number of acutely malnourished children being admitted to ACF and UNICEF’s therapeutic feeding and treatment centres at the district hospital in Mao has shot up in recent months, according to Bernier and UNICEF’s nutrition coordinator in Mao, Augustin Ilunga.


 Photo: Anna Jefferys/IRIN
A nurse at Mao district hospital registers new patients into the nutrition wing

In 2011 they treated 14,400 severely malnourished children, and as of the end of February had already treated 2,000. “It looks like the numbers will be even higher this year,” he told IRIN.
Women come from all over the region to treat their children. Harmatta Ousmane,17, brought her 10-month-old son Abakar from the neighbouring sub-district of Kékédiné, after hearing about the Mao centre through neighbours. “I am learning a lot here about how to feed children - what food to give them, to boil water if they need to drink it,” she told IRIN.
However, many mothers often head too late to the centre so their children die en route - health clinics may take far too long to refer them, said Seydou Dicko, head of the ACF nutrition programme in Mao, or mothers go to the health clinic too late because they prefer to visit traditional healers.
These “healers”, however, often end up inflicting tremendous harm, said UNICEF’s Ilunga, burning children when they vomit or have diarrhoea; cutting off a part of their mouth when they have a cough; and pulling out their baby teeth when they are sick. “These healers are brutal, they do not understand the importance of diet or vaccinations,” said Naga Tibé who, as a member of a women’s association in Mao, tries to warn people against visiting them.
But while part of the solution lies in education and convincing families to change, unless health clinics are operational, many women have no alternative, they told IRIN.
Aid agencies are trying to boost government capacity. ACF trains and pays district health staff in nutrition prevention and care, and then tries to reintegrate them into the district health system - 28 have been reintegrated thus far.
UN and donor partners have helped the government develop a recruitment strategy, which aims to boost health staff by 1,000 countrywide this year. UNICEF’s role in this is to help the government recruit and deploy 400 parademics to regions in the Sahel belt.
People working to develop Chad’s water and sanitation sector - lack of drinking water and latrines has a big impact on children’s nutrition - now work hand in hand with nutritionists, and UNICEF is pushing for all health clinics to at least have latrines and running water (over half currently have no water source). Incremental progress in the water and sanitation sector should also improve nutrition statistics, some staff say: the government will sign off on its first sanitation strategy in April, and for the first time has set aside a national budget for sanitation.
The Health Ministry should take note and develop a malnutrition prevention and treatment strategy, with its own budget line, say aid agency staff. “We must profit from the current political stability to progress on malnutrition,” said UNICEF’s Maes.
The ministry could increase its nutrition performance by increasing its recruitment budget so there is at least one state-registered nurse at each health centre; include it in basic medical training; and up the number of places available in medical schools, said Bernier.
“Everything is a question of priority… Malnutrition is rarely a priority for men in power. Health care is expensive, and the more you develop your health system, the more expensive it gets… but there are also economic dividends, at least in the long term.”
The ministry can do little to impact the increasing frequency of droughts decimating harvests in the Sahel, but it can at least do what it can to improve its own systems. If not, said Ilunga, “We’ll just be here giving Plumpy’nut forever.”
http://www.irinnews.org/Report/95093/CHAD-Fighting-malnutrition-with-dysfunctional-health-sector

MALNUTRITION: Ethiopia: Concern over high levels of child malnutrition in Ethiopia refugee camps

Mark Tran, in Addis Ababa guardian.co.uk, Tuesday 22 November 2011



Somali refugees at the Kobe camp inside Dolo Ado, currently home to around 137,000 refugees. Photograph: Roberto Schmidt/AFP/Getty Images

Children at the Dolo Ado refugee camps in southern Ethiopia are suffering from acute malnutrition despite plentiful supplies of special food for under-fives, say relief officials.
Dolo Ado is host to around 137,000 refugees, most of whom have fled Somalia because of the famine and conflict between al-Shabaab, the Islamist militants, and the transitional Somali government. Refugees have also come from Sudan, Eritrea and Kenya.
Besides high levels of malnutrition, the transit centre is heavily overcrowded, having to take care of 8,000 people who are awaiting the opening of a fifth camp. This camp was supposed to have opened by the beginning of November. Relief officials attribute the delay to the need to put in proper sanitation facilities, but hope the camp will be up and running any day now.
Construction work has been hampered by the excessively hard soil. Aid groups want to avoid a repeat of the experience of the fourth camp, which opened before proper sanitation was in place. The importance of sanitation has been thrown into sharp relief by the outbreak of cholera in the massive refugee complex in Dadaab, in Kenya.
As they await the opening of the fifth camp at Dolo, relief officials are concerned about the high levels of malnutrition among under-fives despite the free availability of Plumpy'nut, a peanut-based paste in a plastic wrapper for treatment of severe acute malnutrition.
"Maybe they're not eating it properly," said Giorgia Testolin, head of the refugee section of the World Food Programme Ethiopia. "The food is there, there is easy access, but why is the situation so bad? This needs to be investigated."
A report by USAid and the Famine Early System Network (Fewsnet) last month said refugees regularly sell Plumpy'nut, mainly to buy sugar, tea leaves, powder milk and meat from the market. Children were also reported to come to the market to exchange Plumpy'nut for sugar.
The number of refugees arriving at Dolo peaked in June and July at 2,000 a day, falling to 350 a day in October due to rains that hampered movement. In recent days, unexpected rains have shut off the camp to UN flights, although plenty of supplies are on the spot.
Relief officials are bracing themselves for a surge in refugee numbers to Ethiopia after the rains end and the escalation of fighting in Somalia, as Kenya sent in troops to pursue al-Shabaab. As of 20 October, Ethiopia was hosting 256,000 refugees.
"We don't know what will happen," said Testolin. "Maybe Kenya will close its borders and more refugees will come to Ethiopia."
If they do, they will head to Dolo, the easiest spot in Ethiopia for Somali refugees to reach. Most arrive with little but jerry cans of water, having sold off most of their assets to pay for transport or other expenses.
In positive news from Somalia, the UN reported on Friday that three areas in Somalia that were declared to be in a state of famine earlier this year have emerged from the crisis as a result of the big relief effort.
The UN Food Security and Nutrition Analysis Unit for Somalia said the situation had improved in the affected areas in the southern regions of Bay, Bakool and Lower Shabelle, and they were no longer famine zones.
However, the UN humanitarian co-ordinator for Somalia, Mark Bowden, said that famine persists in parts of the Middle Shabelle and in the Afgooye corridor, near the capital, Mogadishu, which hosts a large number of internally displaced persons.
Valerie Amos, the UN under-secretary-general for humanitarian affairs, said in a statement that "progress is fragile and needs to be sustained".
"While humanitarian agencies have helped bring food, nutrition, water and sanitation help to millions of people in the last few months, I remain extremely concerned by the critical situation in Mogadishu and other parts of south and central Somalia," said Amos, who is also the UN emergency relief co-ordinator.
http://www.guardian.co.uk/global-development/2011/nov/22/children-malnutrition-refugee-camps-ethiopia?newsfeed=true

MALNUTRITION: Ethopia: The Crisis Continues: Dollo Ado to Open its Fifth Camp

19 November 2011 - 5:01pm By Sam Piranty Share
 
Photo Credit: Sam Piranty Dollo Ado, Ethiopia:

