Rewriting the Story

October 16th, 2011

Thank you for helping to rewrite the story of malnutrition for 195 million children around the world. As one of the more than 138,000 people in 180 countries who signed the petition demanding that donor nations stop supplying nutritionally substandard food to malnourished children and children at risk of malnutrition in developing countries, you have already helped make a significant difference.

Today, on World Food Day, you can continue to help rewrite the story by donating your profile for 24 hours.

Press Release: Food Aid System Continues to Fail Malnourished Children

October 13th, 2011

While Young Victims of War and Famine Are Able to Access Latest Lifesaving, Nutritious Foods, Millions More Malnourished Children Still Receive Poor Quality Food Aid

Childhood Malnutrition – What’s Happening Now
Download Briefing Paper (PDF)

NEW YORK, OCTOBER 13, 2011 – Despite some recent gains in the fight against childhood malnutrition, the global food aid system—led by the United States—largely continues to provide substandard foods to millions of malnourished children every year, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) announced today, in advance of World Food Day on October 16.

Malnutrition—a preventable and treatable condition—afflicts an estimated 195 million children worldwide and is the underlying cause of at least one-third of the eight million annual deaths of children under five years of age, the vast majority of which occur in the developing world.

Children under the age of two are the most vulnerable to the consequences of malnutrition, and without access to nutrient-dense foods necessary for growth and development, such as highly effective ready-to-use supplementary foods now available, they will suffer debilitating lifelong consequences.

“It’s been proven beyond any doubt that getting nutritionally appropriate foods to young, vulnerable children saves their lives, yet the global food aid system has not fully caught up with the revolutionary gains made in nutrition science,” said Dr. Unni Karunakara, MSF’s international president.

The bulk of international food aid shipments, including those sent to countries with a high burden of malnutrition, such as parts of sub-Saharan Africa, are comprised of corn-soy blend (CSB) fortified flours, which do not include the vital nutrients and proteins growing children require. The United States alone annually ships approximately 130,000 metric tons of sub-standard CSB—grown and processed on American farms—to the developing world.

While initiatives led by the US government, such as the “1,000 days” campaign or “Scaling Up Nutrition” (SUN), bring together countries featuring high levels of malnutrition with major international food donors—demonstrating that there is a scientific and political consensus on the need to focus on children under two—most food aid today does not provide appropriate nutrition to young children.

“The catalog of products available for food aid grossly neglects the needs of the most vulnerable,” said Dr. Karunakara. “There’s no excuse for waiting anymore; the world’s major food aid donor countries need to finally get on board.”

MSF today sent letters to representatives of the top food aid donor countries, including the US, European Union member states, Canada, and Brazil. The letters were sent on behalf of more than 133,000 individuals from over 180 countries who signed a petition, demanding that donor nations “stop supplying nutritionally substandard food to malnourished children and children at risk of malnutrition in developing countries.”

In a letter to Secretary of State Hillary Clinton, USAID Administrator Rajiv Shah, and Secretary of Agriculture Tom Vilsack, MSF-USA Executive Director Sophie Delaunay urged the US government to apply the same nutrition standards to the food it sends overseas as it does through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which ensures that low-income American families have access to quality, nutritious foods.

“As the world’s largest food aid donor, the policies and practices of the U.S. are enormously influential in assuring that the right foods reach the right people at the right time,” the letter said.

Some key food aid players have begun to change. The World Food Program, for example, now uses supplementary foods that meet the nutritional needs of children under two as the cornerstone of its interventions in medical emergencies. Such products played a key role in 2010 in response to the nutritional crisis that struck Niger, the floods in Pakistan, and the earthquake in Haiti. And donor nations and aid agencies have improved the quality of foods sent to Somalia and Kenya in response to current nutrition crises there.

Yet the vast majority of malnourished children, who are not caught up in attention-grabbing emergencies, continue to receive products from major international food aid donors that do not meet their specific nutritional needs.

“High profile emergencies, such as those in Somalia and Kenya today, represent just the tip of the malnutrition iceberg,” said Dr. Karunakara. “Most malnourished children are invisible, and they should not have to become victims of war or natural catastrophes in order to have access to the foods they need.”

In late 2008, an expert meeting convened by the World Health Organization (WHO) considered the growing body of scientific evidence and concluded that nutritional standards of food aid needed to be improved. But three years later, the WHO, which most Ministries of Health in developing countries rely on for policy guidance, has yet to issue formal guidelines to ensure the improvement of food for malnourished or young children.

“Guidance from the WHO is crucial to encourage donor countries to adopt better standards for food aid and recipient countries to adopt better measures to ensure their children have access to quality nutrition,” said Dr. Karunakara.

