MALNUTRITION: SAHEL: After 30 years, nutrition strategy revamp at hand

10 September 2010 (IRIN) -
Aid strategies for treating children suffering moderate acute malnutrition (MAM) have remained virtually unchanged for 30 years. As part of UN-led efforts to revamp policy, several initiatives in West Africa are examining how best to treat the condition, a major cause of death and disease worldwide. Across the Sahel - where an estimated six million children are moderately malnourished, according to UN Children's Fund (UNICEF) - aid agencies are evaluating new approaches. Among them is distribution of new ready-to-eat nutrient-rich pastes, which some NGOs urge, but are yet to be rigorously researched as MAM treatment."Unless we can give sound advice backed by scientific research, and translate that knowledege into programmes that reach the majority of children, we will not be able to tackle MAM, which is really one of the forgotten and missing parts of [what we face in the region]," said UNICEF nutrition adviser for West and Central Africa Felicite Tchibindat. In a number of current projects, including a randomized, community-based study in Mali, UNICEF and aid agencies are examining the efficacy of several products and strategies.One product being evaluated in Mali is CSB++, a more nutrient-rich version of the corn-soya blend long used by the UN World Food Programme (WFP) for moderately malnourished children. Nutrition experts say the original CSB does not contain the nutrients to stem MAM.The Mali study, by UNICEF, WFP, University of Bamako and University of California-Davis, is also evaluating Supplementary Plumpy (a nutrient-rich peanut paste), Misola and local foods plus a nutrient powder."It's very hard to ask donors to invest in these approaches without proof they work," said Kenneth Brown, HKI regional adviser for nutrition and child survival and U-C Davis professor, told IRIN. A primary aim is to develop a global protocol for treating moderate acute malnutrition, as exists for severe, principal researcher Robert Ackatia told IRIN in the Mali capital Bamako.A less formal evaluation is under way in Niger, where this year's emergency nutrition response has spotlighted questions over CSB's efficacy for MAM, UNICEF's Tchibindat told IRIN. "When we treat with CSB, some children with MAM are cured, but the vast majority are not cured," Tchibindat said. "We decided, why not use [the lean period] to test some of the new knowledge globally - because we have the money, we have the system in place and let's learn from there." UNICEF in a revised strategy in Niger is doing blanket feeding with a combination of CSB and ready-to-eat peanut pastes. "This will give us an idea in the Sahel context. Do we have something here that would work and is it cost-effective?" UNICEF for the first time is distributing Plumpy'doz, a nutrient-rich supplement, to moderately malnourished children in Chad, where in some regions one in four children suffer from MAM. Agency officials said they are monitoring the operation closely for guidance in future programmes. Sliding into severe Nutrition advisers say tackling MAM calls for huge resources, given the numbers, but that effective prevention and treatment could save a significant number of children from becoming severely malnourished. "It is clear that if we just concentrate on treating severely acute malnourished children we will never solve the issue, because we will not deal with these high numbers of moderately malnourished children," Tchibindat told IRIN. "We have a lot of children in the region who are highly vulnerable, who are just about to go over the edge [from moderate to severe]." She said one challenge in developing strategies for MAM is that the category encompasses a wide range of conditions, and simply giving foods that add energy is not the answer. "Moderately malnourished children range from children close to normal to those who are close to severe; if you give the same product, which is just adding energy [without necessary nutrients], this does not address the problem." It is difficult finding funding for the research such as that taking place in Mali, which is backed by Office of US Foreign Disaster Assistance (OFDA), Tchibindat said. This illustrates one of the challenges of developing nutrition assistance that goes beyond urgent therapeutic feeding once children are in a critical state. "Donors are used to funding supplies and the like. And they have to convince their governments; that's not easy. Governments prefer to fund things that are tangible, not fuzzy," she said.WFP regional nutrition adviser Anna Horner said managing MAM requires a longer-term commitment than most donors contributing to malnutrition programmes are prepared to make. She added: "It is sometimes an activity that is difficult to classify as it can be considered both emergency and development, and touches many different sectors. As such it is sometimes hard to fit into the traditional funding mechanisms." Tchibindat said the nutrition community has also failed to convince donors. "It's coming now but for a long time you were happy to get funds to buy the Plumpy'nut [another ready-to-use supplement]. We were not strong enough in convincing donors that they need to fund the operational research, the capacity-building, the mid- and long-term activities." She added that aid partners must avoid the turf battles that can hamper the close collaboration needed for sound nutrition programmes.Deeper causes Generally nutrition programmes are run by humanitarian agencies, but nutrition is integral to development, aid workers said. WFP's Horner said given the numerous causes of malnutrition, "there is no single way forward for preventing and treating MAM. Success [is possible only by] reducing causes including food insecurity, morbidity, inappropriate feeding practices for infants and young children and limited access to clean water and hygiene." In Chad Action Against Hunger head Jean-Francois Carémel said interventions must encompass all these factors. "The frustration is that the response is focused on curative actions. Acute malnutrition is indeed a medical pathology but it is also social, economic and cultural. "The statistics justify urgent action but also the need for real in-depth, coordinated work on access to and quality of health care." Many approaches exist for preventing malnutrition, including improving food production and livestock breeding and boosting women's status, he said. Nutrition experts say managing moderate malnutrition ultimately should be a task for government, but that varies across the region depending on political commitment, infrastructure and stability. UNICEF's Tchibindat would add civil society as a major player: "We need to educate civil society to question the UN, NGOs and the government on what they are doing to tackle malnutrition." She said donors and NGOs are coming around to linking nutrition with broader development issues."Let's not forget that even managing severe acute malnutrition has improved immensely very, very recently, with ready-to-eat therapeutic foods," she said. The aid community has not had a good understanding of MAM. Most nutrition NGOs deal with severe acute malnutrition, and nutrition was not really high on the global agenda some 10 years ago. Now people are recognizing that if we don't tackle malnutrition we may not be able to achieve most of the Millennium Development Goals."

