MALNUTRITION: ETHIOPIA: Somalis living from drought to drought

BISLE (SOMALI REGION), 12 July 2011 (IRIN)
 Photo: Jaspreet Kindra/IRIN
Shokuri Abdullai, like most mothers in Bisle, feeds her family boiled wheat in the Somali region's Shinile zone

Every day, 500g of boiled wheat is divided up between two adults, four children, a calf, a goat and a donkey in the Farah household. It is the only food they have had after rains failed for the past two seasons.
The 15kg sack of wheat is provided to about 1,200 people in the Bisle area, which has four settlements, under the government-run Productive Safety Net Programme (PSNP) as payment for work, such as digging water holes.
"It is boiled wheat for breakfast and for the main meal – we don't have anything else – no milk, no meat, no vegetables, no oil," says Maria Farah, the mother. Not surprisingly, two of her children are severely malnourished.
The calf and goat that share their "ari" - a collapsible egg-shaped hut made of sticks and covered with sheeting – are emaciated. It is too hot for them outside, in temperatures that soar beyond 40 degrees Celsius.
There is no water in their settlement, about 54km north of Dire Dawa town in the Somali region, one of the worst hit by drought in Ethiopia. More than a million people have been affected.
On 11 July, the Ethiopian government launched an appeal for US $398 million to help 4.5 million people, up from 3.2 million in March, who are in need of food aid due to the drought.
Launching the July-December 2011 Humanitarian Requirements Document in the capital, Addis Ababa, Agriculture Minister Ato Mitiku Kassa said of the total revised 4.5 million beneficiaries, 41 and 32 percent are in Oromiya and Somali regional states respectively.
For Farah's family in Bisle, the worsening drought continues to threaten their livelihood. Their donkey, tied to a post, used to help carry water from the nearest waterhole about four hours. But he is frail. "He is too sick to move now," Farah said.
These pastoralists have lost scores of animals in the past three months.
"What will you do – you are just taking notes, are you going to help us?" asks Ali Abdi, a 60-year-old pastoralist. This is the worst drought he has seen in his lifetime, he adds.
An unrelenting battle with failed rains over eight years has left them with no sense of a future nor any hope of a better life.
The eastern Somali region depends on two rainy seasons, known as the gu (April-May) and the deyr (October-November). The gu rains provide 60 percent of the water needs for the region, and the deyr 30 percent.
Both rains failed in 2010 because of a particularly strong La Niña. Some parts of the region received rainfall in May but not enough to replenish reservoirs. Bisle received none at all.
Shokuri Abdullai, a mother of six, sends two of her children to school, which is free in Ethiopia. But she has not given much thought to what will become of them. They moved to this settlement from their village about eight years ago when they lost all their animals to drought.
The settlement is among the most accessible in the harsh Somali region during the dry season. "So NGOs drop by with some food now and then and there is a health post," said Abdullai, explaining their choice to make their home in Bisle, which has only become drier.
Maria Guled, a mother of five, the eldest 11, lies awake at night worrying about them. "I don’t have any other family anywhere else to send them to." Her children are unable to go to school because "they are too hungry".
The UN Children’s Fund (UNICEF) is supporting Save the Children-UK in running a new community-based therapeutic programme at the health post in the settlement. Thanks to the ready-to-use therapeutic food (RUTF), Farah's children have some additional rations.
"But all the food we provide for the malnourished children - a bottle of oil and 25kg of corn soya blend - is consumed by the entire family so the child still remains malnourished," a community health worker said.
There are others who are even less fortunate than the residents of the settlement. A woman with a severely malnourished child at the health post said she had walked two nights from her village for help. She left 10 of her children – the eldest a 15-year-old - alone at home. “I have no choice – my husband left for Djibouti two years ago because of the drought to look for work.” She is too distraught and angry and refuses to be photographed. "What will you do with all this? Are you going to help me?”
But the feeding programme is only three months old, with funding for another three. "It is not a sustainable solution – we need to address the causes,” Katy Webley, director of programmes at Save the Children-UK, said.
Daniel Maxwell, a food security expert and former aid worker in the Horn, said in an email that "underlying livelihoods crisis and threats to food security have to be dealt with in a much more systematic manner, including social protection programmes for the most vulnerable groups even in years when there is not a major humanitarian crisis, and greater emphasis on resilience and reduction of risk”.
He cited Ethiopia’s unique PSNP as the best example of an ideal social programme.

How PSNP works
The PSNP targets people facing predictable food insecurity and offers guaranteed employment for five days a month in return for transfers of either food or cash.
The PSNP has two–pronged benefits in a harsh arid zone such as Somali: cash or food builds resilience; while projects such as reforestation to stem land degradation and water harvesting would help the land recover in the long term.
"But in these conditions [cycles of drought] – there is not much we can do – there has been no room for recovery,” says Abdi Farah, manager of the PSNP in the Shinile woreda [district], where Bisle is located. “The PSNP has become a food aid operation; we need to get to at least 10,000 people in Bisle alone but we don’t have the resources.”
Shahid Haji, of the World Food Programme (WFP), which supports the PSNP with food, said: "We are stuck in the emergency mode – people need aid. They have not had the chance to build any resilience."



 Photo: Jaspreet Kindra/IRIN
Maria Farah outside her ari

Farah Wayis Ali, an elder from the settlement, explained to Valerie Amos, the visiting UN Emergency Relief Coordinator, that they could not work in the PSNP programmes as they needed water. “To collect the water we have to walk four hours – so when do we do the work?”
The government recently started trucking in water. “It is not a lot – we have big fights over water,” says Ali Abdi.
But supplying water is an extremely expensive exercise. Amy Martin, acting head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Ethiopia, said the operation to supply water in the drought-affected parts of Ethiopia from January to March alone had cost at least US$11 million.
Amos said the government was exploring the option of tapping deeper into the water table for a sustainable supply, but this too was costly.
The PSNP also has the option of providing cash but high food prices have rendered the exercise meaningless. Ali Abdi said a 50kg bag of wheat cost 400 birr (almost $24) compared with 150 birr (about $9) for a goat. “The life of our livestock has become so cheap.”
Maxwell said it should be noted “that much of this activity [PSNP] is still donor-supported [and hence subject to the same budget-cutting]”.

Security concerns
Humanitarian access has also been restricted in parts of the Somali region. In June 2011, two WFP workers were detained in the region.
Shadrack Omol, UNICEF's chief of operations and emergency in Ethiopia, said because of “conflict and security issues a number of health posts are frequently not able to provide essential services, [let] alone nutrition programmes”. As a solution, the agency is deploying mobile health and nutrition teams.
Amos said she had met Ethiopia's deputy Prime Minister Hailemariam Desalegn to discuss a plan to ensure safe access for aid workers to the country’s volatile areas.
http://www.irinnews.org/report.aspx?reportID=93200

MALNUTRITION: Pakistan: Chickpea to fight child malnutrition

03 June 2011
The World Food Programme has turned to the local chickpea to treat young children suffering from malnutrition. Served as ready-to-use, the food will be distributed in government health centres in four provinces in Pakistan.