An extremely high level of malnutrition is apparent in Ethiopia's Dollo Ado refugee camps, which continue to expand in response to the on-going crisis in the Horn of Africa.
Malnutrition and overcrowding remain a real cause for concern in Dollo Ado, a collection of refugee camps in south eastern Ethiopia. The four camps at Dollo Ado are already at capacity with a total polulation of 137,000. It is set to open a fifth camp this weekend, Bur Amino. Though yet unpublished, recent results from a survey conducted in both Kobe and Hilaweyn camps have revealed extremely high malnutrition rates that surpass the emergency threshold of 15%. The issue is complicated by the fact that there is actually a good supply of food available. The World Food Programme (WFP), who are facilitating the General Food Distribution in the camps are providing staples such as cereal, pulses, Corn Soya Blend (CSB), oil, salt and sugar with other NGOs supplying further complimentary foods.
With the Ethiopian government and Médecins Sans Frontières treating those diagnosed with severe acute malnutrition, the WFP aims to tackle those with moderate acute malnutrition. If the programme is followed correctly patients can recover within 60-90 days. The fulcrum around which the programme revolves consists of a premix made up of CSB plus, oil and sugar. Every week, this is given to the mother of each household to distribute to their family. It is a vital part of the recovery process and Giorgia Testolin, Head of Refugee Section for the WFP in Ethiopia, believes that with this already available there should not be such widespread malnutrition across the four camps in Dollo Ado and claims ‘there is something wrong at the household level of the consumption of food’. The precise problem is yet to emerge although it has been suggested that it could be do with the sale of some of the provisions refugees receive. Many sell some of the food they receive in order to purchase other food items and commodities both within the camps and the host communities. However, Testolin believes that the premix is not sold and that ‘we expect refugees to sell part of the food to buy what is not in the food basket provided by WFP. Such as milk, meat, tomatoes and vegetables. They cannot have a standard diet every day’.
The problem of malnutrition does not therefore seem to be merely economic but rather manifests itself in a misconception of the nutritional significance of things like the premix and Plumpynut, a peanut based paste. Testolin believes that it is vital the refugee community develop a greater understanding of the importance of the consumption of the premix but suggests that this will take time for ‘it’s a cultural and behavioural change that cannot be reached in a couple of months... If you don't understand that this food is the right food for you, because as a pastoralist you may be used to camel milk and meat and you don't have that food which you believe is the food which will improve the health of your child. It becomes very difficult for the messages [outlining the importance of things like the premix] to pass through to the mothers and fathers...a lot more needs to be done in a community based approach through outreach workers.’ An assessment is due to be undertaken by the WFP, the UN Refugee Agency (UNHCR) and the Administration for Refugees and Returnee Affairs (ARRA) in December this year to try and both pinpoint the problem and develop a more comprehensive solution.
Overcrowding is also a major issue in the camps in Dollo Ado. Over seven thousand refugees are awaiting relocation in the transit centre with the opening of Bur Amino having been delayed for almost a month and the four remaining camps already at full capacity. The delay has been put down to a number of different factors. Previously, when the fourth camp opened early there were numerous problems with sanitation and services. It is therefore vital that because of the recent rains and overcrowding which increase the probability of the spreading of disease, that the fifth camp is completely finished before those in the transit centre move in. Furthermore, the soil around the site is particularly difficult to excavate and with the torrential rainfall taking the airstrip out of service and blocking the roads into the camps, many of the tools needed have been difficult to co-ordinate. However, Bur Amino is due to open this weekend, which will be a welcome relief for thousands of individuals and families. This could not have come at a more important time, in light of the recent intervention in Somalia by the Kenyan military and the tightening of border controls between Kenya and Somalia. Whereas before many refugees have suggested that Al Shabaab had blocked the route to Ethiopia and directed them toward Kenya, now those looking to flee Somalia will focus on reaching Dollo Ado rather than Dadaab.
http://thinkafricapress.com/ethiopia/crisis-continues-dollo-ado-open-its-fifth-camp

MALNUTRITION: NEPAL: Struggle to spread malnutrition awareness

MANGALSEN, 21 July 2011 (IRIN)

 Photo: Amy Lieberman/IRIN

Many mothers don't understand malnutrition

Convincing mothers their children need treatment in Nepal’s isolated rural districts is an ongoing challenge.

“All of my children look like this,” Dharma Bhatt, 26, told IRIN from her daughter’s bedside at Achham District Hospital, in the far west of the country. “I had no idea she was malnourished.”
A local female community health volunteer persuaded Bhatt to walk one hour to the public hospital after 12-month-old Mankala developed classic pneumonia symptoms. Bhatt did not suspect a lack of food was the cause for her daughter's weakness.
With almost half of all children under five stunted and a national global acute malnutrition (GAM) prevalence of 13 percent, child malnutrition is considered a silent epidemic in Nepal, according to the UN Children’s Fund (UNICEF). GAM is the percentage of children over six months and under five years old who have moderate or severe acute malnutrition.
In the country's mountainous western region, where road access is limited, child malnutrition is more widespread.
Achham District has a GAM prevalence of about 18 percent. Its low levels of education and food security, and its remote location present a challenge for health workers, who are struggling to change public perceptions of what constitutes a healthy child and what it takes to recover from malnourishment.
A trip to Achham District Hospital, near the district capital of Mangalsen, can involve days of hiking from some parts of the district.
“We have to beg mothers to admit their babies,” said Krishna Kadayat, a nutrition expert at the hospital, which provides free medical care. “Drop-out rates for follow-up appointments are also very high.”

Aid attempt
One programme, the Community Management of Acute Malnutrition (CMAM), implemented through UNICEF and the Nepal government and launched in January 2010, has brought health care options closer to those at risk of malnourishment by creating 26 health outpost centres, but the programme cannot flatten the mountains that lie between most peoples' homes and the hospital.

At the end of the district hospital's crowded, dimly lit hallway one recent Saturday morning, Paan Karishma looked on as her nine-month-old daughter Merina's arm was measured with a circumference tape, one of the diagnostic tools introduced by the CMAM programme. The pieces of tape crossed to indicate red, showing her arm circumference was slightly less than 12cm.

 Photo: Amy Lieberman/IRIN : Merina's arm is measured

Kadayat, who also serves as a CMAM monitor, silently mouthed “SAM” - severe acute malnutrition, the most advanced and threatening stage of malnutrition.
“Mothers see the tape visually and they understand,” Kadayat later said. “Before the tape we were judging malnourished cases by weight only, which is not the most accurate representation since children can swell.”
At the hospital, Karishma received 42 complimentary packages of Plumpy'nut, a high-protein peanut-based ready-to-use-therapeutic food. She said she would return after 14 days for a check-up and to get more Plumpy'nut.
It is the second time she has visited the hospital, and she reports that Merina does not like the taste of Plumpy'nut. Kadayat says she frequently hears this from mothers who keep the Plumpy'nut at home, or who eat it themselves if their children do not finish it.
She added that some mothers have also told her that their husbands do not like them taking food handouts from foreigners.

Health volunteers
Nepal's female community health volunteers (FCHV), estimated to number more than 50,000, play a variety of roles in this community, as they do across Nepal. Since the CMAM project was initiated, they are now responsible for referring suspected malnourished children to the hospital and informing mothers about the benefits of the unfamiliar Plumpy'nut.
But even some FCHVs, who take part in paid training sessions subsidized by UNICEF and the government, do not practice in their own homes what they have been taught.
Kokabita Vishwakarmas, an FCHV from Janalibandali Village Development Committee, said she has not measured her 12-month-old daughter's arm in six months and thinks she is malnourished. She explained that her measuring tape broke.
“She never eats anything,” Vishwakarmas said of her daughter at a meeting of volunteers more than an hour's walk from Mangalsen.
Achham (population 300,000) is among five western districts in Nepal that is hosting the CMAM pilot project, expected to expand after 2012.
http://www.irinnews.org/report.aspx?reportID=93283

MALNUTRITION: Uganda: UNICEF and the European Union combat malnutrition in drought-stricken Uganda

Jeremy Green
KARAMOJA, Uganda, 27 June 2011 – A passing herd of cattle is a common sight in Karamoja, where the sound of their hooves gets lost in the gusts of wind that carry dust far beyond the village limit.
This daily scene is a reminder of deeper issues that challenge this remote region in north-eastern Uganda. Here, swaths of arid, unproductive land and a culture of nomadic cattle herding have led to severe food shortages and devastating hunger.
Karamoja suffers from one the worst rates of malnutrition in the world. In 2010, 16 per cent of children under the age of five suffered from acute malnutrition, and nearly 40 per cent of children in this age group were underweight.
To tackle this critical problem, the European Union humanitarian aid department (ECHO), UNICEF and Action Against Hunger are working hand-in-hand with Uganda’s Ministry of Health, referral hospitals, health centres, and communities to integrate the treatment and prevention of malnutrition into routine health services.

