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
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
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.
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.
AID POLICY: Getting the recipe right for US food aid
© Antonin Kratochvil/VII
JOHANNESBURG, 13 May 2011 (IRIN) – Changing the food the US government supplies as aid could deliver better results and still save money, a new study says. The review for the US Agency for International Development (USAID) by researchers at the Tufts University Friedman School of Nutrition Science and Policy has been welcomed by NGOs and US food aid experts, but the findings have also come in for some criticism.
The two-year review considered if USAID food aid was up to date with current science, especially in its use of blended food and whether programmes matched the right products with expected outcomes.
“What we’re recommending is approaches to enhance the many great things already being done with US food aid under the most difficult circumstances imaginable,” Amelia Reese Masterson, research coordinator of the review, wrote to IRIN, referring in part to USAID’s budget pressures.
The review came up with 20 recommendations on some of the food products and programmes under Title II of the US Food for Peace Act, which covers food aid provided in emergency and non-emergency situations.
Getting the ingredients right
The Tufts review addressed the issue of the source of protein in food products for children, pregnant and lactating women, and undernourished people on HIV medication.
Médecins Sans Frontières (MSF) has noted that US food aid destined for children usually comprises fortified flours based on grains and pulses such as corn-soya blend (CSB) or wheat-soy blend (WSB) and has lobbied for the inclusion of other sources of protein, vitamins and minerals.
Recent scientific evidence shows that animal-source proteins such as milk, better promote the growth of muscle tissue and resistance to infections, and are critical to children recovering from severe malnutrition, the Tufts review agreed. It also acknowledged that ready-to-use therapeutic foods (RUTF), usually lipid-based spreads, whose ingredients typically include nuts and milk powder, have led to a radical change in the way severe malnutrition is treated.
The review recommended that a wider range of products, offering varying quantities and types of nutrients for different programmatic contexts, be made available.
It is here that the review has contradicted itself, Nathalie Ernoult, Stephane Doyon and Susan Shepherd, members of the MSF’s nutrition team, maintained in a written submission to the Tufts academics.
A la carte or menu fixe?
“The report itself states that there can be no ‘one-size-fits-all’ food supplement, and we could not agree more,” the MSF team said, yet it “focuses primarily on how to improve the nutritional value of fortified blended flours.”
The Tufts study argued for a single formulation for a cost-effective, enhanced CSB, which they dubbed CSB14, to meet the minimum nutritional requirements of three key target groups: infants from 6 to 11 months; children between one and three years; and pregnant women.
The MSF team said at least two enhanced CSB formulations would be necessary: one tailored to the needs of infants and young children and those affected by moderate acute malnutrition; the other for older children and adults.
UN organizations the World Food Programme (WFP) and the UN Children’s Fund (UNICEF) are also considering experimenting with different formulations of CSB.
“As a field-level agency and occasional implementing partner for UNICEF and WFP, we [MSF] cannot over-emphasize the need for coherence in the nutritional supplements on offer for a given category of beneficiary,” the MSF team said. “If the fortified foods provided by WFP, UNICEF and USAID for similar programmes are not interchangeable, nutrition programmes will simply become confused and ineffective.”
MSF maintained that the formulation for younger children should have a higher protein content from animal-sourced food; and that the proposed fortification levels of iron and zinc were also too low.
Zita Weise Prinzo of the World Health Organization (WHO) said they were recommending that the diets of moderately malnourished children contain animal-sourced foods, without specifying how much. WHO is expected to release its guidelines for food formulations for moderately malnourished children in June 2011.
According to MSF, the proposed second formulation for older children and adults, would not require animal-sourced ingredients, and the current CSB recipe, with some adjustments to its vitamin and mineral content, would serve the purpose.
However, a senior nutritionist who preferred not be named told IRIN that in many instances it would be hard to imagine relief agencies successfully distributing two or more similar looking products for different segments even within a single family.
“Most large-scale programmes using CSB-type products involve take-home rations. It would be difficult for a programme to ensure the proper use of several similar products at home. The solution could be to have one ‘generic’ option used by most big programmes, similar to that proposed by the [Tufts] paper, and then several other options that would be used by ‘speciality’ programmes.”
The CSB14 formulation depends on the addition of oil fortified with vitamin A to provide enough of the vitamin. “Our experience shows that it is difficult to count on the prescribed amounts of oil being added to the porridge in the home, not to mention all the logistical difficulties encountered with the distribution of multiple commodities to constitute a single ration,” the MSF team pointed out.