Quetta: Ready-to-use therapeutic foods (RUTFs) have become an important weapon in fighting child malnutrition, since their early development in Malawi, and subsequent endorsement by major NGOs and UN agencies.
A new variant in production in Pakistan replaces a key ingredient, peanuts, with chick peas which saves money, stimulates the local economy and fits better with local tastes, according to the World Food Programme.



Child malnutrition is a long-standing problem in Pakistan, and according to the World Bank the number of children who are underweight or stunted "is of particular concern since Pakistan has long been considered self-sufficient in diverse agriculture produce and refined foods."
A study by the UN Children’s Fund (UNICEF) early this year, following the devastating floods of 2010, found "critical levels" of malnutrition among flood-affected children. It also found significant evidence that malnutrition, one manifestation of acute poverty and deprivation, was linked to feudalism and the country’s class structure.
The UN World Food Programme (WFP) is distributing a chickpea-based RUTF, known as "Wawa Mum" or "Good food, Mum". The fortified paste is more acceptable to local people than those prepared with peanut butter, a food item rarely used in the country.
The paste contains a rich vitamin and mineral formulation blended with the cooked chick peas and each packet is designed to meet the daily nutrient requirements of children in the targeted age group.

Rich in nutrients
"The chickpea paste is being distributed to children suffering from moderate malnutrition. It comes ready to use, in 50-gram packets, is produced locally and is meant for children aged 6-36 months and suffering from moderate malnutrition," WFP spokesman Amjad Jamal told IRIN.
Three factories are currently processing 200 tons per month which is enough for four million packets of the paste. The WFP hopes to raise that number to 500 metric tons by June and to 1,000 tons by the end of the year, by contracting two additional factories.
The foods, he added, had been provided in four provinces through NGO partners and treatment centres such as government-run Basic Health Units (BHUs) since September 2010, when the post flood situation led to a greater focus on nutrition. Doctors and health workers at government health centres and those working with NGOs identify children in need of dietary supplementation.
"It is not uncommon to spot malnourished children in communities everywhere," Faisel Aziz, who volunteers with the charitable Edhi Foundation in Balochistan, told IRIN.
WFP reports that the chick pea formulation may soon be available in Afghanistan, Tajikistan and Ethiopia
http://southasia.oneworld.net/todaysheadlines/chickpea-to-fight-child-malnutrition-in-pakistan

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: Getting the recipe right for US food aid

JOHANNESBURG, 13 May 2011 (IRIN)

 Photo: Manoocher Deghati/IRIN
More of all the good things - protein and vitamins

Changing the food the US government supplies as aid could deliver better results and still save money, a new study says. The review for the US Agency for International Development (USAID) by researchers at the Tufts University Friedman School of Nutrition Science and Policy has been welcomed by NGOs and US food aid experts, but the findings have also come in for some criticism.
The two-year review considered if USAID food aid was up to date with current science, especially in its use of blended food and whether programmes matched the right products with expected outcomes.
"What we're recommending is approaches to enhance the many great things already being done with US food aid under the most difficult circumstances imaginable," Amelia Reese Masterson, research coordinator of the review, wrote to IRIN, referring in part to USAID’s budget pressures.
The review came up with 20 recommendations on some of the food products and programmes under Title II of the US Food for Peace Act, which covers food aid provided in emergency and non-emergency situations.

Getting the ingredients right
The Tufts review addressed the issue of the source of protein in food products for children, pregnant and lactating women, and undernourished people on HIV medication.
Médecins Sans Frontières (MSF) has noted that US food aid destined for children usually comprises fortified flours based on grains and pulses such as corn-soya blend (CSB) or wheat-soy blend (WSB) and has lobbied for the inclusion of other sources of protein, vitamins and minerals.
Recent scientific evidence shows that animal-source proteins such as milk, better promote the growth of muscle tissue and resistance to infections, and are critical to children recovering from severe malnutrition, the Tufts review agreed. It also acknowledged that ready-to-use therapeutic foods (RUTF), usually lipid-based spreads, whose ingredients typically include nuts and milk powder, have led to a radical change in the way severe malnutrition is treated.
The review recommended that a wider range of products, offering varying quantities and types of nutrients for different programmatic contexts, be made available.
It is here that the review has contradicted itself, Nathalie Ernoult, Stephane Doyon and Susan Shepherd, members of the MSF's nutrition team, maintained in a written submission to the Tufts academics.
"The report itself states that there can be no 'one-size-fits-all' food supplement, and we could not agree more," the MSF team said, yet it "focuses primarily on how to improve the nutritional value of fortified blended flours."
The Tufts study argued for a single formulation for a cost-effective, enhanced CSB, which they dubbed CSB14, to meet the minimum nutritional requirements of three key target groups: infants from 6 to 11 months; children between one and three years; and pregnant women.
The MSF team said at least two enhanced CSB formulations would be necessary: one tailored to the needs of infants and young children and those affected by moderate acute malnutrition; the other for older children and adults.
UN organizations the World Food Programme (WFP) and the UN Children's Fund (UNICEF) are also considering experimenting with different formulations of CSB.
"As a field-level agency and occasional implementing partner for UNICEF and WFP, we [MSF] cannot over-emphasize the need for coherence in the nutritional supplements on offer for a given category of beneficiary," the MSF team said. "If the fortified foods provided by WFP, UNICEF and USAID for similar programmes are not interchangeable, nutrition programmes will simply become confused and ineffective."
MSF maintained that the formulation for younger children should have a higher protein content from animal-sourced food; and that the proposed fortification levels of iron and zinc were also too low.
Zita Weise Prinzo of the World Health Organization (WHO) said they were recommending that the diets of moderately malnourished children contain animal-sourced foods, without specifying how much. WHO is expected to release its guidelines for food formulations for moderately malnourished children in June 2011.
According to MSF, the proposed second formulation for older children and adults, would not require animal-sourced ingredients, and the current CSB recipe, with some adjustments to its vitamin and mineral content, would serve the purpose.
However, a senior nutritionist who preferred not be named told IRIN that in many instances it would be hard to imagine relief agencies successfully distributing two or more similar looking products for different segments even within a single family.
"Most large-scale programmes using CSB-type products involve take-home rations. It would be difficult for a programme to ensure the proper use of several similar products at home. The solution could be to have one ‘generic’ option used by most big programmes, similar to that proposed by the [Tufts] paper, and then several other options that would be used by ‘speciality’ programmes."
The CSB14 formulation depends on the addition of oil fortified with vitamin A to provide enough of the vitamin. "Our experience shows that it is difficult to count on the prescribed amounts of oil being added to the porridge in the home, not to mention all the logistical difficulties encountered with the distribution of multiple commodities to constitute a single ration," the MSF team pointed out.
The chemical forms of micronutrient supplements proposed by Tufts also differed from those on the list approved by the WFP, the biggest dispenser of US aid. "It is very important to come to common agreement on a list of acceptable chemical forms for all additives," the MSF team noted.