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MALNUTRITION: Zimbabwe: WFP warns of toddler malnutrition

Vusimuzi Bhebhe
04 September 2010
HARARE – Less than 10 percent of Zimbabwe’s children aged two and under are consuming a diet that is “minimally acceptable”, the World Food Programme (WFP) warned in a report published last week.The UN agency said the majority of Zimbabwean toddlers were at risk of malnutrition due to a lack of balanced diets.“Only 8.4 percent of children under 2 are consuming a diet that is minimally acceptable,” WFP said in the latest Global Update: Food Security Monitoring released on Tuesday.The WFP report corroborates a recent joint survey by the Zimbabwe government and the UN Food and Nutrition Council FNC) which found that more than a third of children aged below five in the southern African country are malnourished.The Zimbabwe National Nutrition Survey carried out in January 2010 revealed a worsening problem of chronic malnutrition, posing long-term survival and development challenges for the southern African country that is battling to shake off the effects of a 10-year recession and political strife.Once a net food exporter Zimbabwe has faced food shortages since President Robert Mugabe’s controversial land reform programme that he launched in 2000 and which has seen agricultural output plummet because the government failed to provide blacks resettled on former white farms with inputs and skills training to maintain production.A unity government formed by Prime Minister Morgan Tsvangirai and Mugabe last year is pushing to revive the economy although it has to date failed to ensure law and order in the mainstay agricultural sector where mobs of supporters of Mugabe’s Zanu (PF) party continue harassing the few remaining white commercial farmers.
http://www.thezimbabwean.co.uk/index.php?option=com_content&view=article&id=33944:wfp-warns-of-toddler-malnutrition-&catid=52&Itemid=32