 © UNICEF VIDEO In north-eastern Uganda’s remote, drought-stricken region of Karamoja, nearly 40 per cent of children under the age of five are underweight.

This effort, known as the Integrated Management of Acute Malnutrition programme in Karamoja, or IMAM, is helping curb malnutrition in the region, and save children’s lives.

Fighting for survival
One-year old Lochoto Lochero and Francis Lokiru, 2, are both children whose lives have been saved due to IMAM interventions. Lochoto suffered from kwashiorkor, a common type of acute malnutrition caused by a lack of protein in a child’s diet. He developed skin rashes and oedema, and his body was swollen due to water retention.
Francis suffered from marasmus, a form of malnutrition caused by not having enough calories and protein for long periods of time. Francis’ little body was severely emaciated as a result of the condition.
When the two boys were admitted to hospital, their odds of survival were low. But after seven days of intensive medical and nutritional care, they both recovered and were able to return home.

 © UNICEF VIDEO :
The nurse at Moroto Health Centre in Karamoja, Uganda, gives Francis' mother plumpy nut, a high-protein peanut-based paste, that will help treat his acute malnutrition.

Weekly visits to the nearby health centre over the following weeks – part of the IMAM programme’s follow-up care – led to increased health and well-being for the boys. Just two weeks after returning home, Lochoto’s skin rash had almost disappeared and the swelling had gone down. Francis’ weight had increased to seven kilograms, and he was gaining energy and liveliness.
The IMAM programme reaches beneficiaries like Lochoto and Francis at home through the efforts of Village Health Teams, who track weekly progress and take anthropometric measurements.

Health teams on the go
In order to address the root causes of malnutrition, IMAM also includes training for the health teams to conduct health promotion activities with mothers on nutrition, food security, water and sanitation.
As more weeks pass, Francis’ appetite is getting better and his little body has gained more weight and energy. Lochoto’s skin is also looking healthier and his smile much bigger.

The VIDEO is well worth watching and is accessed through the website below:

UNICEF's Dheepa Pandian reports on efforts to reduce malnutrition in Uganda's remote Karamoja region. Watch in RealPlayer
http://www.unicef.org/infobycountry/uganda_59021.html

MALNUTRITION: MADAGASCAR: Poverty and malnutrition on sisal plantations

AMBOASARY SUD, 23 June 2011 (IRIN)



 Photo: Hannah McNeish/IRIN
Lambo, 3, with his grandmother and mother

At the Centre for Treatment of Acute Malnutrition with Complications (CRENI) in the town of Amboasary Sud in the Anosy region of southeastern Madagascar, Samina Tahiaritsoa, 20, cradles her son, Lambo, 3, who still weighs less than six kilograms after 10 days at the centre.
According to the UN Children's Fund (UNICEF), two out of three Malagasy live in poverty and 50 percent of children younger than five have stunted growth due to malnutrition.
Tahiaritsoa is nine months pregnant with her third child, but has only a tiny bump to show for it. Her US$15 salary from working 10 days a month on a local sisal plantation must support the 20 members of her household, who get by on one small bowl of corn each a day and eat meat just once a month when she gets paid.
Already one of the world's poorest nations, Madagascar’s protracted political crisis has deepened poverty. In the drought-prone south, the increasingly unpredictable climate is pushing the risk of acute malnutrition among children even higher, particularly during the "lean season" between October and March when food is scarce.
"When you have a drought, an emergency, prices of food go up and a child doesn't get fed, or gets fed very little over a short period of time," said UNICEF spokesperson, Shantha Bloemen.
Prices of cattle and goats fall during a drought, as households sell off their livestock and eventually resort to consuming seeds and tamarind mixed with ash to survive.
UNICEF supports 49 centres for treating severe malnutrition across the island. A chart at the CRENI in Amboasary Sud shows that around a third of the 130 admissions in 2010 occurred between March and May (the end of the lean season), but local doctors say drought is a cyclical problem affecting the region every few years, while other longstanding social and economic problems are a constant threat to food security.
Children are admitted to the CRENI after weight-for-height measurements determine they are suffering from acute malnutrition. Another centre for acute malnutrition without complications (CRENAS) is attached to the health clinic in Amboasary Sud.
Bloemen said chronic malnutrition is usually caused by poor feeding practices over a period of time, like not exclusively breastfeeding for the first two years of a child's life, or a lack of protein and other nutritious foods in their diet.
"They'll grow, they won't die, but they basically won't ever grow to their proper full size, and it can affect their mental development," she said.
"Above all, it's the poverty that's causing this," said CRENI's head doctor, Samuel Rasaivaonirina, adding that most wage earners support an average household of 10 people on just $10 a month.
They usually earn this paltry living either from small-scale farming or working on the sisal plantation that stretches for kilometres outside the town and has remained in the hands of its French owners since Madagascar gained independence from France in 1960. In an area with over 220,000 people, the plantation takes up 80 percent of arable land in five of the 16 communes (villages).
"The people in these five communes are always poor, always in difficulty. Even in prosperous times for the rest of our region, they are food insecure," said district doctor Andry Rabetsivahiny. "The proof is that in our CRENAS, almost 70 percent of the children admitted come from the sisal-growing areas."
Clinic staff and community health workers trained to identify malnutrition refer children to the CRENAS, from where the most severe cases and those with complications are sent to the CRENI. Rasaivaonirina said children normally spent 10 days in the CRENI and after gaining sufficient weight, were moved back to CRENAS, where mothers and children are provided with support and education.
They also receive supplies of Plumpy'nut - a ready-to-use therapeutic food - to take home. This highly nutritious peanut paste containing micronutrients plays a vital role in an area where 60 percent of the people live more than 5km from the nearest health centre.
Lambo’s severely malnourished state has made him vulnerable to a diarrhoeal infection and he has lost weight since entering the CRENI nine days ago. He will need a course of antibiotics before he can make progress and be discharged. Such complications, which are common in children whose immune systems have been weakened by malnutrition, can quickly lead to death if left untreated.
Rabetsivahiny noted that local "fady", or taboos relating to eating certain foods, has contributed to widespread protein deficiency in an area where meat is an unaffordable luxury for most.
"Children are forbidden from eating eggs and chicken, and sweet potatoes can only be eaten as soon as they are dug up," he said. Chickens are considered "dirty", and eggs are believed to make women and children mute.
He added that men in the area often have numerous partners and are considered wealthy according to how many children they father. The result is large families, often headed by single mothers who struggle to earn enough money to support their children.
Tahiaritsoa was only able to breastfeed Lambo and her other child for two months before going back to work at the plantation. Now, with another child on the way, it seems even less likely she will be able to feed her ever-expanding family.
http://www.irinnews.org/report.aspx?reportID=93050

MALNUTRITION: AID POLICY: Call for local manufacture of nutrition-rich foods

MEDFORD, USA, 6 June 2011 (IRIN)