PEPFAR food
Programming should "be evidence-based, not driven by simple data on tonnages and 'hungry people fed', but by an understanding of the unit cost of impact," and this included HIV/AIDS-related programmes, said the review. It found that orphans and vulnerable children, and HIV-positive pregnant and lactating women, identified for priority food assistance in the US President's Emergency Plan for AIDS Relief (PEPFAR), were receiving not getting priority compared to other HIV-positive women and adults.

Photo: Jason McLure/IRIN
US food aid is evolving

The review suggested stronger links between ongoing antenatal, Prevention of Mother-to-Child Transmission (PMTCT), and Maternal and Child Health (MCH) services, and with programmes treating malnourished children.
PEPFAR country coordinators reported that requests to approve the use of funds for food were "commonly met with caution", the review said, which "contributes to low coverage of food assistance within programmes", and PEPFAR needed to send a stronger signal on supporting the allocation of funds to food in HIV support.

Saving money
Budget-constrained donors were "facing hard trade-offs between feeding as many people as possible and providing higher quality foods to improve nutritional impact per person," said Christopher Barrett, a food aid expert who teaches development economics at Cornell University in the US.
Scarce resources should be put to work more efficiently, and the Tufts review contributed significantly to improving understanding of these tradeoffs by policymakers, operational agencies and commercial suppliers, Barrett commented.
"It's important to move beyond a dollar-per-ton of food metric - the conventional way of looking at things - since that does not take into account exactly what kinds of foods are used for what purposes," said Patrick Webb, principal investigator of the Tufts review project.
"If we become more efficient in treating or preventing malnutrition, then it's the cost per case of malnutrition treated or prevented that matters, and that will go down when the appropriate tools (foods)are used in the right ways, even if unit costs of products rise slightly... because less is needed (over a shorter period of treatment)."
Some of the Tufts recommendations would cost more money - the addition of dairy products, new smaller packaging of some products for mothers and infants to prevent it from being consumed by the entire family - but Webb said the costs would be offset by improved targeting of the enhanced products.
Barrett noted that "With greater bang for the buck, it also becomes easier to defend valuable food aid programmes against those looking to trim budgets."
The review, the issues it covers and its recommendations will be debated at the US government's annual conference on food aid in June.
http://www.irinnews.org/Report.aspx?ReportID=92717

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

 Feb 17, 2011 Stephanie Springer
FITZGERALD, GA (WALB) – A brand new plant in Ben Hill County will soon start producing a product that will help feed starving children across the world. It's called MANA, and not only will it help children, but it will also help boost the local economy.
MANA stands for Mother Administered Nutritive Aid and in the past, clinics and hospitals had to mix up a product to give to children. This product can be given by the mother herself to her starving child.
Every six seconds a child dies from malnutrition related causes, but thanks to this new factory, more starving kids around the world will survive. "We have people around the world who cannot feed themselves so we have to step in a do something," said Mike Salza, Mana Operations.
It's called Mana, and each pouch contains peanut butter mixed with fortified milk. "On average we are seeing children gaining a pound per week," said Salza.
If a starving child eats three packets a day, for six weeks, he will get back to normal nutritive levels. "Typically, reports are showing us that once a kid recovers from severe acute malnutrition any of the 'Ready to use therapeutic foods' they never experience malnutrition again," said Salza.
It's the only Mana facility in America. The reason the plant is in Fitzgerald is because of Allen Conger. He is the only one who took a chance on the Non-profit company.
Conger says he's been to Africa a handful of times, and has seen with his own eyes just how bad the situation is. "Some of these kids look like a watermelon with four sticks stuck in them," he said.
He invested 1.7 million dollars in his own funds to build the facility, and design the system. "Hopefully we will be producing somewhere around 30 million pounds in the next year," said Conger.
His company, American Blanching is located adjacent to the new plant and will be instrumental in the production of Mana. "They are going to bring product over from next door, and they are going to mix that with a milk product and mix it with minerals," said Conger
This up and coming plant will also help out the local economy adding about 60 jobs over time and help the trucking industry. "It will put Mana on the map but also Fitzgerald on the map because we will be helping people worldwide, said John Flythe, Executive Director Fitzgerald Ben-Hill Co. Development Authority.
Next up, the hope plan to open up a smaller facility in Rwanda.
American Blanching has also been asked to make a product to help feed disaster victims who may not have any electricity or access to food in the case of an emergency. These products will be made with different ingredients, and they wont need refrigeration and will last for about two years.
They hope to start production on April 6th.
http://www.walb.com/Global/story.asp?S=14028515

MALNUTRITION: 54,000 Nigerian children to benefit from 3m Euro emergency aid

Jan 17, 2011 BYCHIOMAOBINNA
AT least 54,000 children suffering from acute malnutrition in seven drought-affected, states of northern Nigeria are to benefit from emergency aid funded by a 3-million Euro grant from the European Commission for Humanitarian Aid (ECHO) to UNICEF Nigeria.
The funding will support the governments to treat malnourished children in the seven affected states. They are Kebbi, Sokoto, Katsina, Zamfara, Jigawa, Yobe and Borno states. These states border Niger Republic and the Republic of Chad – both of which appealed last year for humanitarian food aid following severe food shortages caused by the ongoing Sahel drought and climate change.
A press statement from the United Nations Children Fund (UNICEF) states that the money purchased 53,730 cartons of Ready to Use Therapeutic Foods (RUTF) used to treat children with severe malnutrition. One course of treatment consumes about one cartoon of RUTF over eight weeks.
According to the statement, “To date about 40,000 children have benefitted from the project – also known as Community Management of Acute Malnutrition (CMAM). It is a joint initiative of the Federal and State governments in collaboration with UNICEF; initially for 15 communities in Gombe, Kebbi and Sokoto, it has now been expanded to 145 communities in seven states”.
This expansion has been possible through the support of ECHO, the humanitarian aid agency of the European Union.
CMAM field work is implemented directly by respective state governments in partnership with Médecins Sans Frontières (MSF)-France, Save the Children UK, and Action Against Hunger (ACF)-US. Part of the ECHO funds also supported the second round of Rapid Nutrition Assessment surveys in December 2010 in eight Sahel States.
UNICEF recognises food insecurity, poor child care practices, and poor health care services as the three main causes of malnutrition. Apart from the effects of Sahel drought in Northern Nigeria, other major challenges in the region include poor child care practices – particularly low exclusive breastfeeding rates – as well as inadequate quality and quantity of complementary foods.
http://www.vanguardngr.com/2011/01/54000-nigerian-children-to-benefit-from-3m-euro-emergency-aid/

MALNUTRITION: UNICEF Receives 3 Million Euros From ECHO to Fight Child Malnutrition in Northern Nigeria

