MALNUTRITION: A Free Miracle Food!

By NICHOLAS D. KRISTOF

Published: July 10, 2013 

MOPTI, Mali — Can you name a miracle food that is universally available, free and can save children’s lives and maybe even make them smarter?

Damon Winter/The New York Times

Nicholas D. Kristof

I’m on my annual win-a-trip journey, in which I take a university student along with me so we can report on global poverty. The winner, Erin Luhmann of the University of Wisconsin, and I randomly stopped in a village near the Malian town of Mopti to ask about food shortages.

Then we spotted a baby boy who was starving to death. The infant, only 3 weeks old, was wizened from severe malnutrition and had the empty, unresponsive face of a child shutting down everything else to keep his organs functioning.

The teenage mother, Seyda Allaye, said that she didn’t have much milk and that the baby wasn’t nursing well. She saw that he was dying and that morning had invested in cow’s milk in hopes of saving him.

Erin and I had a vehicle, so we offered to take her and her son to a hospital to see if doctors could save his life. At the hospital, a doctor examined the baby, asked his mother to try to nurse him and immediately diagnosed the problem.

“The mother doesn’t know how to breast-feed properly,” said the doctor, Amidou Traoré. “We see lots of cases of child mortality like this.”

Dr. Traoré repositioned Seyda Allaye’s arm, helped the infant latch on to her breast, and the baby came alive. And there’s the answer to my opening question. The miracle food that could save so many lives is: breast milk.

The latest nutritional survey from The Lancet estimates that suboptimal breast-feeding claims the lives of 804,000 children annually. That’s more than the World Health Organization’s estimate of malaria deaths each year.

Look, I realize that there’s something patronizing about a man griping about poor breast-feeding practices, and, in the West, the issue is linked to maternity leaves and other work practices. But, if we want to save hundreds of thousands of lives, maybe a step forward is to offer more support to moms in poor counties trying to nurse their babies.

Nursing a baby might seem instinctive, but plenty goes wrong. In some parts of the world, a problem has been predatory marketing by formula manufacturers, but, in the poorest countries, the main concern is that moms delay breast-feeding for a day or two after birth and then give babies water or food in the first six months. The World Health Organization strongly recommends a diet of exclusively breast milk for that first half year.

In a village in Mali, Erin and I watched a woman wash a baby — and then pour handfuls of bath water down his mouth. “It makes the baby strong,” a midwife explained.

On hot days, African moms routinely give babies water to drink. In fact, breast milk is all infants need, and the water is sometimes drawn from unsanitary puddles.

Here in Mali, fewer than one-quarter of women breast-feed exclusively for six months. In Niger, where Erin and I are also traveling on this win-a-trip journey, it’s 8 percent. In our third country, Chad, it’s only 2 percent.

This isn’t just an issue in poor countries. In the United States, 16 percent of children are exclusively breast-fed for six months. Then again, in the United States, the child’s life does not normally hang in the balance.

Several studies highlight other advantages of breast-feeding, including increases of several points in a child’s I.Q. and improved development of areas of the brain associated with language and planning.

While many moms think they don’t produce enough milk, nutritionists say that that’s rare. Even when moms are malnourished, the baby’s frantic suckling will stimulate more milk.

Erin and I traveled partway on this trip with Shawn Baker, a public health expert with Helen Keller International. One day we asked him where he would invest a billion dollars if he had it.

“To me, the next big win in saving kids’ lives is breast-feeding promotion,” he said. “It’s absolutely unacceptable that more than 800,000 kids are dying annually of suboptimal breast-feeding.”

Ghana is a model of a country that has successfully used public health campaigns to raise rates of exclusive breast-feeding very significantly.

There are many ways to save lives, some involving dazzling technologies. But maybe in our sophistication we’ve overlooked a way to ease childhood malnutrition that is sustainable, scalable, free — and so straightforward that all hungry newborns cry for it.

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MALARIA: additional questions about Chloroquin

:	William Brieger
Date:	Fri, Jul 5, 2013 6:37 am

1)      There has been some report also of CQ-antihistamine effectiveness in Southern Nigeria. Could it be that administration of CQ is done in combination with antihistamines that are now known to reverse CQ resistance (at least in vitro)?

Innocent
(Cameroon)

There was a study published 5 years ago that addressed this question, but since the advent of widespread use of ACTs, the issue was never taken any further:

Ann Trop Med Parasitol. 2008 Jan;102(1):3-9. doi: 10.1179/136485908X252179.