 Photo: Georgina Cranston/UNICEF
Plumpy'Nut destined for Southern Sudan

Why ship-in nutrition-rich foods from abroad to treat malnourished children when they can be made locally, at a fraction of the cost?
Nutrition expert Steve Collins believes it is not only a waste of money for aid agencies to import ready-to-use therapeutic foods (RUTF) manufactured in Europe or the USA, but also a lost opportunity to develop an added-value local manufacturing capacity.
Collins points out that developing countries such as Botswana and India have developed their own RUTF but many aid agencies, including the UN, prefer to buy branded RUTF manufactured abroad such as Plumpy'nut - a lipid paste made from peanuts and milk powder and fortified with vitamins and minerals proven to be effective in treating severe acute malnutrition.
Part of the reason for this was that similar peanut pastes produced in poor countries do not meet the stringent UN requirements on aflatoxin content, which it has set at a maximum of five parts per billion (ppb).
“You can sit in the US and eat food with aflatoxin content of 20 ppb, but if a peanut paste made in Malawi has an aflatoxin content of even 10 ppb it will not be approved by the UN agencies [for use in an intervention programme run by them],” said Collins, addressing a panel discussion at the World Conference on Humanitarian Studies at Tufts University, Medford, USA, on the opportunities in scaling up nutrient-rich food aid.
As a result the cost of product manufacture goes up. Ingredients such as milk powder also add to the costs.
Aflatoxin is produced by a species of fungus which contaminates the peanuts after they are harvested and can affect the liver and even cause cancer. Moderate levels of aflatoxin can moderate a child’s growth. International food standards allow for a maximum of 10-20 ppb of aflatoxin.
NGOs are experimenting with other locally available protein sources such as chickpea to bring the costs of RUTF down.
Jean Herve Bradol, the former president of Médecins Sans Frontières, suggested during the discussion that perhaps a headline-grabbing campaign, similar to those which led to the eradication of small-pox and the manufacture and use of generic antiretrovirals to treat HIV, was needed to create a momentum to tackle malnutrition.
These efforts would help to find a way towards cheaper and more sustainable alternatives.
Maria Kasparian, who heads Edesia, an NGO set up in the USA by Nutriset, the manufacturers of Plumpy’nut, said they were collaborating with partners in developing countries to produce RUTF locally.

Effective distribution networks
Mark Moore, a manufacturer of RUTF in the USA who was trying to set up a plant in Rwanda, said local manufacturers would not be able to handle the distribution networks required to scale-up operations.
He suggested partnerships with private sector multinationals, which have good distribution networks even in remote corners of Africa, such as soft drinks manufacturers.
Bradol pointed out that multinationals are not altruistic and the product would still be unaffordable for the poor. “Price will always be a factor,” he said.
In a commentary in the February 2011 edition of the journal of the World Public Health Nutrition Association, Michael Latham of Cornell University’s nutritional sciences division, and Urban Jonsson, the former chief of nutrition at the UN Children’s Fund (UNICEF), and others caution that the debate around commercial RUTF as a “miracle” cure could distract attention from “rational and sustainable policies and programmes” such as the promotion of breastfeeding.
“As things now are, 'scaled-up' delivery of commercial or foreign 'packages' of nutrition interventions is being aggressively promoted, inside the UN, and outside by major governments, their agencies, foundations, and other big NGOs. Branded, commercial RUTF is now part of these packages," the authors noted.
“In contrast, the promotion of community-based and local government-supported empowerment of people living in poverty to claim their human rights to good nutrition, which is the rational way forward, is neglected.”
Even severe acute malnutrition can be treated with local foods. The authors noted India’s refusal to allow UNICEF to import commercial RUTFs in 2009. About 49 percent of the world’s malnourished children live in India. The authors said: “For decades good Indian hospitals have successfully treated severe acute malnutrition with local foods, comparable to the sugar, casein, oil and milk commonly used in Africa.”

http://www.irinnews.org/report.aspx?reportid=92913

MALNUTRITION: Yemen: Plumpynut to the Rescue

William Lambers: May 25, 2011
The political unrest and violence in Yemen are not the only battles ongoing in the impoverished country. The smallest children in Yemen have their own struggle against deadly malnutrition. Yemen has one of the highest child malnutrition rates in the world.
That is why three UNICEF trucks with life-saving plumpynut arrived in Sa'ada governorate in Northern Yemen last week. Plumpynut is a special peanut paste which can give small children the nutrition they need to survive.

 (Mohammed Al-Asaadi/UNICEF)

A convoy of three trucks loaded with UNICEF emergency supplies funded by the UK Department for International Development (DFID), makes it through to Sa’ada on 19 May 2011
Children who lack the right foods early in life can suffer lasting physical or mental damage. They may even perish. If enough plumpynut were in Yemen or other needy countries, you could prevent many deaths related to malnutrition. Plumpynut comes in a package and requires no refrigeration or cooking, so it's fairly easy to distribute.
UNICEF says the plumpynut and other supplies "will cover the required treatment of 3,000 children under the age of five suffering severe acute malnutrition. This figure represents about six percent of the total number of severely malnourished children in Sa’ada."
Also, UNICEF reports that a nutritional survey conducted in 2010 showed about 45 percent of children under the age of five are acutely malnourished in some districts of Sa'ada. More investment in plumpynut and other interventions is needed from the international community to save these children.
Geert Cappelaere, head of UNICEF Yemen, says, “The arrival of the convoy is a breakthrough for enhancing humanitarian space and ultimately for delivering the urgent assistance all children in conflict-affected Sa’ada require."
Sa'ada has seen years of conflict between the government and the Al-Houthi rebels. A lasting peace treaty is desperately needed. There has to be a united front against the worst enemy—hunger.
Cappeleare warns, "The supplies will last for one to three months, so we must make sure a continual pipeline of life-saving supplies is secured.” Much more work needs to be done to enhance the lives of children in Sa'ada and other governorates of Yemen. This is an area where we can take action now.
 http://blogcritics.org/culture/article/plumpynut-to-the-rescue-in-yemen/#ixzz1OOjwFNew

MALNUTRTION: UNICEF Yemen has delivered life-saving nutrition supplies (Plumpy'nut)

UNICEF and DFID deliver life-saving nutrition supplies to Saada



21/May/2011

SANA’A, 21 May (Saba)- In cooperation with the UK department for International Development, UNICEF Yemen has delivered life-saving nutrition supplies to the governorate of Saada in northern Yemen.

The three truckloads included life-saving therapeutic food Plumpy Nut, anthropometric scales, antibiotics, micronutrient supplements and other medication and equipment related to the management of acute malnutrition.
The supplies will cover the required treatment of 3000 children under the age of five suffering severe acute malnutrition. This figure represents about six percent of the total number of severely malnourished children in Saada.
“With some of the worse rates of malnutrition in the world, many children are suffering as a result of the humanitarian crisis in northern Yemen. British-funded supplies are now helping to save lives in Saada, thanks to the delivery of this emergency aid, including medicine and food supplements. But the suffering here is extensive and established. That is why we have just confirmed additional British support for UNICEF to tackle malnutrition in tens of thousands more children affected by the conflict”, UK Minister of State for International Development, Alan Duncan said.
The delivery is part of UNICEF Yemen’s emergency response plan, geared to provide all 15 districts in the conflict-ridden governorate of Saada with malnutrition management services. The governorate has long suffered repeated bouts of armed conflict between government-backed and Al-Houthi armed groups, displacing more than 300,000 people, a large number of whom are school-aged children.
The governorate has been inaccessible to humanitarian assistance for several years because of the conflict, and recorded some of the highest levels of acute malnutrition in the world. According to a nutritional survey conducted in 2010, about 45 percent of children under the age of five are acutely malnourished in some districts.
“The arrival of the convoy is a breakthrough for enhancing humanitarian space and ultimately for delivering the urgent assistance all children in conflict-affected Saada require”, says UNICEF Yemen representative Geert Cappelaere. “The supplies will last for one to three months, so we must make sure a continual pipeline of life-saving supplies is secured”.
It is estimated that the supplies will help revive and boost the services of 29 health facilities in the governorate, which have been semi-operational since the recent outbreak of armed conflict. With DFID funding, UNICEF has previously helped train 130 health workers in outpatient therapeutic programmes, therapeutic feeding centres and outreach mobile clinics, kickstarting the delivery of malnourishment services in Saada governorate. However an additional 300 health workers and 2,600 community health volunteers need to be trained to further boost the services in 95 health facilities throughout the governorate.
“Thanks to all involved parties, this life-saving corridor was now made possible”, says Cappelaere, “and with continued commitment of all, malnutrition can be eradicated. But this will require continued investment, commitment and capacity-building”.
http://www.sabanews.net/en/news241775.htm