ABUJA, 14 January 2011:
About 54,000 severely malnourished children in seven drought-affected, northern Nigerian states will benefit from emergency aid funded by a 3-million Euro grant from the European Commission for Humanitarian Aid (ECHO) to UNICEF Nigeria.
The funding will support governments to treat malnourished children in Kebbi, Sokoto, Katsina, Zamfara, Jigawa, Yobe and Borno. These states border Niger Republic and the Republic of Chad – both of which appealed last year for humanitarian food aid following severe food shortages caused by the ongoing Sahel drought and climate change.
The money purchased 53,730 cartons of Ready to Use Therapeutic Foods (RUTF) used to treat children with severe malnutrition. One course of treatment consumes about one cartoon of RUTF over eight weeks.
To date about 40,000 children have benefitted from the project – also known as Community Management of Acute Malnutrition (CMAM). It is a joint initiative of the Federal and State governments in collaboration with UNICEF; initially for 15 communities in Gombe, Kebbi and Sokoto, it has now been expanded to 145 communities in seven states.
This expansion has been possible through the support of ECHO, the humanitarian aid agency of the European Union. CMAM field work is implemented directly by respective state governments in partnership with Médecins Sans Frontières (MSF)-France, Save the Children UK, and Action Against Hunger (ACF)-US. Part of the ECHO funds also supported the second round of Rapid Nutrition Assessment surveys in December 2010 in eight Sahel States.
UNICEF recognises food insecurity, poor child care practices, and poor health care services as the three main causes of malnutrition. Apart from the effects of Sahel drought in Northern Nigeria, other major challenges in the region include poor child care practices - particularly low exclusive breastfeeding rates - as well as inadequate quality and quantity of complementary foods.

About UNICEF
UNICEF is on the ground in over 150 countries and territories, including Nigeria, to help children survive and thrive, from early childhood through adolescence. UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF has been on the ground in Nigeria since 1953 to support the Government of Nigeria implement programmes and policies for the realization of children's rights.

http://www.reliefweb.int/rw/rwb.nsf/db900sid/JALR-8D4CG4?OpenDocument

MALNUTRITION: Pakistan: treating childhood malnutrition after the floods

 07/10/2010 Nurse Hamdullah has been treating children suffering from malnutrition with MSF in Pakistan’s neglected Balochistan province for the last ten years. Major floods forced about 600,000 people to flee from neighbouring Sindh province to Balochistan in Pakistan’s southwest. Many of them made the difficult 300 km journey to the provincial capital, Quetta, in search of help.
Many people have lost everything, including their homes and family members. Tenant farmers are considered the poorest of the poor and they have come with nothing. As a result of these mass movements, Hamdullah has seen the severely malnourished children of these tenant farmers in large numbers at MSF’s feeding programmes. “In Dera Murad Jamali and the surrounding areas I saw many malnourished children in the camps. I admitted 15 to 20 patients to our feeding programme every day,” Hamdullah said.
Food aid provided in the wake of the flood often focuses on assuaging hunger rather than treating malnutrition, and is not sufficient in meeting the needs of children most at risk.
“Treating malnutrition in children under the age of five is essential. This improves their chance at survival while immune system is still developing. When children are severely malnourished they cannot resist the infections and diseases most likely to claim their lives. If not treated in time, the damage malnutrition leaves on their physical and mental state is irreversible,” explained Dr Ahmed Mukhtar, a medical coordinator in Pakistan.
MSF operates nine outpatient therapeutic feeding programmes across Pakistan through outreach teams. These teams provide systematic medical check-ups and a week’s supply of ready-to-use therapeutic food (RUTF) in sachets to people showing signs of malnutrition. This paste, made from peanuts and milk, is enriched with the vitamins and micronutrients that children need to recover quickly. We are currently treating 1,748 children for severe and acute malnutrition in Sindh and Balochistan.
We spent a day with Hamdullah and team members Ali Sher, Noor Mohammed and Muhammed Iqbal as they worked to ensure that malnourished children get treatment.
09:00: MSF office, Quetta
Hamdullah’s nutrition outreach team fill their pickup with seven boxes of RUTF sachets, a scale, a medicine trunk containing antibiotics, a tent, a table and chairs and some clean drinking water. They also pack the patient register listing their young patients' names and weight tracked over a three to six week period. We head out on the Sariab Road to the outskirts of Quetta.
09:30: Quetta eastern bypass camp
About 40 tents dot the once densely populated yard of the Muslim Health Clinic compound. Hamdullah is surprised: “Some families have started returning home sooner than we thought. They are anxious to get to their land before winter sets in.”
Within minutes of setting up their post, about 20 young Sindhi girls carrying their younger siblings are already crowded around Hamdullah’s table and scale. They clutch small pieces of paper given to them the previous week. The notes bear the child’s name, their weight and the follow-up visit date.
And so begin the proceedings for the day. Ali Sher calls out a name; Hamdullah then confirms the name and the patient's village of origin before weighing and measuring him or her. He does a quick calculation to determine progress, and then Noor Mohammed and Muhammed Iqbal hand out a prescribed number of RUTF sachets.
10:20
Gulbano Nazir has pushed into the mob of women and children, holding tightly onto her two sons Khalid, 18 months, and Hussain, aged three. The floodwaters washed away their mud-walled home near Jacobabad a month ago. She and her husband, Mohammed Rafiq, along with seven other desperate families scraped together the 60,000 PKR (over $600 US) to pay for a truck ride to Quetta by borrowing some money and selling what they had left.
Khalid was diagnosed with severe and acute malnutrition, but is recovering and has put on weight rapidly thanks to the nutrient-rich RUTF. He digs into it as soon as Gulbano opens the sachet for him.
Despite lacking vital information about conditions in Jacobabad, the family will return home to their devastated village. This could make Khalid’s long-term recovery as uncertain as the family’s future.
“I just want to go home. Camp life is tough and winter is coming,” said Galbanum. All Khalid can depend on for now is the 14 sachets of RUTF his mother is carrying back to their tent.
This supply should see him through until the family reaches another transit camp near Dera Murad Jamali on their route back to Jacobabad where MSF also provides outreach feeding care.
13:00 Camp 2 near the Quetta railway line
The sun beats down on this 300-tent camp as the team sets up shop. Their tent is barely erect on the parched landscape, and already desperate mothers jostle to get their babies onto Hamdullah’s scale, trying to minimise the time their crying children spend under the hot sun.
When Hakim Zadi and her son, Akhsa Banu, reach Hamdullah’s table, he takes a look at the child and reaches into a box for a coloured-coded mid and upper arm circumference (MUAC) bracelet. He slips it around Akhsa’s tiny left arm and measures it. The arrows point to the red zone – a circumference of less than 110mm.
“For an 18 month-old this child is severely malnourished,” Hamdullah said, handing Hakim a supply of RUTF sachets.
15:00
The outreach team head back to the office and for afternoon prayers; having weighed and measured nearly 200 patients and distributed just over 50kg of RUTF to more than 40 patients.
“It makes me feel good when the child’s condition improves with every visit. People might be moving back home now but there is more to be done because the effects of the floods aren’t over yet,” Hamdullah said.
http://www.msf.org.uk/articledetail.aspx?fId=childhoodmalnutritionoct2010pakistan_20101007