“Children cannot afford the delays caused by having to demonstrate the safety and efficacy of these new specialized foods with every single government from one crisis to the next,” he said. “This only serves to delay the initiation of lifesaving programs.”

In June 2010, MSF and the VII Photo agency launched “Starved for Attention,” a multimedia campaign exposing the neglected and largely invisible crisis of childhood malnutrition. VII photojournalists traveled to malnutrition “hotspots” around the world—from war zones to emerging economies—to shed light on the underlying causes of the malnutrition crisis and innovative approaches to combat this condition, producing eight documentaries, which can be viewed at www.starvedforattention.org.

In 2010, MSF admitted more than 300,000 malnourished patients to feeding centers at 139 projects in 28 countries.

Starved for Attention Exhibition

October 7th, 2011

The Starved for Attention exhibit tours the East Coast, recreating a Doctors Without Borders/Médecins Sans Frontières (MSF) field hospital specializing in the treatment of malnourished children, just like those used in the field. MSF medical staff and aid workers—who have worked in malnutrition projects in the field—will guide visitors through a simulated clinic and describe how MSF works to treat and prevent malnutrition.

NY1 Spotlights Starved for Attention Exhibit

September 26th, 2011

On Friday, NY1 featured three clips on the Starved for Attention interactive exhibit. The exhibit drew more than 2,000 visitors during its run in New York, and will be heading to Philadelphia later this week, followed by Baltimore and Washington DC. Watch the NY1 clips, including interviews with exhibit guides here.

“Everyday we are not utilizing these life-saving products is basically a failure on our part as humans.” – Dr. Leo Ho, Medical Coordinator

Infographic: Malnutrition Worldwide

September 16th, 2011

MSF Fights the Nutritional Double Standard at Food Aid Policy Conference

August 26th, 2011
Reactions from the MSF aid workers and staff who participated in the Kansas City meetings:

Last month, policymakers and representatives from various organizations involved in the international food aid system gathered in Kansas City, Missouri to assess current U.S. food aid policy

Several MSF aid workers and staff, including a pediatrician and a nutritionist who both recently treated malnourished children in MSF field clinics, attended the conference to give voice to the Starved for Attention campaign and promote the improvement of food aid quality.  As Dr. Susan Shepherd recently wrote in an opinion piece in the Kansas City Star,  “Investments in child health and nutrition programs should be based on what children need, no matter where they live.”

While some incremental progress was achieved with the release of a report by Tufts University experts calling for higher levels of key nutrients in corn-soy blend, a food aid staple, the MSF team reports that quicker and more significant changes are still needed to treat the millions of malnourished children around the world.

Dr Susan Shepherd Responds to Nick Kristof’s Editorial, ‘The Breast Milk Cure’

July 6th, 2011

Breast-Feeding in Niger

To the Editor:

Forgive my skepticism at Nicholas D. Kristof’s pronouncement that breast-feeding is the cheap miracle cure for malnutrition and child mortality in Niger (“The Breast Milk Cure,” column, June 23).

Exclusive breast-feeding during a child’s first six months of life is not cheap anywhere. Decisions must be made by women about how to allocate time to earn money to feed the family, tend the fields or nurse a new baby.

As a pediatrician with Doctors Without Borders, I have met plenty of mothers in Niger. They walk for miles or work fields under a broiling desert sky carrying their babies on their backs. When a woman is parched, she suspects that her baby is, too — so she gives the baby some water. Breast milk is the best food for babies, but focusing only on exclusive breast-feeding masks the collective failure to provide safe water.

The severe malnutrition Mr. Kristof describes is far more prevalent in 1-year-old Niger infants — an age when breast milk must be complemented with animal-sourced foods to provide infants the nutritional value they need. The meager plant-based foods typical in the Niger diet are as much a contributor to early childhood deaths as poor water and malaria.

I have seen how combinations of better diagnosis and treatment of malaria, immunization and nutrition supplementation with good-quality foods for 6-to-24-month-olds are saving lives. The only reason these programs work is that mothers are willing partners.

SUSAN SHEPHERD
New York, June 29, 2011

Empty Calories and Promises

June 27th, 2011


The US Standard and A Double Standard
The access to nutritious, enriching foods that the U.S. government provides to young American children is a stark contrast to the nutritionally devoid blend of fortified flour sent to malnourished children outside the country.

Press Release: Child Mortality Observed 50% Lower With Better Food

The following op-ed by Dr. Susan Shepherd, MSF child nutrition adviser, was printed in the Kansas City Star today in light of the 2011 International Food Aid & Development Conference happening this week in Kansas City.