POVERTY: Hunger is a business

April 06, 2011


The world's hungry people may not seem like an investment opportunity, but that is how nutrition expert Dr Steve Collins wants them to be seen. As Dr Collins puts it, hunger is a $10bn (€7.1bn) opportunity. "The multinationals are beginning to be interested. We have to show them the evidence that the market is there."
The economist Amartya Sen has written that famine is almost always a problem of food distribution and poverty, not global food production. In validation of his research, the Food and Agriculture Organization estimates that 80 percent of malnourished children in the developing world live in countries that produce food surpluses. The socioeconomic aspect of the problem is even starker when one considers how much edible food is discarded annually in the West as waste.
Every year, more than 10 million children under the age of five die globally, and malnutrition is associated, directly or indirectly, with more than half of these deaths. Chronic undernutrition is the underlying cause for many of the principal child killers including diarrhea, pneumonia, malaria, measles, and AIDS. Malnutrition compromises child immunity such that episodes of illness tend to last longer or be more severe, thus interacting with infection in a vicious cycle.The World Health Organization cites malnutrition as the single gravest threat to global public health. Nearly 20 million children under age five suffer from severe acute malnutrition.
Nutrition is widely regarded as the most effective form of aid. Because foods such as wheat and soy do not contain a full complement of vitamins and minerals, emergency rations often provide the 40 essential nutrients that are critical for the first 1,000 days of life in sachets of fortified powders, mixed with peanut butter, or directly through supplements. 'Ready-to-use therapeutic food' (RUTF) is a term that could be used generically to refer to any food known or reliably believed to have special benefits as therapy, in particular in cases of severe acute undernutrition. However, as now used, the term refers to a nutrient-dense and energy-dense peanut-based paste originally designed primarily for the treatment of severe acute malnutrition in young children. It can be consumed directly by the child, and does not need to be mixed with water. It can be stored for three to four months without refrigeration, even at tropical temperatures.
'Scaled up' delivery of commercial or foreign 'packages' of nutrition interventions is being aggressively promoted, inside the UN, and outside by major governments, their agencies, foundations, and other big non-government organisations. Branded, commercial ready-to-use therapeutic food is now part of these packages. In contrast, the promotion of community-based and local government-supported empowerment of people living in poverty to claim their human rights to good nutrition, which is the rational way forward, is neglected. The commercially produced RUTF, bought and distributed by UN agencies and non-governmental aid organisations, is a totally unaffordable option for most people who live in poverty. The promotion of RUTF is now medicalising and commercialising the prevention of malnutrition, which is better achieved by local measures to improve food intakes, health services and child care. It is unrealistic, and even irresponsible, to suggest that RUTFs could be provided worldwide to the very many millions of children identified as having mild malnutrition or chronic hunger. Food is a necessary but not a sufficient condition for preventing young child malnutrition. Good child nutrition always simultaneously requires food, health and care. In other words, adequate household food security, access to basic health services and adequate caring practices, are all necessary. Many feeding programs are able to improve childhood malnutrition, but unfortunately, the effects are usually temporary. Children gain weight while in the feeding program, but then lose it again once they are not being fed.
The products are expensive. At around US 6 cents a package, a full two-month treatment with Plumpy'nut costs around US$ 60 a child. Parents of children with severe acute malnutrition cannot afford this. The costs so far have been borne primarily by United Nations agencies and by international non-governmental organisations such as MSF and it is not clear if these quoted costs include the price for delivery and distribution. A recent article co-authored by economist Jeffrey Sachs estimated that the direct cost of providing Plumpy'nut to the billion people reckoned to be hungry in the world would be US $ 360 billion per year.
In most cases as with Plumpy'nut, peanuts from the South are shipped to the north, the product is made commercially in France and is then shipped back south. Nutriset (Plumpy'nut) currently produces 80 percent of the RUTF market, sold commercially to aid agencies and NGOs. Nutriset produced 14,000 tons of its trademarked Plumpy'nut line of products in 2009 for sales totaling $66 million. The family-owned company has paid out millions in dividends. Even with franchises for the local production of RUTF, many of the ingredients and packaging materials are imported. What are the social, economic and other implications of a move from family foods to wide use of RUTF for people who live in poverty? The situation would be very similar to the negative effects of the aggressive promotion and marketing of breastmilk substitutes as witnessed by the Nestle baby-milk .
There was no foil-wrapped snack-bar answer to the persistence of poverty only social change can remedy the problem. Food security is about meeting the dietary needs of all people, at all times, enabling them to live a healthy life and not to be constantly in fear of the vagaries of the market. Only by addressing the monetary element, by coming to terms with the absolute necessity of removing it and any profit motive from the food supply will farmers, consumers and all the peoples of the world have the security of knowing that sufficient food is available to all, at all times and in all situations. Food security for all the world's citizens is just not possible in a capitalist system. Food production should be about meeting the self-defined needs of people, not a profit-motivated venture for corporations, agribusinesses and their boards and shareholders.
One aid agency writes " What we can foresee, is the possibility of amplification of the RUTF market by transnational food corporations, with their own branded products. In this scenario, Nutriset would play only a small part in a much bigger play. This would make mothers and children throughout the South into targets for company brands, seamlessly from birth to weaning throughout young childhood, and then on to adolescence and throughout adult life. Ironically, the families most able to buy such branded products would be those in least need of them. Is this the plan?"
Enter Spammy, a turkey spread that has been fortified with zinc, iron, B vitamins, and other essential vitamins and minerals. “Hormel Foods sought to create a product high in protein to help serve malnourished and poverty-stricken communities worldwide,” said Jeffrey M. Ettinger, chairman of the board, president and chief executive officer at Hormel Foods “The children who eat Spammy are more active, their grades are improving, and overall, they are happier and healthier.”

http://socialismoryourmoneyback.blogspot.com/2011/04/hunger-is-business.html

MALNUTRITION:

Laurance Allen : April 5, 2011

Steve Collins has worked in some of the worst famines and wars—Somalia, southern Sudan, Angola, Burundi, Rwanda, (then) Zaire, Liberia, Sierra Leone, and North Korea. During the late 1990s, while in his mid-30s, Collins was running a nutrition program in Liberia. He was an expert in tackling malnutrition by establishing large therapeutic feeding centers where malnourished patients were admitted for an average of 30 days.
His years of experience treating patients led Collins to a breakthrough idea that has changed the landscape of how severe acute malnutrition is treated in the developing world. Collins found that people were drinking contaminated water en route to the feeding centers, or were falling ill to parasites and other diseases within the centers, where mortality rates of 30 percent were routinely recorded. He researched and tested a plan for "community-based therapeutic care" by taking the treatment directly to the sufferers. His new method lowered mortality rates to 4 percent.
The results were initially met with skepticism, but Collins persisted in presenting his case to others in the field until nine years later the United Nations accepted his findings and endorsed his demonstrably better way. The results of his pioneering work were published in the journal Nature.