MALNUTRITION: Providing Child Malnutrition Services in Haiti

Haitian children have suffered increasingly from malnutrition over the last decade. To address these needs, the U.S. Agency for International Development (USAID)-funded Santé pour le Développement et la Stabilité d ‘Haiti – (SDSH) project led by Management Sciences for Health (MSH) integrated nutritional monitoring into maternal and child health services in all 147 health centers sponsored by USAID.
After the severe 2008 hurricane season in Haiti, however, many more Haitian children suffered from severe malnutrition. The Management of Severe Acute Malnutrition Program was introduced with additional funding from the USAID, to provide malnutrition services for the affected areas. After the January 2010 earthquake, the program continued to provide nutritional interventions to children in need.
Begining in 2009, advanced therapy for severely malnourished children under the age of 5 was introduced in 20 health facility sites in the 8 areas most affected by the storms. A three-step protocol is used to diagnose and treat malnutrition: affected children are diagnosed and stabilized at a stabilization center; then the child receives Ready-to-Use Therapeutic Food (RUTF) as outpatients; and finally, they benefit from a regimen of nutritional supplementation using dry food rations provided by the World Food Program (WFP).
For Ti Jean, an 18-month-old boy, this program saved his life. His mother brought him to the Saint Louis du Nord health center in Haiti – he only weighed 16 pounds and the health workers were able to diagnose him with malnutrition, but were unable to provide services. Ti Jean and his mother were referred to another medical center called House of Hope in La Pointe Beraca Palmistes. The House of Hope received some of the funding and was able to provide malnutrition services to Ti Jean. After only a few weeks of care, he quickly gained weight and became well-nourished.
Through this supplemental program, 14 hurricane affected sites were rehabilitated and 837,000 children benefited from child health services within a year. Over 204,000 children were diagnosed as Low Weight for Age (LWA), with 45,200 (about 5%) suffering from moderate to acute severe malnutrition. Treatment was provided to 3,700 malnourished children (56% girls) and over 16,200 (58% girls) received food supplementation.
SDSH offers a basic integrated package of services in Haiti: maternal and child health care, including growth monitoring, reproductive health, and prevention and control of infectious diseases including HIV & AIDS and tuberculosis.
SDSH is an MSH-led collaboration of Johns Hopkins Bloomberg School of Public Health/Center for Communications Programs (CCP), AIDS Healthcare Foundation (AHF), JHPIEGO, and Fondation pour la Santé Reproductrice et l’Education Familiale (FOSREF) with USAID, the Government of Haiti, local NGOs, community leaders, and the commercial private sector.

For additional information or to arrange for a press interview, please contact Barbara Ayotte, Director of Strategic Communications, at 617.852.6011 or bayotte@msh.org.
http://www.blogger.com/post-create.g?blogID=3604033512937490051

MALNUTRITION: Plumpy'nut

Jeffrey Sachs
September 6, 2010

We read with concern this week's (September 5) New York Times magazine article "The Peanut Solution," since it is likely to propagate a very serious misunderstanding about the solutions to global hunger, and especially about the role of specially fortified foods such as Plumpy'Nut, the main focus of the article. We commend journalist Andrew Rice for writing an interesting piece on an important and under-covered topic. Nonetheless, it is extremely important to correct certain ideas left dangling by the article.
The article describes a special peanut-based fortified "ready-to-use therapeutic food" (RUTF) with the brand name Plumpy'Nut, which is produced under a patent held by the French company Nutriset. This peanut-based and micronutrient rich paste has proven to be effective in addressing acute malnutrition in famine conditions resulting from crop failures, war, and other causes. Plumpy'Nut can save famine-stricken children in an advanced stage of wasting (severe low weight for height) and at a high risk of death.
This severe form of acute malnutrition affects around 20 million children under five years of age each year and contributes to around 1 million child deaths per year. Plumpy'Nut has the advantage that it is a way of treating serious acute malnutrition on an outpatient basis (at home) rather than requiring an in-patient treatment (in a hospital). It also requires no additive water that can introduce bacteria and other contaminants. At a reported $60 per child for a two-month course, Plumpy'Nut is far less expensive than alternatives involving hospitalization.
It is critical, however, that we not confuse the many types of hunger and malnutrition (poor nutrition) around the world. Plumpy'Nut is not a miracle cure for global hunger or for global malnutrition. Plumpy'Nut addresses only one kind of hunger -- acute episodes of extreme food deprivation or illness, the kind mainly associated with famines and conflicts. Plumpy'Nut is not designed for the other major kind of hunger, notably chronic hunger due to long-term poor diets. Nor is it designed to fight long-term malnutrition that is due to various kinds of chronic micronutrient deficiencies, such as iron, zinc and vitamin-A deficiencies.
The chronic kind of hunger is by far the most prevalent kind of hunger in the world, though it is more hidden and less recognized by the American public. As part of the UN Millennium Project, which one of us (Jeffrey Sachs) directed on behalf of then-UN Secretary General Kofi Annan, the Hunger Task Force found that chronic undernourishment accounts for more than 90 percent of global hunger, while acute undernourishment (starvation) addressed by Plumpy'Nut accounts for less than 10 percent. Of course, the acute episodes are far more widely known to the US public because those are the ones seen on TV in the context of wars, droughts, and other upheavals.
For the vast majority of the world's hungry, the main solutions lie in more productive local agriculture (higher food output per acre), a more diverse mix of nutritious crops, and much greater public awareness regarding feasible and low-cost approaches to a healthy diet. Plumpy'Nut has little role to play in circumstances of chronic hunger. Nonetheless, some people are apparently promoting its as a cure-all.
The article quotes the owner of the sole US Plumpy'Nut manufacturer suggesting that her product is the solution to global hunger. Here is how the article describes the pitch:
There are over a billion people in our world that are malnourished,' Salem said. 'It's a shocking statistic. The good news is there's a very simple solution.' And that, she said, was Plumpy'nut. 'It's really revolutionary, because it doesn't need to be mixed with water or refrigerated,' Salem continued. 'And the most miraculous part is, it will transform a child from literally skin and bones to certain survival in just four to six weeks.
Navyn Salem is right about the therapeutic value of Plumpy'Nut and her efforts should be commended in ensuring this product gets to children in need, but her statement, as reported, can be seriously misconstrued. Of the billion or so people in our world suffering from undernourishment, Plumpy'Nut is appropriate only for a small fraction. Most of the chronically under-nourished need not a solution to acute under-nutrition through food aid but regular access to a long-term, balanced healthy diet. Ms. Salem and we agree on this combination approach: RUTF's for acute under-nutrition, and regular access to a balanced healthy diet and adequate health care to overcome chronic under-nutrition.
Plumpy'Nut comes into relevance when an emergency has struck. And while the $30 per child per month is a very low cost for saving the child, it would in any event be an impossibly high cost for a "solution" to hunger based on food aid! Suppose that the billion hungry people in the world were put on a permanent Plumpy'Nut diet (a totally misguided idea) at a cost of $30 per month, or $360 per year. The result would be a direct cost of some $360 billion per year, an absurdly high cost compared to the real solutions of improved local agriculture, improved household dietary practices, and expanded access of the poor to basic healthcare.
The article agonizes over the patent status of Plumpy'Nut. We have two observations. First, it is absurd to think that a patent should legitimately give a monopoly right to use a fortified peanut-paste to fight acute hunger. The ingredients are simple: peanut paste, vegetable oil, powdered milk, powdered sugar, vitamins, and minerals. The nutritional values of peanuts and the other ingredients have been known for ages, and only the worst misuse of patent law would grant a broad monopoly claim to such knowledge.
Second, as the article mentions, but does not adequately emphasize, it is a standard solution of global intellectual property law that urgent public health needs supersede patent rights. Poor countries should exercise their full right of "compulsory licensing" and other legal protections to produce or to import urgently needed low-cost nutritional supplementation in the face of famines, just as they do to obtain low-cost AIDS medicines. Of course, any RUTF should ensure quality control in the preparation, packaging, and shipment of the foodstuffs. Nor should UNICEF, the world's leading and highly effective organization on behalf of the world's children, give any comfort to a private company seeking undeserved and ultimately life-threatening price markups for basic and widely held nutritional knowledge, especially since those price-markups demonstrably limit UNICEF's and others' ability to deliver emergency foodstuffs to all of the children in acute need.
We also note that Nutriset cannot claim that it expended vast R&D outlays to come up with Plumpy'Nut. It would be fine public policy to award Nutriset a one-time public payment to cover and even exceed its past R&D costs, but the public-health community should insist on the right of any producer to bring to the market low-cost, quality-controlled, peanut-based, fortified, ready-to-use foods in response to famines and other food emergencies.
Our recommended solutions therefore include the following. In cases of acute malnutrition, UNICEF and other agencies should promote locally produced, quality-controlled, ready-to-use fortified foods and should resist claims of patent protection that impede local production or low-cost imports, as needed. In cases of chronic undernourishment, rich and poor governments in partnership should promote improved agriculture and dietary diversity.
The general public should be helped to understand the difference of acute and chronic hunger, so that both are addressed appropriately. And we will need more scientific research in future years to secure even more nutritious crops, and to develop varieties that can withstand the more extreme climate change that is on the way. Of course, slower population growth in poor and hungry countries must also be a key part of any long-term equation.
Jessica Fanzo is a Senior Scientist of Nutritionist at Bioversity International in Rome. Dr. Sonia Sachs is a pediatrician and health coordinator for the Millennium Villages Project.
http://www.huffingtonpost.com/jeffrey-sachs/saying-nuts-to-hunger_b_706798.html