Finding the right recipe of diet and exercise to keep children healthy is never easy for a nation. Within a generation, we have gone from “Hunger in America,” the landmark 1968 report on the millions of American children suffering from severe malnutrition, to “Let’s Move,” the new initiative to improve nutrition and reduce childhood obesity.

One consistent bright spot, however, has been the Women, Infants and Children’s program (WIC) that emerged in the early 1970s. Through WIC, low-income families are given the means to improve children’s and pregnant or breastfeeding mothers’ diets. In the first two years of life, children are growing and learning at breakneck speed — and there’s a crucial 18-month window to make a lifelong difference. From 6 months onward, children need a range of nutritious foods that provide the right mix of proteins, fats, vitamins and minerals essential to health, growth and development. WIC assures access to these costly, healthy foods: milk, eggs, baby foods, fortified cereals, fresh fruits and vegetables.

This program has helped wipe out childhood malnutrition in America.

It’s time the U.S. government applied the same nutrition standards to the foods it sends overseas to children in need. In Kansas City this week, U.S. and international policymakers, health care professionals, aid practitioners and advocates will discuss ways to improve the quality of the foods provided to the developing world.

Every year the U.S. sends more than 100,000 tons of fortified corn-soy bean flour to nutrition programs, primarily in sub-Saharan Africa. These flours, grown on American farms and processed in American factories, are used as porridge to feed malnourished children. Tragically, they do not meet the nutritional requirements of these children.

Fortified corn-soy porridge is seen as emergency food aid, as if it’s intended just to tide children over for a short time until things improve. But a recent Government Accountability Office report reveals that more than half of this food actually goes to some countries year after year like an international WIC program. A young child in Ethiopia has the same nutritional needs as a child in Kansas City, and they need more than corn and soy beans, they need animal-sourced foods like milk.

Unfortunately, new recommendations in a USAID-commissioned Food Aid Quality Review still fall short of what young children need. WIC provides at least a third of an infant’s daily calories as milk, eggs or meats; the Quality Review adds a meager offering of 2 percent of energy from milk to the food it intends for malnourished children living in the most food-insecure regions of the world. The other 98 percent is corn, soy and vegetable oil.

Last year in Niger, an impoverished sub-Saharan nation, Doctors Without Borders distributed a milk-based paste fortified with vitamins, minerals and other essential nutrients to 150,000 young children between 6 months and 2 years, as part of a program providing medical care for common childhood illnesses, including malaria.

We monitored closely, and observed that deaths among those children receiving the milk-based supplement were reduced by half compared with those who did not receive it.

The USAID quality review recommends the inclusion of these “baby foods” but because they cost more humanitarian aid agencies will likely continue to rely on the less appropriate corn-soy flours.

Investments in child health and nutrition programs should be based on what children need, no matter where they live.

Susan Shepherd of Butte, Mont., is a pediatrician. She has worked for Médecins Sans Frontières/Doctors without Borders for the last four years and coordinates work in nutrition. She has worked in Uganda, Chad, Niger and Ghana.

We Still Need Your Help to Rewrite the Story of Malnutrition

June 23rd, 2011

Over the past year, MSF has met with government officials from the top food aid donor countries and held photographic exhibitions and events in over a dozen countries in an international effort to rewrite the story of malnutrition.

Sign the “Starved for Attention” petition before June 27 to play an invaluable role in keeping the pressure on the top food aid governments to improve the nutritional quality of foods sent to feed malnourished children overseas.

On June 27 in Kansas City at the International Food Aid & Development Conference, the US government will announce reforms to its international food aid policy. This will be the first time the foods used in this decades-old, billion-dollar program will be significantly retooled.

Every year the US sends over a hundred thousand tons of fortified corn-soy bean flour to be used to make porridge to feed malnourished children, primarily in sub-Saharan Africa. Tragically, these flours, grown on American farms and processed in American factories, do not meet the nutritional requirements of these young, growing children.  Thus, the US sends inadequate food overseas to vulnerable children that it would not use in its domestic nutrition programs.

Unfortunately, the proposed food aid reforms being announced in Kansas City still fall far short of the highly successful nutritional standards employed in the Women, Infants, and Children’s (WIC) program that has helped wipe out childhood malnutrition in America. It’s time to end the double standard of US food aid.

We need your help to push the US government to ensure that the food sent to these vulnerable children actually meets their nutritional needs to grow and thrive.

Thank you for your support.

Press Release: Child Mortality Observed 50% Lower With Better Food

May 24th, 2011

PARIS/NIAMEY, May 24, 2011 – Mortality rates were observed to be 50 percent lower among a large group of young children in the west African nation of Niger in 2010, after they received a highly nutritious supplemental food, according to preliminary findings in a study by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

The encouraging findings reinforce the need for international donors and policymakers to make high-quality foods a cornerstone of childhood health programs, especially in areas where malnutrition is rife.