Scale of the Problem
Every year, more than 10 million children under the age of five die globally, and malnutrition is associated, directly or indirectly, with more than half of these deaths. Chronic undernutrition is the underlying cause for many of the principal child killers including diarrhea, pneumonia, malaria, measles, and AIDS. Malnutrition compromises child immunity such that episodes of illness tend to last longer or be more severe, thus interacting with infection in a vicious cycle.
The World Health Organization cites malnutrition as the single gravest threat to global public health, and nutrition is widely regarded as the most effective form of aid. Because foods such as wheat and soy do not contain a full complement of vitamins and minerals, emergency rations often provide the 40 essential nutrients that are critical for the first 1,000 days of life in sachets of fortified powders, mixed with peanut butter, or directly through supplements.
Shelf life is one advantage of the peanut sachets, and proponents tout that they don't have to be reconstituted with local water, which is often contaminated. But it is also a disadvantage that peanut butter doesn't provide any water and so must be washed down, as anyone who has ever eaten a spoonful can attest. In some cases it may be preferable for an infant to continue breastfeeding so as to receive nutrients and sanitary hydration at the same time.
The economist Amartya Sen has written that famine is almost always a problem of food distribution and poverty, not global food production. In validation of his research, the Food and Agriculture Organization estimates that 80 percent of malnourished children in the developing world live in countries that produce food surpluses. The socioeconomic aspect of the problem is even starker when one considers how much edible food is discarded annually in the West as waste.
Severe acute malnutrition (SAM) is defined as a weight-for-height measurement of 70 percent or less below the median, or three standard deviations or more below the mean reference values posted by the CDC National Center for Health Statistics. A mid-upper-arm circumference of less than 110 mm can be used to measure this in children ages one to five years.
Nearly 20 million children under age five suffer from SAM, and the disorder is associated with 1 to 2 million preventable child deaths per year. Hundreds of millions of other children suffer from chronic malnutrition, which results in stunted development and lifelong negative impacts on earning potential.

The New Silver Bullet?
Ready-to-use therapeutic foods (RUTF) have lately been a subject of discussion in the media. For example, World Nutrition ran a February 2011 feature on "RUTF stuff: Can the children be saved with fortified peanut paste?" The article leads with this thought:
'Therapeutic food' in general is any appropriate food product or products, enhanced nutritionally, and thus made to be more energy-dense and more nutrient-dense. When needed, usually in emergency situations, it should be used in effect as medicine, in conjunction with necessary therapy, for as short a time as possible. 'Ready-to-use therapeutic food' (RUTF) … is a specific type of therapeutic food, now almost always in the form of commercial products, which in the last several years has leapt onto the nutrition scene. It has some special benefits. It is creating new opportunities, new challenges and, in our judgement, an increasing number of new problems.
The World Nutrition editorial discusses what might happen if Big Pharma or Big Snack were to take over and dominate the large, underserved RUTF market. Echoes of Nestlé promoting its infant formula over breast milk certainly haunt the conversation.
Similar concerns were addressed in depth last year in the "The Peanut Solution" in New York Times Magazine. The French company Nutriset currently produces 80 percent of the RUTF market, sold commercially to aid agencies and NGOs. Nutriset produced 14,000 tons of its trademarked Plumpy'nut line of products in 2009 for sales totaling $66 million. Plumpy'nut is mostly manufactured in France and shipped to the developing world, and the company has come under criticism for overzealous patent enforcement when children's lives are at stake.

The Valid Way
Recognizing an opportunity, Collins founded Valid Nutrition in 2005 to make and market his own line of RUTF peanut pastes. The company is set up as a charity and its business model is based on locally grown inputs, as well as local manufacture and delivery. With operating plants in Malawi and Kenya, and a new one coming online in Ethiopia in a few months, Valid is approaching sustainability. Being structured as a registered charity has limited the firm's ability to raise capital, as compared to the for-profit Nutriset, which is well capitalized the old-fashioned way.
Another challenge Valid faces is that peanuts are prone to contamination by aflatoxins and need to meet strict UN guidelines of less than 5 parts per billion, so the company's researchers in Africa are constantly conducting efficacy trials of various combinations of locally grown crops. Valid products are medical doses to treat malnutrition and so must be dispensed by health personnel from a national government, NGO, or other qualified outfit.
While Valid's social enterprise model may differ from the patent-based for-profit approach, Collins believes that major corporations have yet to grasp the full corporate social responsibility potential in preventing malnutrition at the bottom of the pyramid, a market he estimates at $10 billion.
It is worth noting that in October 2010 Nutriset announced that it would extend access to its patent through a "user agreement" in selected African countries.
Collins immediately welcomed this move:
We believe that Nutriset's decision enables increased and meaningful competition for the production of Ready to Use Foods and is an important step forward. Since the global acceptance of the community-based model for the treatment of Severe Acute Malnutrition, developed by our sister organisation Valid International, supported by Concern Worldwide and Irish Aid, worldwide demand for these products has escalated dramatically, outstripping supply. Increasing competition in this vital market will help to increase the availability of these life saving foods to people who need them and reduce the price.
Collins, meanwhile, has entered into an agreement with the innovative for-profit Two Degrees. For every snack bar Two Degrees sells in the West, it purchases a Valid Nutrition sachet and donates it to a malnourished child in Africa, with the doses administered by Partners in Health.
In this manner, Valid Nutrition is bringing some balance and food security to a world facing an unprecedented spike in food prices.
http://www.policyinnovations.org/ideas/innovations/data/000189

MALNUTRITION: Plumpy'nut supporter

Every year, more than 15 million children die from malnutrition. Thats one child every six seconds. Just Jewelry is honored to partner with Doctors Without Borders in its mission to save children from malnutrition through the distribution of a revolutionary product called Plumpynut. This ready-to-eat, vitamin-enriched nutritional supplement can mean the difference between life and death for a
To support the Plumpynut Project, Just Jewelry has designed a bracelet to raise funds. They are affectionately calling the project Get Nutty, implying both a call to action and symbolizing the life-saving product Plumpynut. For each bracelet sold, Just Jewelry will donate the funds necessary to provide two Plumpynut meals to a malnourished child. We are so excited to watch God do incredible things through this effort of sharing Faith, Hope and Love around the world, says Virginia Depp, Co-Founder of Just Jewelry.
http://hollywoodindustry.digitalmedianet.com/articles/viewarticle.jsp?id=1404846

MALNUTRITION: The origins of Plumpy'nut

The French doctor André Briend is the father of the “peanut butter” idea, after much thinking about ways of treating severe malnutrition. He realized that this substance keeps well in warm places on people’s shelves without going bad and retains its nutritional value well.
Professor Per Ashorn’s group heard about the idea in the early 2000s and invited Dr. Briend to visit Malawi.
Children with severe malnutrition can be treated in many different ways. But using Plumpy Nut (pictured) all that is needed is three sachets per day and some drinking water. No cooking, no other ingredients, no other meals.
Research on the substance speeded up, and it became famous, largely due to clinical trials and public health interventions conducted in Malawi. Dr. André Briend is currently an adjunct professor at the University of Tampere.
“Remedying a state of malnutrition is quite tricky. If a person is severely undernourished, trying to put things right the wrong way or too fast can even end in death,” says Per Ashorn.
A severely undernourished child should be treated should be treated with three sachets of peanut butter a day and some drinking water. No cooking, no other ingredients, no other meals.
The preparation reminiscent of peanut butter includes milk powder, sugar, peanuts, oil and minerals. The fatty acid component is still under consideration: rape oil has a good consistency but is not easy to obtain in Africa. Soya oil is now being tested.
“Among the ingredients milk power is very costly. It would be nice if we could replace it with something.”
The paste should be as tasty as possible. The sachets go around the world, sometimes there is a meeting to taste the preparation and then it is either accepted or rejected.
As a former green politician Ashorn wants to draw attention to the packaging.
“It’s not a good thing to have the whole of Africa full of this foil. Cans are easier to reuse.”
The company manufacturing Plumpy Nut (pictured) has taken out a free patent on the product, that is, anybody at all can manufacture it locally.
“Whatever country you go to where there is severe malnutrition you will see this product or something like it being used.”
One important question is who should receive the product. In children the onset of malnutrition is generally before birth, possibly even before conception.
Ashorn’s group is currently starting up a new study in Malawi to find out about the combined effect of infections and nutrition and to attempt to make a difference in the nutrition of pregnant women.

http://researchandstudy.uta.fi/2011/03/09/saving-the-world-%E2%80%93-with-peanut-butter/

