Dr. Susan Shepherd
We got some great feedback on this recent blog post about treating malnutrition in Niger. Here, Dr. Shepherd responds.
Darrel H. (on Facebook): FYI…As you share Plumpy nut, make sure it is only given to children 6 months to 2 years. It has to high of a content of fat for older children. Just learned this at the International Food Aid and Development Conference in Kansas City.
Dr. Susan Shepherd: PlumpyNut is given to severely malnourished children at any age for a limited period of time (6-8 weeks) to support lean tissue weight gain after a period of weight loss. The issue is not fat content for a specific age group, but for a specific metabolic state. A high fat diet is appropriate for people who have abnormal weight loss (catabolic state); it is not appropriate for healthy children who are growing at a normal rate (anabolic state).
Chika O. (on Facebook): What is the government of Niger doing to solve this problem? Why are they abdicating that responsibility to MSF? That is the real question.
Dr. Susan Shepherd: The government of Niger has supported the development and revision of a national protocol for the treatment of malnutrition. It has included severe and moderate malnutrition in its health statistics, monitored weekly, similar to other diseases that require rapid response (meningitis, cholera, measles). Childhood malnutrition is now being taught to medical students at the University in Niamey. In 2010, the Ministry of Health is participating in the oversight of innovative programs to reduce the incidence of severe malnutrition in the under 2 year age group. Niger is one of the regions of the world most affected by childhood malnutrition, it is a huge public health concern. The real challenge is to devise strategies to address the problem that don’t break a weak, developing health system.
Caro O. (on Facebook): God bless, its breast feeding week from 16th to 20th in Kenya, wish you would attend. Breast feeding is suppose to stop malnutrition to the still breast feeding kids, i agree with you Darrel H, plumpy nuts does miracle, have seen its amazing positive effect,they are great!
Dr. Susan Shepherd: Breast milk is all a child needs for the first 6 months, but at that point, all infants need quality complementary foods that provide quality protein, fats and vitamins/minerals: particularly calcium, zinc and iron [breast milk cannot meet babies' requirements for these]. So breastfeeding is essential, but it is not sufficient on its own to assure proper nutrition from 6 months – 2 years, the transition period when children shift from breast milk alone to family food. This is why children need baby foods that are calibrated to their particular nutritional needs. Foods similar to PlumpyNut can provide the proper nutritional balance in an infant’s diet, in addition to breast milk, of course.
We welcome more feedback or questions. You can leave them in the comments here, post them on our Facebook page, or tweet them to us at @MSF_USA.
According to you “Breast milk is all a child needs for the first 6 months” (which is also known to us) but I would like to know what are you doing for the infants who are not having breast milk at all or just having too little (insufficient) since birth ?
(In every society there are some mothers who do not have breast milk at all or have insufficient and it is natuarally after delivering a baby. Besides, there are many mothers who die during delivering baby particularly in 3rd world countries.
i’m studying medicine in Armenia and i really wanted to help MSF from the beginning but i don’t know how and i don’t even know where is the MSF office in Yerevan!! how can i find that out??
I can’t comment properly because I am writing from a mobile phone. I’d urge the interested persons to read on the facts provided by the WHO and Unicef regarding the importance of breastfeeding in emergency situations.
All of the elements the interviewed assumes breastmilk lacks after the first 6 months simply are incorrect (except for iron).
Too many interests regarding children (mal)nutrition, too many people getting profit out of it.
Is the whole plumy nut magic bullet response to malnutrition a money grab for companies like nutriset? The resources put to the purchase of improving the rates of exclusive and sustained breastfeeding, nutrition education using local culturally appropriate foods to improve complementary feeding, subsidized agricultural inputs and other sustainable solutions to reducing and preventing malnutrition. Additionally much malnutrition is triggered by infectious diseases such as diarhoeal disease, and malaria and parasites. The eradication of malaria and the treatment and prevention of parasites in young children will go along way to reducing undernutrition and malnutrution.
“Breast milk is all a child needs for the first 6 months, but at that point, all infants need quality complementary foods that provide quality protein, fats and vitamins/minerals: particularly calcium, zinc and iron [breast milk cannot meet babies' requirements for these]”
This statement is unfortunately wrong and at the heart of why some “medical aid programmes” do more damage than good in developing countries, spreading the myth that mother’s milk is not enough and pressuring mothers into adding foods that can lead to diarrhoea and respiratory illnesses in young infants. Breastmilk is very very very high in fat, and though lower in iron than some other foods, because of enzymes it contains it is much more easily absorbed by the body. So even if it had only half the iron concentration of a comparable food, it would still meet the iron needs just as well.
The main reason for malnutrition and infections is the belief that other foods need to be added quick. I wish doctors were more educated on this issue so that they could really help health outcomes for the children. Unfortunately, many doctors rely on infant formula propaganda that is aimed at selling breast milk substitute to the billions of people who can’t afford it. Unfortunately, well meaning but uninformed doctors are helping them with their agenda.