MALNUTRITION: SAHEL: Peanut pastes and milk powders to save children

20 August 2010 (IRIN) - Aid agencies in Niger and Chad have begun giving tens of thousands of malnourished children a product called Plumpy'doz to save them from sliding into often-fatal severe malnutrition. The highly nutritious ready-to-eat Plumpy'nut, to treat severe acute malnutrition, has been widely used since its first widespread application in Darfur in 2003. Today several African countries including Niger are producing Plumpy'nut locally. Meanwhile Plumpy'doz and other products for moderate acute malnutrition (MAM) are being studied for their efficacy and cost-effectiveness. http://www.irinnews.org/Report.aspx?ReportId=90242In Chad the monthly distribution of Plumpy'doz from July to October (the lean season) marks the first-ever use of the product there, and the UN Children's Fund (UNICEF) is closely monitoring the intervention for future planning. Supplementary Plumpy is among other therapeutic foods being studied in a UNICEF project in Mali, aimed at filling what many nutrition experts call a troubling gap, in which there is little scientific evidence of the effect of various products on MAM, despite it being a major cause of morbidity and mortality among children worldwide. UNICEF estimates that of the 6.5 million acutely malnourished children in West and Central Africa, five million have moderate acute malnutrition. From UNICEF-Niger, here is a rundown of products aid agencies are using to stem the Sahel nutrition crisis: Plumpy'nut Therapeutic food with high nutritional value for children aged one to five. A high-protein, high-energy peanut-based paste, designed to appeal to children. It does not need to be refrigerated and has a shelf-life of two years, making it easy to deploy for treating severe malnutrition. Treatment takes six to seven weeks. It contains vitamins A, B-complex, C, D, E and K, with the necessary minerals calcium, phosphorus, potassium, magnesium, zinc, copper, iron, iodine, sodium and selenium. Used as an alternative to therapeutic milk F100 (see below) for treating severe malnourishment, or for children without medical complications who are outpatients. Plumpy'dozAdministered to prevent malnutrition in children aged six to 23 months. A ready-to-use paste of vegetable fat, peanut butter, sugar, milk and nutrients. It has a longer shelf-life than previous diet supplements. Three teaspoons of Plumpy'doz three times a day provides a child with additional energy, including fats, high-quality proteins and essential minerals and vitamins required for growth and a healthy immune system. Malnutrition termsGlobal acute malnutrition, or "wasting", is defined as low weight for height or the presence of oedema. It can be moderate (MAM) or severe (SAM). It occurs as a result of recent rapid weight loss, malnutrition, or a failure to gain weight within a relatively short period of time. Wasting occurs more commonly in infants and younger children. Recovery from wasting is relatively quick once optimal feeding, health and care are restored. Wasting occurs as a result of deficiencies in both macronutrients (fat, carbohydrate and protein) and some micronutrients (vitamins and minerals). Chronic malnutrition, commonly referred to as "stunting", is a failure to grow in stature, which occurs as a result of inadequate nutrition over a longer period. It is a slow, cumulative process, the effects of which are usually not apparent until the age of two years. Severe acute malnutrition (SAM) is the most dangerous form of malnutrition. Left untreated, SAM can result in death.Sources: Action contre la Faim and UNICEFSupplementary Plumpy Treats moderate acute malnutrition and deficiency-related illnesses in children aged one to five. It is also given to children leaving therapeutic nutrition programmes to prevent the re-emergence of severe acute malnutrition. Supplementary Plumpy requires no cooking or refrigeration, the dose is generally one sachet per day per child, and the duration of treatment is three months. It contains vegetable fat, sugar, soya flour, peanut paste, whey powder, fat-reduced cocoa, and mineral and vitamin complex. Therapeutic milk F75 For the initial phase of treating severe malnutrition, and with medical complications. As a rapid weight increase is dangerous during the first phase of treatment for severe acute malnutrition with complications, F75 is designed to re-establish the metabolic balance without weight gain. Treatment is three to four days. Therapeutic milk F100 For nutritional rehabilitation of severely malnourished children. Qualified staff must administer the milk to the children. Use must be closely monitored as the need for water poses a risk of contamination. Both the F75 and F100 milks contain powdered milk, vegetable oil and concentrated combinations of vitamin and dextrin. They are high in energy, proteins and fats.