MALNUTRITION: London, Yemen, and Plumpy'nut

William Lambers : Feb 16, 2011
London has hosted many important conferences over the years. Herbert Hoover received an invitation to one of them almost immediately after arriving in Britain in April 1946. His invitation was to an emergency conference on European food supplies in the aftermath of World War II.
Hoover, then serving as the U.S. food ambassador, made a speech at the conference. He urged action, particularly child feeding for the war-torn countries. Hoover said, "The rehabilitation of children cannot wait. It cannot be postponed until some other day. They are not like a bridge or a factory. They lose ground every day that is lost."
Infant children, without proper nutrition in the first 1,000 days, can suffer lasting physical and mental damage. That is a key theme of an upcoming conference in London which will focus on malnutrition in Yemen.
Yemen is often in the headlines because of the terrorist elements that plague their society and threaten the United States. More recently, Yemen has also been in the news because of protests by the citizenry against their government.
Less often, though, do you hear of the terrible malnutrition that afflicts the population, with its greatest impact on infants. The UN World Food Programme says that "half of Yemen's children are chronically malnourished."
The Yemen malnutrition conference will analyze the crisis at hand, what is being done, and the way forward to ending malnutrition in Yemen. It is problem-solving for the greatest of all threats to Yemeni society: hunger and malnutrition.
ABC News recently presented a special highlighting the miracle food plumpy'nut and how it can save children from dangerous levels of malnutrition. Well, plumpy is something Yemen is in dire need of, and it would not cost very much, relatively speaking, for them to get it.
UNICEF and the UN World Food Programme (WFP), with enough funding, could treat severely and moderately malnourished Yemeni children. Dr. Wisam Al-timimi of UNICEF said late last year that "about $31 million will be needed to address both moderate and severe malnutrition country-wide."
WFP needs about $23 million for its plumpy plan to feed small children. Georgia Warner of WFP says, "270,000 children (6-59 months) would receive targeted supplementary feeding (supplementary plumpy) and 412,000 children (6-24 months) would receive blanket supplementary feeding (plumpy'doz)." This is part of an overall WFP operation aimed at increasing food security amidst high food prices, feeding displaced war victims, and rehabilitating agriculture.

Getting these supplies is the first step, but then you have to also look toward long-term solutions. Minds have to meet, but cooperation between the Yemeni government and the international community must also be forged. There must be political will. With that will come some much-needed funding.
When Hoover spoke in London in 1946, there was a threat of millions of Europeans facing starvation. Food supplies were mustered and a European reconstruction program, the Marshall Plan, started in 1948. The organization UNICEF was formed during this time period. Child feeding and rehabilitation became a top priority.
The Yemen malnutrition conference is being hosted by UNICEF and the Yemen Forum on February 22nd at the Chatham House in London.
 http://blogcritics.org/culture/article/london-yemen-and-plumpynut/page-2/#ixzz1EcqtKIIC

MALNUTRITION: Pakistan: Battling Malnutrition Amid Access Challenges

07 January 2011
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In his ongoing look at how WFP uses nutritional products in emergency situations, WFP programming officer Guillaume Foliot looks at the solutions found in the wake of the catastrophic flooding in Pakistan last summer, when access was a major challenge.
After the extensive monsoon flooding in Pakistan not only the provision of food but also of specific nutritional assistance was crucial for the survival of millions of people. Though the emergency situation created an environment where access continues to be limited WFP was able to introduce supplementary feeding programmes for particularly vulnerable populations alongside the general food distribution.

Challenges through Limited Access
Implementing nutritional interventions in Pakistan has proven very challenging due to the huge number of affected people, the immense damage and severe access problems after the devastating floods. The only way to introduce a large-scale blanket supplementary feeding programme aimed at preventing malnutrition was through the general food basket distribution.
The general food basket, consisting of fortified wheat flour and oil, is designed for a family of seven people. In addition, it contains one ration of ready-to-use supplementary food (Plumpy’Doz or a similar local product) for a child under the age of two as well as two rations of high-energy biscuits for children aged 2–12 years. The huge scale and complexity of the disaster did not allow for further nutritional interventions at the beginning of the emergency operation.

Targeted Supplementary Feeding
By mid-October WFP had reached about 2 million children aged between 6 months and 12 years through the blanket feeding programme. However, there were also increases in the incidence of severe and moderate malnutrition reported in some flood-affected areas, particularly among young children. As soon as access conditions improved, WFP together with UNICEF started to implement a targeted supplementary feeding programme. It provides nutritional support in form of Supplementary Plumpy and other fortified food to more than 12,000 young children and pregnant and lactating women through established medical facilities.
http://www.wfp.org/aid-professionals/blog/pakistan-battling-malnutrition-amid-access-challenges

MALNUTRITION: Niger: UNICEF-supported health centres

 04 Jan 2011 :  Joëlle Onimus-Pfortner
Seeking shade from the scorching midday heat, a small crowd of mothers who have brought their children in for malnutrition screening gather at the public health centre in Niger's south-central Maradi Region.
"I heard the health centre here treated children for malnutrition, so I brought my grandson Adamou. His mother died eight months ago and I take care of him now," says Hadiza, one of the many women gathered at the centre.
Hadiza has travelled 20 km to get treatment for two-year-old Adamou. Weighing less than six kilograms, he has already lost three brothers. One in four children dies before his or her fifth birthday in Niger, and malnutrition is often an underlying cause.

Sharing information
The centre at Takieta is one of 822 therapeutic feeding centres located throughout Niger. In 2010, more than 318,000 children under the age of five were admitted to these centres with severe acute malnutrition.
Despite an above-average harvest in 2010, admission rates to Niger's therapeutic feeding centres remain very high, at around 5,000 per week. This figure highlights the importance of the treatment approach at centres like the one at Takieta, where families learn how to treat and prevent malnutrition – and how to seek timely health care for their children when they see warning signs such as fever, weight loss or respiratory infections.
This year, a malaria epidemic sent a large number of children to the nutrition centres. The three huts in the courtyard of the Takieta facility represent its three-step process for malnutrition treatment. At each step, sharing information with mothers and other caregivers is key.

Screened for malnutrition
To begin with, mothers are advised of simple hygiene and nutrition practices that can significantly reduce malnutrition at home, such as washing hands with soap and practicing exclusive breastfeeding during the first six months of an infant's life.
Next, children are measured for height and weight, or for upper arm circumference, to screen for malnutrition. During the medical examination, the child receives routine medication such as vitamin A and folic acid supplementation, as well as deworming treatment.
Finally, in the third hut, food is distributed. It is here, that Zeinabou Moussa, a dedicated health and social worker, gives mothers a weekly ration of either Plumpy'nut, a high-energy peanut paste for children suffering from severe acute malnutrition, or a corn-soya blend that is used to treat moderate acute malnutrition.
A crucial role
"This food is for this child only," Ms. Moussa explains to one of the mothers. "If you share it among other members of the family, he will not get well."
A mother of six named Zouhera has come to the centre with her daughter Aichatou to receive treatment for the fourth week running. She nods attentively as she listens to the instructions. "Everyone understands that Aichatou is sick and needs more attention," she says.
UNICEF plays a crucial role in the fight against severe acute malnutrition in Niger. With the support of its donors and partners, including the European Union, UNICEF provides the government and non-governmental organizations with therapeutic foods, essential drugs, equipment and capacity-building assistance. Needs have increased with the nutrition crisis here, and providing supplies on time is critically important.
http://wwww.reliefweb.int/rw/rwb.nsf/db900sid/KKAA-8CT55U?OpenDocument

MALNUTRITION: D.R. Congo: ACF Fighting deadly malnutrition

Jan 4th, 2011 By ONE Partners
Putting an end to world hunger can seem like an impossible task, but Susannah Masur from Action Against Hunger has the numbers to prove that we’re making progress.
Last month I traveled to Kisangani, a mid-sized city that hugs the banks of the famed Congo River, to document Action Against Hunger’s partnership with the Congolese Ministry of Health to combat deadly malnutrition in the three rural health zones around the city.
Severe malnutrition is a leading killer of children worldwide. In fact, at least 3.5 million of them die every year from the condition. Yet, this public health catastrophe gets very little public attention. I think part of the reason is that hunger, especially in Africa, is often seen as an inevitable result of poverty. In other words, it’s just something that happens.
But while the causes of hunger are many, one thing is for certain: Childhood deaths from hunger are entirely preventable.
For the first time, caregivers can bring malnourished children to their local health clinics once a week to be weighed and measured and get a supply of Plumpy’nut — a specially-formulated Ready-to-Use Therapeutic Food that has revolutionized care for severe malnutrition — to eat at home. Before, all treatment for severe malnutrition required prolonged hospitalization, presenting a major challenge in many underserved areas.