Comparative study of interactions between chloroquine and chlorpheniramine or promethazine in healthy volunteers: a potential combination-therapy phenomenon for resuscitating chloroquine for malaria treatment in Africa.

Gbotosho GO, Happi CT, Sijuade A, Ogundahunsi OA, Sowunmi A, Oduola AM.

Source

Malaria Research Laboratories, Institute of Advanced Medical Research and Training, College of Medicine, University College Hospital, Ibadan, Nigeria. solagbotosho@yahoo.co.uk

Abstract

Although, in in-vitro and limited in-vivo studies, chlorpheniramine (CP) and promethazine (PR) have each been shown to reverse chloroquine (CQ) resistance, the pharmacokinetic basis of this reversal has not been fully elucidated. In the present study, 15 healthy volunteers were randomly allotted to receive standard doses of CQ alone or in combination with CP or PR. Blood samples were collected from each volunteer at 21 time-points, from immediately before to 168 h after the initial dose. These samples were used to follow the changes in the plasma and erythrocytic concentrations of CQ. The ratio between the mean maximum CQ concentration in the erythrocytes and that in the plasma was 4.2 for the volunteers given CQ alone, 7.3 in those given CQ-CP, and 3.2 in those given CQ-PR. CP significantly enhanced the erythrocytic accumulation of CQ, increasing the maximum CQ concentration observed in the erythrocytes by 24% (P = 0.02). The bio-availability of CQ was also significantly increased in the presence of CP, with the mean value for the area under the curve, of erythrocytic concentration v. time, increasing from 99,921 to 214,516 ng/ml.h (P=0.001). The mean half-life of CQ in the erythrocytes also increased when CP was used, from 51 to 100 h, but this change was not statistically significant (P=0.83). In contrast to CP, PR had no statistically significant effect on the disposition of CQ. As CP clearly enhances disposition of CQ, a combination of CQ with CP may be useful in the management of CQ-resistant infections. Detailed toxicological studies are required to understand the full clinical implications of CP's elevation of erythrocytic CQ concentrations.

2)      "Given that Nigeria has a 'talking culture' (as opposed to a writing one),..' Tarry Asoka http://www.africa-health.com/articles/march_2013/AH%20Nig%20Mar%2013.pdf page 1,  Which means that many of the actions taken by government and her agencies in Nigeria are not evidenced based or at best slanted. The recent experience with polymer bank notes is a case in point. A few years ago we were told it would be the best thing that would happen to our currency. Now, we know better. Yet, the proponents have assumed A SIDDON LOOK posture.  Please, before chloroquine disappears from the scene, let us be VERY SURE the alternatives are AFFORDABLE, BETTER and readily available in rural Nigeria.

Yombo.

Basically CQ no longer work/clears the parasitess in most of Nigeria, although in the far northwest it may be better than nothing. In the southeast I have seen almost dead children who were given the full dose of CQ to no avail.  True the alternative and officially recognized ACTs are more expensive, but from the consumer’s point of view child treatment in public clinics with ACTs should be free – emphasis on should.  ACT is now standard practice, but as the authors in the abstract shown above have said elsewhere, we are not helping people if ACTs are used with the same non-compliance to standard regimens as was CQ.

MALARIA: Africa Fighting Malaria Updates and Events July 2013

Africa Fighting Malaria Updates and Events Africa Fighting Malaria (AFM) seeks to raise awareness of the huge burden of malaria in sub-Saharan Africa and promote sensible policies for long-term solutions.

DDT use would save many lives in Uganda   It is most painful and very sad to see that some Ugandans feel comfortable dancing on the graves of between 200 to 300 Ugandans, mostly children and pregnant women, dying due to malaria daily. These numbers are equivalent to 25 minibuses with 14 passengers each, crushing every day. It is even very possible that these numbers are an under-estimation of the people who actually die due to malaria in Uganda. There are those who die at home or on the way to a health facility or die in private clinics or even die while waiting for a Health Worker in a health facility and are never captured in the statistics presented.    Read More Other News Encourage countries to strengthen their own health systems, DfID told... EU and India unite to study malaria... New malaria tool to help track insecticide resistance... Malaria Policy Advisory Committee to the WHO: conclusions and recommendations of March 2013 meeting...  Events and Information July 08-12 2013, SARN Annual Constituencies Consultative Meeting, Johannesburg, South Africa July 15-19 2013, Molecular and Population Biology of Mosquitoes and other Disease Vectors: From Basic Vector Biology to Disease Control Check out the book "The Excellent Powder: DDT's Political and Scientific History". 'Too few' bed nets paid for by UK are being used The UK has funded 25 million mosquito nets since 2010 but the National Audit Office said usage among target groups, such as children, was disappointing. The watchdog urged the UK to work with aid recipients to "change attitudes" and to ensure proper value for money. Ministers said the increased use of bed nets was part of a multi-faceted strategy acknowledged to save lives.    There is no vaccine for malaria and the disease killed an estimated 660,000 people last year and left 250 million people seriously ill.    Read More Malaria experts meet in Kampala to expand access to quality-assured antimalarial treatment   Experts from 25 countries across Africa are meeting, at the 12th annual National Malaria Control Program (NMCP) Best Practice Sharing Workshop in Kampala, to discuss the problem of sub-standard antimalarials in Africa and address key topics and challenges faced by the malaria community.   Read More  Also on FightingMalaria.org News AFM Articles Research About AFM Contact Us Donate to AFM Please email Africa@fightingmalaria.orgfor more information.

