MALNUTRITION: Pakistan: Chickpea replaces peanut in new supplementary food recipe

June 03, 2011

Ready-to-use foods 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 ready-to-eat supplementary food, 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. [Note: the original version of this article - and its headline -wrongly referred to Wawa Mum as a therapeutic food, but it is better described as a supplementary food].
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.
“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://www.speroforum.com/site/article.asp?idCategory=33&idsub=128&id=54944&t=Pakistan%3A+++Chickpea+replaces+peanut+in+new+supplementary+food+recipe

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