  Photo courtesy of ACF-DR Congo, S. Vidyarthi.

This year, in collaboration with local health authorities, we treated 35,000 cases of severe malnutrition across the Democratic Republic of Congo by employing a community-based model that is bringing life-saving care close to home. I wanted to see the model at work in the areas around Kisangani, where child malnutrition is rife and the effects of the second Congolese civil war can still be seen in the bombed out buildings and crumbling infrastructure. [video shows the programs in action]
In outpatient centers managed by the Congolese Ministry of Health and integrated into the local health system, nurses trained and equipped by Action Against Hunger are treating and monitoring acutely malnourished children during their weekly visits. This year 3,200 doctors and nurses received comprehensive training on care for severely malnourished children through the partnership. And, the beauty of the system is that it can continue long after we leave.
On my first day in the village of Wanie Rukula I met Nico, a young boy who just a few months ago was so severely malnourished he was on the brink of death and could barely move. But last month I watched him kick around a handmade soccer ball with his friends while his beaming parents looked on. What better proof do we need that deaths from malnutrition can become a relic of the past. All we need is the will to do it.

Susannah Masur is the communications officer at Action Against Hunger. To learn more about ACF, visit http://www.actionagainsthunger.org
http://www.one.org/blog/2011/01/04/fighting-deadly-malnutrition-in-d-r-congo/

MALNUTRITION: In Somalia, UNICEF-supported programme treats malnutrition before it becomes life-threatening

By Mike Pflanz  

 
© UNICEF Somalia/ 2010/ Pflanz :  Filsan Yusuf, a health worker at the Outpatient Therapeutic Clinic in Hargeisa, hands a mother portions of Plumpy’nut food supplement. Severely malnourished children are monitored on a weekly basis and are treated with the high-energy peanut paste to bring them back to health.


HARGEISA, Somalia, 30 December 2010 – Salman Haji, 4, stands in the corner of a tin-walled hut, solemnly staring at the man in the white coat as he searches through an impressive amount of official looking paper spread across a large table in a seemingly random fashion. Eventually, a yellow medical card is found recording the details of Salman’s last visit to this mobile clinic, located on the outskirts of Hargeisa.
“He was improving, but now there are signs again of malnutrition, and of an underlying chronic respiratory illness,” Ali Mayag Muse explains to Salman’s mother, Hodan Mohamed, as her son struggles to contain a sudden coughing fit.

UNICEF provides support
Mr. Muse is a supervisor at an innovative Outpatient Therapeutic Programme which aims to treat children before malnutrition becomes so severe that other deadly illnesses - tuberculosis, diarrhoea and pneumonia chief among them - can take hold. The project is supported by UNICEF, and is funded by the European Commission Humanitarian Aid Department (ECHO), UK Department for International Development (DfID), Governments of Italy, Spain, and Denmark, as well as the Italian and French National Committees for UNICEF.


 © UNICEF Somalia/ 2010/ Pflanz : A child eats Plumpy’nut after his mother bought him to a mobile clinic in Hargeisa, Somalialand. The high-energy, high-protein peanut paste is formulated to treat severe malnutrition.

The weight and height of the children are measured, as is the circumference of their upper arms, to create a weekly snapshot of each child’s nutrition status, which is then checked against records from previous visits. In addition, Plumpy’nut - a pre-packaged high-nutritional quality peanut paste specially formulated to treat severe acute malnutrition - is handed out, as are Vitamin A supplements and zinc tablets to treat diarrhoea. Children with underlying complaints, like Salman, may be started on a course of antibiotics.
In the first ten months of 2010, 90 per cent of the more than 6,000 children treated in Somaliland for severe acute malnutrition recovered. Unfortunately, UNICEF estimates only half of those in need can be reached.

Measured interventions
Asha Mohamed’s nine-month-old daughter, Ayan, was one of those still beyond the reach of the programme, in their remote village a 24-hour journey to the south of Hargeisa.
“She was sick for a month, and getting worse and worse,” Ms. Mohamed says. “Finally, I made the decision on my own to get a truck to come to Hargeisa. It was a day and a night on the road, and Ayan was so sick and exhausted. We were told to come here, and now she is recovering so fast.”

 © UNICEF Somalia/ 2010/ Pflanz : A baby is weighed at a special ward for critically malnourished children at the Hargeisa Group Hospital in Somaliland. Severely malnourished children with medical complications are provided with round-the-clock special care at the UNICEF-supported stabilisation centre.

Little Ayan received her treatment at a special ward supported by UNICEF in the Hargeisa Group Hospital. It is one of Somaliland’s three ‘stabilisation centres’ for inpatient treatment, the step above the outpatient programme for the most serious cases. The infants must be slowly brought back to strength with measured interventions.
“It can kill a malnourished child to rush in to treat the malnutrition, first we need to treat the complications,” said supervisor Hawale Abdullahi.
Hope for expansion
Approximately forty cases are admitted to the centre each month, but Mr. Abdullahi has hope that those numbers will drop if the outpatient programme can be expanded.
Zivai Murira, UNICEF’s Nutrition Specialist based in Hargeisa, agrees.
“Children can deteriorate so quickly to the point where their severe malnutrition is difficult to manage,” he explains. “That’s why the stabilisation centres are there, but it’s also why we are trying to widen the reach of the outpatient programme, to catch children before complications set in.”
http://www.unicef.org/infobycountry/somalia_57331.html

MALNUTRITION: Malnourished Children in Yemen Need Plumpy'nut

 William Lambers:  Dec 17, 2010
  A severely malnourished child being treated in Yemen. Foods like plumpy'nut can bring children back to health. (UNICEF photo).


The most important aid Yemen needs right now is food to save its youngest children from dangerous malnutrition. UNICEF and the World Food Programme (WFP) are calling for arsenals of the nutritious peanut paste plumpy'nut to feed children in Yemen.
Impoverished Yemen has one of the highest rates of child malnutrition in the world. WFP says "half of Yemen's children are chronically malnourished." When a small child does not receive proper nutrients in the first 1000 days of life, devastating physical or mental damage will occur.
If a child suffers from severe acute malnutrition, a simple infection could lead to death. Even in more moderate cases, simple infections can descend the child deeper into malnourishment. This is what many children in Yemen face from birth.
Low funding for both WFP and UNICEF has limited their ability to help Yemen. Both aid agencies depend on donations from the international community. Food security has simply not been given a priority among donors, a huge failure in the foreign policy strategy of many governments.
The conflict in Northern Yemen (Sa'ada) between the government and rebels has placed small children in even further danger. The chaos from the conflict is increasing the risk of malnutrition.
A survey released by UNICEF found "Nearly half of the 26,246 children aged 6-59 months screened in five western districts of Sa’ada in July 2010 were found to be suffering from global acute malnutrition; in one area, the proportion was as high as three out of four children. Overall, 17 per cent of the children screened suffer from severe acute malnutrition and 28 per cent from moderate acute malnutrition. "
Geert Cappelaere, UNICEF's director in Yemen says, “Malnutrition is the main underlying cause of death for young children in Yemen, and therefore this grim situation could spell disaster for the children of Sa’ada. As winter approaches, thousands of children are at serious risk if we are not able to act immediately.”
http://blogcritics.org/culture/article/malnourished-children-in-yemen-need-plumpynut/