MALARIA: Agriculture's impact

Caspar van Vark

• Guardian Professional, Wednesday 19 June 2013 11.03 BST
• Jump to comments (1)

Rice is a staple crop in sub-Saharan Africa. But it relies on flooded paddies, which provide breeding sites for mosquitoes. Photograph: Corbis/ Gideon Mendel

Raising agricultural productivity is a priority in much of sub-SaharanAfrica, where some 70% of people live in rural areas and rely on farming. But 90% of the estimated 660,000 global deaths caused by malaria in 2010 were also in Africa, and agricultural development can play a role in its transmission. How should this be reconciled to create a more "malaria smart" approach to agricultural growth?

One of the main links between malaria and agriculture is irrigation. It's estimated that irrigation could boost agricultural productivity in Africa by 50% and many development organisations see irrigation as crucial to future development.

But irrigation can also be conducive to mosquitoes, which transmit malaria. Rice, for example, is a staple crop in sub-Saharan Africa and important for food security. It also relies on flooded paddies, which provide breeding sites for mosquitoes such as Anopheles gambiae, one of the principal vectors of malaria.

That can be problematic, but the irrigation-malaria link is complex and varied. For example, research has shown that even where the introduction of irrigation systems increases mosquito density in a given area, malaria transmission can actually decline.

In other words, more mosquitoes may not automatically mean more malaria. This is known as the 'paddies paradox'.

"In my view there are two possible explanations for this," says Martin Birley, a former lecturer at the Liverpool School of Tropical Medicine and an expert in health impact assessments.

"Either the irrigation scheme attracts mosquitoes that are less able to transmit malaria, or the people who live on the irrigation schemes are better able to avoid getting malaria, because their income is growing. Poor people, when provided with additional wealth, tend to have an improvement in their health, and that applies everywhere."

But the effect isn't universal: studies of the 'paddies paradox' distinguish between areas where malaria is 'stable', or sustained, and areas where it is 'unstable', or episodic. The paradox is seen in the stable areas, where there is a higher level of immunity in the population.

In areas of unstable transmission, immunity tends to be low or non-existent, and malaria is a threat to adults as well as children, which in turn threatens adult worker productivity. The introduction of irrigation systems in such areas – and the associated increase in mosquitoes – may be much more serious. Well designed irrigation systems can help control this.

"The important thing is to reduce surface pooling in the irrigation schemes, so there's not too much water in the fields," says Steve Lindsay, a disease ecologist at the University of Durham and malaria expert.

"Make sure the irrigation channels do not leak and fill in areas which puddle. In Khartoum there is local legislation that requires the farmers to have dry fields one day per week, and that has helped reduce malaria. Ultimately malaria is a problem of surface water. Remove the breeding sites, you remove the problem."

Where populations are most vulnerable, irrigation projects need to take this on board and build malaria awareness into the scheme from the start. But too often, according to Kwadwo Asenso-Okyere, former director of the eastern and southern Africa regional office of theInternational Food Policy Research Institute and now a consultant to its Ghana programme, rural populations themselves lack understanding of malaria transmission and policymakers also fail to act.

"Most irrigation projects do not incorporate such externalities," he says. "They need to internalise this externality and incorporate malaria control – education, provision of bednets, screening of doors and windows, aerial spraying of insecticide, early diagnosis and treatment – as a component of the project."

Irrigation is not the only potential 'bridge' between agriculture and malaria. Mosquitoes are known to feed on maize pollen, and a 2005 study reported an association between intensified maize cultivation and higher malaria transmission in an area of Ethiopia, where a high-yielding variety introduced in the mid-90s replaced more traditional crops such as teff, barley and sorghum.