MALNUTRITION: Plumpy'nut® and associated products

Plumpy'nut® is specifically designed for the treatment of severe acute malnutrition. It is suitable for ages 6 months and up.
Treatment generally lasts between 6 and 10 weeks depending on the severity of the condition. The nutritional value is identical to F-100 milk. Breastfeeding is recommended until 24 months (exclusive until 6 months).
Ingredients: Blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil), sugar, peanuts, nonfat milk powder, whey, maltodextrin, vitamin and mineral complex, cocoa, emulsifier: monoglycerides, lecithin.
Recommended Use: Plumpy’nut® does not require any prior cooking, dilution or refrigeration. Simply open the package and eat the contents.
Dosage: For severe acute malnutrition: 200 kcal/kg/day (i.e. two sachets/day/5 kg child).For moderate acute malnutrition: 75 kcal/kg/day (i.e. one sachet/day/5 kg child).
Storage: The shelf life is 24 months. See best before date stamped on each sachet.It is recommended to keep the product in a cool and dry place at a temperature below 86°F (30°C). It is recommended not to stack the pallets.
Plumpy’nut® complies with the definition of Ready-to-Use Therapeutic Food (RUTF) that requires no prior preparation, dilution or reconstitution.*
*Reference: “Community Based Management of Severe Acute Malnutrition”. A joint statement by the World Health Organization, the World Food Program, the United Nations Standing Committee on Nutrition and the United Nations Children Fund, May 2007.


Supplementary’Plumpy® is a Ready-to-Use Supplementary Food (RUSF) used to address moderate acute malnutrition.It is a high-energy nutritional food supplement, suitable for ages 6 months and up.
It is particularly adapted for children exiting therapeutic nutrition programs as a means of preventing the re-emergence of severe acute malnutrition.
This product is also suitable for other groups of people suffering from moderate acute malnutrition (adolescents, pregnant and lactating women, people living with HIV and other vulnerable adults). Breastfeeding is recommended until 24 months (exclusive until 6 months).
Ingredients: Blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil), sugar, peanuts, whey, maltodextrin, soy protein isolate, cocoa, vitamin and mineral complex, emulsifier: lecithin.
Recommended Use: Supplementary’Plumpy® does not require any prior cooking or dilution and does not need to be refrigerated. Simply open the package and eat the contents.
Dosage: For moderate acute malnutrition: 75 kcal/kg/day (i.e. one sachet/day/5 kg child).Adult dosage: diagnose on a case by case basis.
Storage:The shelf life is 24 months. See best before date stamped on each sachet.It is recommended to keep the product in a cool and dry place at a temperature below 86°F (30°C). It is recommended not to stack the pallets.

Plumpy’doz® is a Ready-to-Use Supplementary Food (RUSF) used to reduce the incidence of acute malnutrition in children 6 to 36 months during times of food insecurity.
It should be used as a supplement to traditional food and it is well suited for emergency humanitarian situations. Ideally, children are breastfed until 24 months (exclusive until 6 months). As they get older, the complementary energy and nutrient contribution from traditional foods becomes increasingly important for meeting daily requirements.
Ingredients: Blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil), peanuts, sugar, nonfat milk powder, whey, maltodextrin, vitamin and mineral complex, cocoa, emulsifier: lecithin.
Recommended Use: Plumpy’doz® does not require any prior cooking or dilution and does not need to be refrigerated. Simply open the cup and eat the contents with a clean spoon.
Dosage: Three teaspoons three times per day OR one tablespoon three times per day. Equivalent to one 325 g cup per week.
Storage:The shelf life is 24 months. See best before date stamped on each cup.It is recommended to keep the product in a cool and dry place at a temperature below 86°F (30°C). It is recommended not to stack the pallets.