Malnutrition weakens the immune system, exposing a child to higher risk of death from other illnesses, such as malaria, respiratory infections, and diarrhea. Adding a quality supplemental food to an essential package of care—including vaccination and effective treatment and prevention of primary ‘killer diseases’ of young children—will accelerate the fight against child mortality.

Last year in Muskoka, Canada, G8 member states committed to refocus efforts over the next five years to cut mortality rates of children under five years of age, by two-thirds from 1990 levels. At their meeting this week in Deauville, France, G8 members should commit to ensure that appropriate foods reach vulnerable children, MSF said.

“Our preventive strategies focused on getting a nutritionally appropriate food to children during the most crucial time—the critical window of six months to two years of age—instead of waiting for them to start losing weight, and we observed child mortality rates to be lower by half,” said Dr. Isabelle Defourny, MSF program manager for Niger. “If donors and policymakers are serious about reducing child mortality rates, then providing child-appropriate foods must be made a standard component of any pediatric program in the world’s ‘malnutrition hotspots’.”

At any given time, an estimated 195 million children are affected by malnutrition worldwide. It contributes to at least one-third of the eight million annual deaths of children less than five years of age.

For several years, MSF has been developing preventive approaches to malnutrition—based on quality supplementary foods—in order to lower the burden of deaths in ‘malnutrition hotspots’ such as in the Sahel region of Africa. The Sahel features child mortality rates among the highest in the world. During a severe food and nutrition crisis in 2010 in the Sahelian country of Niger, local authorities, together with MSF and the Nigerien organization FORSANI (Forum Santé Niger), implemented the largest-ever distribution of supplemental foods designed to prevent malnutrition in young children.

Between July and December, 2010, three-to-six-month supplies of a ready-to-use paste rich in milk, minerals, and vitamins were distributed to approximately 150,000 children—most between 6 months and 2 years-of-age—in five districts of the Tahoua, Maradi, and Zinder regions. Some of the children also benefitted from protection rations (mainly cereals and fortified flours) provided by WFP. Pediatric healthcare for common childhood illnesses, such as malaria, and acute malnutrition, was also available in the distribution areas, including for the children who did not receive a nutritional supplement.

Epicentre, MSF’s epidemiology branch, conducted monthly surveys among a cohort of several thousand young children living in the distribution zones. All benefitted from monitoring for signs of malnutrition and illness. Children requiring medical care were referred to MSF and its partners working within Nigerien health-care facilities.

The mortality rate was seen to be more than 50 percent lower among those who received the foods tailored specifically to the nutritional requirements of young, growing children.

In the Madarounfa district in Maradi region, the observed mortality rate among children who received the enriched foods was 2.2 deaths per 10,000 children per day, compared to 5.3 deaths per 10,000 children per day among those who did not receive supplements. In the Guidan Roumji district of Maradi, mortality rates were 1.1 per 10,000 per day compared to 2.5 per 10,000 per day. In the town of Mirriah in Zinder region, the rates were 1.2 per 10,000 per day versus 3.2 per 10,000 per day.

“Providing young children with high quality nutritious foods has long been one of the foundational principles of successful malnutrition and child mortality reduction programs in Europe, Latin America and the United States, along with immunization, for instance,” said Dr. Susan Shepherd, MSF child nutrition advisor. “It’s time to stop applying different standards for children living in malnutrition hotspots. We can save children’s lives today if the appropriate resources are put behind similar interventions to those we deployed last year in Niger.”

Countries such as Mexico, Thailand, the United States, and many European nations, have successfully reduced early childhood malnutrition and mortality through programs that ensure infants and young children from even the poorest families have access to nutritious foods, such as milk and eggs. However, many food-insecure families cannot afford these animal-sourced foods, which contain the high-quality proteins, fats, and other essential nutrients that children require. National programs that fill this nutritional gap for young children are essential.

The development in recent years of a new generation of nutritional foods tailored to the needs of the most vulnerable children, which are simple to use, make possible the establishment of a new standard in childhood mortality prevention.

In 2010, in addition to malnutrition prevention activities, MSF and its partners, FORSANI and BEFEN / ALIMA, carried out pediatric and nutritional activities in 64 primary care facilities and nine hospitals in Niger’s Tahoua, Maradi and Zinder regions. Approximately 150,000 children suffering from malnutrition were treated—nearly half of all the malnourished children treated in the country in 2010—of whom approximately 24,000 were hospitalized. Between 85 and 92 percent of children were discharged. MSF and its partners also treated 216,330 cases of malaria among children less than five years of age, conducted more than 370,000 pediatric consultations, and admitted more than 13,000 children to hospital.