Previously a marginal garden crop, maize became intensely cultivated close to homesteads, with correspondingly high levels of pollen. The new variety also released its pollen a few weeks later in the season, coinciding perfectly with mosquito breeding times.

This doesn't mean maize causes malaria, but it shows how certain agroecological changes can accelerate it in perhaps unforeseen ways. According to James McCann, professor of history at Boston University and a specialist in the agricultural and ecological history of Africa, who co-authored the research in Ethiopia, this association is now recognised – even if policies haven't responded.

"The director of a key agency's crop programme – the Ethiopian Institute of Agricultural Research – came to a workshop on maize and malaria and stated that he was convinced of the link, but then honestly advised us that his primary mandate from his bosses was food production and that the government was committed to maize as the engine of that growth," says McCann. "Health implications were not a consideration."

Greater policy alignment in achieving health and agricultural objectives is therefore the challenge. One approach is for health impact assessments to be built into irrigation projects, just like environmental impact assessments (EIA) often are. This happens, but isn't yet standard practice, particularly for smaller schemes.

"The bigger ones have it," says Birley. "So where an EIA would look at the impact of an irrigation project on many aspects of the environment, the health impact assessment looks at unintended health consequences. But most national governments don't have regulations for health impact assessments."

In the example of maize, fairly simple changes such as growing other crops near mosquito breeding grounds and maize further away is one way of addressing the problem. Maize can also be de-tasselled by hand to remove the pollen-producing tassels, or maize breeders could potentially select for different pollen shedding patterns in their breeding strategies.

But for such 'malaria-smart' policy responses to happen, there needs to be broader awareness of how agricultural productivity and other objectives overlap, says McCann. This is where advocacy by development actors could make a difference.

"Malaria-smart investment would need to build NGO awareness and a broader view within the major agriculture efforts from Gates and Rockefeller that their efforts to increase yields and returns also have important ecological implications around health, crop disease resistance, and biodiversity," he says.

"The food/seed production system has continued to emphasise yield as the overwhelming priority. Changing that policy would be like turning the Queen Mary. These things move very slowly. The mosquitoes and the parasites respond much more quickly than human bureaucracies.

MALNUTRITION: Timor-Leste: Calls for nutritional behaviour change

Photo: Cate Heinrich/IRIN

Improving child nutrition is a key challenge

DILI, 2 July 2013 (IRIN) - More work is needed to improve nutritional behaviour in Timor Leste, where 58 percent of children under five are stunted (too short for their age) due to chronic malnourishment, experts say. 

“The focus needs to be on behavioural change. Simply increasing the quantity of food will not improve people’s nutritional status if this food source, such as rice, has limited nutritional value,” Mirko Gamez Arias, a programme manager at CARE, told IRIN. 

“It is not always simply a case of whether people have access to enough food, but often more a question as to whether the quality of food consumed is sufficient to prevent malnutrition. Many people’s diet consists of little more than the basic staples,” said Alberto Mendes, country director for the World Food Programme (WFP). 

According to a 2013 report by the UN Children’s Fund (UNICEF) Timor-Leste has the highest percentage of children under five who are moderately or severely stunted in the world, matched only by Burundi. The report does not contain figures for Afghanistan and Yemen, where equally high rates of stunting among children were previously reported. 

The proportion of stunted children under five increased from 50 percent in 2002 to 58 percent in 2009-10. 

Stunting reflects chronic undernutrition during the most critical periods of growth and development in early life. 

Globally, undernutrition contributes to more than one third of child deaths. In Timor-Leste (population 1.1 million), the number of underweight children has increased from 41 percent in 2002 to 45 percent in 2009-10, the report said. 

“Massive impact” 
“The situation remains very critical in Timor-Leste as stunting has a massive impact on both physical and mental development, which mostly cannot be reversed after a child reaches the age of two. This can have long-term negative impacts on a country's economic and social development when its children cannot reach their potential due to poor nutrition,” said Geoffrey Keele, UNICEF regional communication specialist in Asia. 

According to the UN, contributing factors to the high rates of malnutrition in the small half-island country include inadequate child feeding practices, limited health services, poor hygiene practices and a lack of healthcare infrastructure. 

“A focus on addressing the socio-cultural issues around malnutrition and on behaviour change communication in Timor-Leste needs to be strengthened as socio-cultural behaviour leads to improper feeding practice and care for children and women,” UNICEF country representative in Dili Hongwei Gao told IRIN. 

The government is working to address long-term chronic malnutrition rates, notably through the ongoing implementation of the National Nutrition Strategy, revised in 2012. 