Nutributter® is a Lipid-based Nutrient Supplement (LNS) that enhances linear growth and cognitive and motor developmentwhile working to prevent malnutrition in children 6-24 months of age.
Nutributter® should be used as a daily supplement, and can be eaten alone or mixed with traditional foods. Nutributter® is not a substitute for a balanced diet. Breastfeeding is recommended until 24 months (exclusive until 6 months).
Ingredients: Peanuts, sugar, blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil), nonfat milk powder, whey, maltodextrin, vitamin and mineral complex, emulsifier: lecithin.
Recommended Use: Nutributter® does not require any prior cooking or dilution and does not need to be refrigerated. Simply open the package and eat the contents.
Dosage: One 20 g sachet per day for a minimum of 4-6 months. In malaria endemic areas it is recommended to split the 20 g sachet into two servings (10 g in the morning 10 g at night), in order to avoid a single large dose of iron.
Storage: The shelf life is 18 months. See best before date stamped on each sachet.It is recommended to keep the product in a cool and dry place at a temperature below 86°F (30°C). It is recommended not to stack the pallets.

Plumpy’soy® (production pending) is a Ready-to-Use Food (RUF) designed to support people whose daily food intake lacks the necessary macro and micronutrients. It is used for the prevention of malnutrition and nutrition-related deficiencies. Plumpy’soy® is particularly adapted for use in emergency situations and as a supplemental food for individuals living with illnesses, such as HIV/AIDS. Plumpy’soy® is suitable for anyone over the age of two.
Ingredients: Peanut, blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil),
sugar, maltodextrin, soy, whey, vitamin and mineral complex,
cocoa, emulsifier: lecithin.
Recommended Use: Plumpy'soy® does not need any prior dilution or cooking. Simply open the package and eat the contents.
Dosage: For children 2 years and up: 1 sachet per day. For adults: 2 sachets per day (provides the daily requirement of calories). One sachet is 92 grams.
Storage: The shelf life is 18 months. The best before date is stamped on each sachet. It is recommended to keep the product in a cool, dry place at a temperature below 86°F
(30°C). It is recommended not to stack the pallets
http://www.edesiallc.org/productinfo.html

MALNUTRITION: A plan for ending child hunger and malnutrition: Plumpynut

July 7th, 2010
When you read the Roadmap to End Global Hunger legislation, the alarming statistics on child hunger and malnutrition leap off the page.
"The United Nations Children's Fund estimates that 9,200,000 children under the age of 5 die every year, mostly from preventable and treatable causes, and that child and maternal malnutrition contributes to approximately 6,000,000 deaths of children under the age of 5 annually."
What can we do? There is a special food that can largely alleviate this massive hunger crisis. This food is called plumpy'nut, and it is produced by Nutriset in France, Edesia in the United States, as well as other organizations around the world.
Funding is desperately needed for emergency programs that would provide this life-saving food.
It's also imperative that the food reaches children before they fall deep into malnutrition. Ensuring that countries have adequate supplies of this nutritional food is a much more effective strategy. Navyn Salem, director of Edesia, says, "Avoiding dangerous levels of malnutrition is more cost effective and much better for the health of the children."
To accomplish this means developing an effective distribution of plumpy'nut across the globe. There are already production facilities in Ethiopia, Malawi, the Democratic Republic of Congo and several other countries. These facilities need to increase their capacity.
Developing plumpy'nut production facilities in other countries will increase the availability of the life- saving food and speed its delivery .The example of Yemen was cited in one of my most recent articles. There are others, including Guatemala and Haiti.
Here is a description of plumpy'nut and supplementary plumpy from the Edesia web site.
Plumpy'nut® is specifically designed for the treatment of severe acute malnutrition. It is suitable for ages 6 months and up.
Treatment generally lasts between 6 and 10 weeks depending on the severity of the condition. The nutritional value is identical to F-100 milk. Breastfeeding is recommended until 24 months (exclusive until 6 months).
Ingredients: Blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil), sugar, peanuts, nonfat milk powder, whey, maltodextrin, vitamin and mineral complex, cocoa, emulsifier: monoglycerides, lecithin.
Recommended Use: Plumpy’nut® does not require any prior cooking, dilution or refrigeration. Simply open the package and eat the contents.
Dosage: For severe acute malnutrition: 200 kcal/kg/day (i.e. two sachets/day/5 kg child).For moderate acute malnutrition: 75 kcal/kg/day (i.e. one sachet/day/5 kg child).
Storage: The shelf life is 24 months. See best before date stamped on each sachet.It is recommended to keep the product in a cool and dry place at a temperature below 86°F (30°C). It is recommended not to stack the pallets.
Plumpy’nut® complies with the definition of Ready-to-Use Therapeutic Food (RUTF) that requires no prior preparation, dilution or reconstitution.*
*Reference: “Community Based Management of Severe Acute Malnutrition”. A joint statement by the World Health Organization, the World Food Program, the United Nations Standing Committee on Nutrition and the United Nations Children Fund, May 2007.
Supplementary’Plumpy® is a Ready-to-Use Supplementary Food (RUSF) used to address moderate acute malnutrition. It is a high-energy nutritional food supplement, suitable for ages 6 months and up.
It is particularly adapted for children exiting therapeutic nutrition programs as a means of preventing the re-emergence of severe acute malnutrition.
This product is also suitable for other groups of people suffering from moderate acute malnutrition (adolescents, pregnant and lactating women, people living with HIV and other vulnerable adults). Breastfeeding is recommended until 24 months (exclusive until 6 months).
Ingredients: Blend of vegetable oil (contains one or more of the following: palm oil, soybean oil, rapeseed oil), sugar, peanuts, whey, maltodextrin, soy protein isolate, cocoa, vitamin and mineral complex, emulsifier: lecithin.
Recommended Use: Supplementary’Plumpy® does not require any prior cooking or dilution and does not need to be refrigerated. Simply open the package and eat the contents.
Dosage: For moderate acute malnutrition: 75 kcal/kg/day (i.e. one sachet/day/5 kg child).Adult dosage: diagnose on a case by case basis.
Storage:The shelf life is 24 months. See best before date stamped on each sachet.It is recommended to keep the product in a cool and dry place at a temperature below 86°F (30°C). It is recommended not to stack the pallets.
http://www.examiner.com/global-hunger-in-national/a-plan-for-ending-child-hunger-and-malnutrition