While the strategy has been in place since 2004, only in 2008 did the country develop nutrition interventions to assist in both screening for malnutrition and to bolster behavioural change. 

These interventions promote behavioural changes to improve nutrition, including promotion of infant and young child feeding (exclusive breastfeeding and appropriate complementary feeding practice), micronutrient supplementations, treatment of severely malnourished children, and a salt iodization programme. 

Specialized nutritious foods are provided to vulnerable women and children, supported by WFP. However, to assist in changing behaviour, information is also provided to communities on cooking methods, good hygiene practices, and how to prepare a balanced, sufficient diet. 

Photo: Cate Heinrich/IRIN

A local food market in Dili

Education assists behavioural change 

Behavioural change plays an important role in improving nutrition of children and needs strengthening, health experts say. 

HIAM Health, a national NGO in Dili, works on education and support programmes together with Dili National Hospital to address the malnutrition of children referred by hospitals. 

“Often the families are here because of a lack of knowledge about nutrition, and not due to poverty,” said Hiam Health’s organization capacity builder, Jill Hillary. “These skills that the parents learn can be passed on to community members when they return home and mostly the children recover.” 

Rice, cassava and corn form the basis of most children’s diets when families are unable to afford meat, eggs or dairy. 

Meanwhile, health workers note the need for a greater awareness of the importance of proper childcare and feeding practices. 

Although the World Health Organization (WHO), recommends exclusive breastfeeding during the first six months of life, the latest Timorese Democratic and Health Survey (2009-10) revealed the rate to be only 52 percent. 

“As nutrition is a complex issue, Timor-Leste would benefit from a more multi-sector approach to addressing the problem which integrates health, nutrition and behaviour change actions,” said WFP’s Mendes. 

ch/ds/cb 

MALNUTRITION: Responsible for 45 Percent of all Child Deaths

June 6, 2013

Breaking News

By Maureen Gallagher

Senior Nutrition Advisor

The influential new figures on maternal and child malnutrition reinforce how pervasive and destructive undernutrition remains

Today, the latest series on maternal and child malnutrition was published by the leading medical journal The Lancet, and its findings are revelatory. Global malnutrition now accounts for 45% all child deaths worldwide: a staggering 3.1 million young lives are lost each year—a half million from wasting, or severe acute malnutrition—making undernutrition the single greatest threat to child survival.

Five years after this groundbreaking series launched in 2008, The Lancet’s leading nutrition experts once again confirm that acute malnutrition remains a critical global health crisis. The publication goes beyond diagnosis by emphasizing the need for immediate action, with a special emphasis on lifesaving treatment for severe malnutrition as one of the most cost-effective of the nine nutrition interventions outlined in the report.

MALARIA nexus weekly update 28 June 2013

Latest News   Posted on 28 June 2013 Validation of thiamine utilization as an antimalarial drug target An article recently published in Nature Communications reports that interfering with thiamine (vitamin B1) utilization inhibits Plasmodium sp growth in vitro and in vivo.   Posted on 27 June 2013 Registration deadline for the 24th Annual Molecular Parasitology Meeting (MPM) extended! The MPM will be held this year from September 8 to 12 in Woods Hole, MA, USA. The registration deadline for poster abstract submission has been extended to July 20.   Feature Articles   Posted on 26 June 2013 Malaria eradication: is it possible? Is it worth it? Should we do it? The Lancet Global Health, Volume 1, Number 1, Jul 2013, Pages e2-e4. Jenny Liu, Sepideh Modrek, Roly D Gosling, Richard GA Feachem   Posted on 26 June 2013 A blood stage fraction of Plasmodium berghei induces protective and long lasting immune response in BALB/c mice Parasitology International, Volume 62, Issue 3, June 2013, Pages 329-336 Upma Bagai, Anil Pawar   Posted on 26 June 2013 Association of naturally acquired IgG antibodies against Plasmodium falciparum serine repeat antigen-5 with reduced placental parasitemia and... Parasitology International, Volume 62, Issue 3, June 2013, Pages 237-239 Tonny J. Owalla, Nirianne Marie Q. Palacpac, Hiroki Shirai, Toshihiro Horii, Thomas G. Egwang   Posted on 26 June 2013 Synthesis and evaluation of phenoxyoxazaphospholidine, phenoxyoxazaphosphinane, and benzodioxaphosphininamine sulfides and related compounds as... Bioorganic & Medicinal Chemistry Letters, Volume 23, Issue 12, 15 June 2013, Pages 3580-3583 Christine Mara, Enda Dempsey, Angus Bell, James W. Barlow

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