MALNUTRITION: WEST AFRICA: The Sahel's nutrition revolution

DAKAR, 21 July 2010 (IRIN) - Food shortages and high rates of malnutrition have long been a reality in the Sahel, but the understanding of malnutrition has drastically changed since the prolonged drought in the early 1970s. "Food and nutrition used to be seen as one, so the response to malnutrition was through food security; we started talking about nutrition security relatively recently. There is the question of access to food, but also of its nutritional quality and safety, child care practices, access to health, hygiene and sanitation," said Félicité Tchibindat, West Africa adviser on nutrition to the UN Children's Fund (UNICEF). IRIN provides a brief overview of this quiet nutrition revolution in the Sahel, the vast transitional zone along the southern edge of the Sahara Desert. The Great Sahelian Drought, 1968-1974 Several years of low rainfall sapped water reserves in Mali, Niger and Chad. By 1971 Lake Chad was one-third its normal size, grass and shallow-rooted plants shrivelled, cattle died. Pastoralists began migrating to cities and towns, joined by rural communities no longer able to farm; the population of Senegal's capital, Dakar, swelled by 42 percent. Up to 100,000 people and a third of livestock died of starvation and disease, according to the United States Agency for International Development [http://www.adf.gov/ndpart1-thedrought.pdf].
O"The response to malnutrition depends on our understanding of the causes," Tchibindat told IRIN. In the 1960s and '70s, malnutrition was defined as a deficit in protein and energy. "The distinction between hunger and malnutrition was unclear. It was thought that malnutrition could be cured by providing enough food - children were hospitalized and given high-protein treatments; mortality rates were up to 50 percent." 1983-84 Sahel drought Sahelian countries received some of the lowest rainfall ever recorded until 1983 and '84. Even though this drought was more severe than that of the 1970s, the UN Environment Programme says that there was less damage because economies and societies had developed better coping mechanisms [http://www.unep.org/Themes/Freshwater/Documents/pdf/ClimateChangeSahelCombine.pdf]. Still, crops failed, pastures shrank and one-third of the livestock died, according to a 2008 study by the Organisation for Economic Co-operation and Development and the Economic Community of West African States [http://www.oecd.org/dataoecd/10/8/41848366.pdf].
A decade after the Great Sahelian Drought, scientific understanding of malnutrition was evolving - malnutrition was not only empty stomachs, but also a lack of life-sustaining nutrients - nevertheless, treatment remained the same. "We still thought that the crises were exceptional, and intervened when the situation was catastrophic," Stéphane Doyon, head of the Médecins sans Frontières (MSF) nutrition campaign, told IRIN. "We put up hospitals to treat the severely malnourished children with porridge; in the meantime, general food distributions were taking place." The treatment was relatively successful - three out of four children recovered, but were undersized; it was also labour-intensive - every bed required a medical worker and health facilities hosted a maximum of 200 children. "We focused on the most affected children, [those] with high mortality risks," said Doyon. "We would have to turn patients away and give them food out of compassion. [Mothers] had to come to hospitals in urban centres and stay for 30 to 40 days with their child, leaving other children behind." 2005 Niger food crisis First the rains ended early and then the locusts came. In Niger the shortages of cereals and animal fodder brought death, compounded by rocketing food prices. Some 3.3 million people were affected, including 800,000 under-five children, the UN said. [http://irinnews.org/Report.aspx?ReportId=56324]
The development of ready-to-use therapeutic food (RUTF) [http://www.irinnews.org/report.aspx?ReportId=72897], like Plumpy'nut, in the late 1990s, meant that children without medical complications could be treated for severe acute malnutrition as outpatients. "It allowed us to treat many more children, with similar or even better success rates - 85 to 90 percent - and a much better coverage of the population. People responded well to mobile clinics since they no longer had to leave home for days. It also spared children from being exposed to other diseases in the hospital," said MSF's Doyon. Large-scale responses became possible. In 2002 MSF needed 2,000 staff [http://www.irinnews.org/Report.aspx?ReportId=32719] to treat 10,000 malnourished children in Angola; two years later a similar number were treated in Niger by 120 people dispensing nutrient-dense spreads from mobile clinics. When the crisis hit Niger in 2005, MSF reached 70,000 children. "That is about the number that we had treated during the three previous decades," Doyon commented. 2010 food crisis and beyond Falling cereal production and poor pastoral conditions, set against a backdrop of poverty, rapid population growth and high food prices, have put over 10 million people at risk of hunger before the September harvests in Niger, Chad, Mali, Burkina Faso and northern Nigeria, according to the UN Food and Agriculture Organization [http://irinnews.org/Report.aspx?ReportId=89598]. Nowadays, most children are treated at home but aid organizations have called for more attention to children aged under two, and to moderate acute malnutrition [http://www.irinnews.org/Report.aspx?ReportId=88233]. In countries like Niger, 3 to 4 percent of children are typically severely malnourished, compared to 10 to 15 percent who are moderately so, noted UNICEF's Tchibindat. The World Health Organization (WHO) indicates that without adequate support, moderately malnourished children may progress towards severe acute malnutrition, "But it took a long time before we started seeing this as a continuum," she added. "In 2006, we realized that we were constantly facing high [rates of acute] malnutrition, and that the lean season would always be difficult," said MSF's Doyon. "We thought that we should try treating children before they become severely malnourished. It worked." The usual treatment for moderate malnutrition, which has remained virtually unchanged over the last 30 years, should be improved. "Cereal-based flours lack essential nutrients and are not in line with WHO's criteria," he said. Banda Ndiaye, Senegal country director of the Micronutrient Initiative, pointed out that children with insufficient micronutrient intake and absorption could suffer lifelong repercussions. "For example, a deficit in vitamin A will reduce a child's resistance to infection and put him more at risk of death from diarrhoea or measles, while a lack of iron will affect the development of intellectual capacity." Tchibindat agreed. "The earlier we act, the greater the impact. We should even intervene during pregnancy to prevent children from being born with intra-uterine growth deficit, which leads to children being born with a low weight and a high risk of developing malnutrition during early childhood," she said. "We have to look at the genesis of malnutrition and step away from medical intervention. The investment needs to be done over 5 to 10 years, and not over 12 to 18 months." [http://www.irinnews.org/report.aspx?ReportId=76527] clg/pt/he
Factbox: The Sahel [http://www.irinnews.org/Report.aspx?ReportId=78514] is a semi-arid belt of barren, sandy and rock-strewn land that stretches 3,860km from Senegal to Eritrea and marks the physical and cultural divide between Africa's more fertile south and Saharan desert north. It covers parts of Senegal, Mauritania, Mali, Burkina Faso, Algeria, Niger, Nigeria, Chad, Sudan, Somalia, Djibouti, Ethiopia and Eritrea.
Factbox: Malnutrition terms Chronic malnutrition occurs over the long term and is caused by an insufficient intake of some nutrients. It especially affects children younger than five. The symptoms of short-term chronic malnutrition in children include growth faltering and weight loss, with associated micronutrient deficiencies. The longer-term effects are associated with impaired physical and mental development.
Acute malnutrition: A drastic deterioration of nutritional status in a short time can lead to acute malnutrition or wasting (individuals too thin for their height). This form of malnutrition poses more severe health risks than chronic malnutrition and leads to weight loss, impaired bodily functions, and specific micronutrient deficiencies. In its severe form acute malnutrition can lead to death. Source: UNICEF