The chemical forms of micronutrient supplements proposed by Tufts also differed from those on the list approved by the WFP, the biggest dispenser of US aid. “It is very important to come to common agreement on a list of acceptable chemical forms for all additives,” the MSF team noted.
PEPFAR food
Programming should “be evidence-based, not driven by simple data on tonnages and ‘hungry people fed’, but by an understanding of the unit cost of impact,” and this included HIV/AIDS-related programmes, said the review. It found that orphans and vulnerable children, and HIV-positive pregnant and lactating women, identified for priority food assistance in the US President’s Emergency Plan for AIDS Relief (PEPFAR), were receiving not getting priority compared to other HIV-positive women and adults.
The review suggested stronger links between ongoing antenatal, Prevention of Mother-to-Child Transmission (PMTCT), and Maternal and Child Health (MCH) services, and with programmes treating malnourished children.
PEPFAR country coordinators reported that requests to approve the use of funds for food were “commonly met with caution”, the review said, which “contributes to low coverage of food assistance within programmes”, and PEPFAR needed to send a stronger signal on supporting the allocation of funds to food in HIV support.
Saving money
Budget-constrained donors were “facing hard trade-offs between feeding as many people as possible and providing higher quality foods to improve nutritional impact per person,” said Christopher Barrett, a food aid expert who teaches development economics at Cornell University in the US.
Scarce resources should be put to work more efficiently, and the Tufts review contributed significantly to improving understanding of these tradeoffs by policymakers, operational agencies and commercial suppliers, Barrett commented.
“It’s important to move beyond a dollar-per-ton of food metric – the conventional way of looking at things – since that does not take into account exactly what kinds of foods are used for what purposes,” said Patrick Webb, principal investigator of the Tufts review project.
“If we become more efficient in treating or preventing malnutrition, then it’s the cost per case of malnutrition treated or prevented that matters, and that will go down when the appropriate tools (foods) are used in the right ways, even if unit costs of products rise slightly… because less is needed (over a shorter period of treatment).”
Some of the Tufts recommendations would cost more money – the addition of dairy products, new smaller packaging of some products for mothers and infants to prevent it from being consumed by the entire family – but Webb said the costs would be offset by improved targeting of the enhanced products.
Barrett noted that “With greater bang for the buck, it also becomes easier to defend valuable food aid programmes against those looking to trim budgets.”
The review, the issues it covers and its recommendations will be debated at the US government’s annual conference on food aid in June.
MSF is one of several aid organizations advocating for the preventative treatment of malnutrition for children in Niger. Adding nutrient-rich food supplements to a regular diet provides vulnerable children with the protein and vitamins their bodies need to grow and develop.
In Niger, where food shortages are common, children often lack these essential dietary needs. As Patrick Barbier, head of MSF’s Niger mission explains, “There is a clear link between access to healthcare and acute malnutrition being a disease and not only a deficiency of food. Access to health care is poor, so the health status of the children is poor.”
Read the full article from Voice of America News and learn more about MSF’s research on preventative malnutrition in a recent article in the medical journal Pediatrics.
Women wait in a food distribution line at a health clinic in the Maradi region of Niger. © Yann Libessart / MSF
France 24’s broadcast program Beyond Business takes a look at the legal battle over the patent for the life-saving ready-to-use therapeutic food, PlumpyNut. In the studio interview, MSF nutrition expert Stephane Doyon explains how the patent stymies efforts to treat malnutrition effectively and affordably. Watch the report.
A Bangladeshi mother feeds PlumpyNut to her child in a malnutrition clinic. © Ron Haviv/VII
ABC News features an MSF clinic in Niger in this piece from their “Be the Change: Save a Life” global health reporting series. Christiane Amanpour follows with an interview with USAID Director Rajiv Shah, who says, “I think we’ve all now recognized…that we need to move to higher quality, higher nutrition foods.”
Sign the “Starved for Attention” petition today so we can continue to put pressure on the US government and other top food aid donors to turn the rhetoric into action for the 195 million malnourished children around the world.
Recent flooding in Niger has drastically affected food supply, increasing the country’s already-high rate of childhood malnutrition.
MSF’s nutritional centers expect to treat close to 150,000 Nigerien children this year. Listen to MSF’s Dr. Susan Shepherd discuss malnutrition in Niger on BBC’s World Service radio program, “World Today”.
Despite the current spike in malnutrition, Dr. Shepherd says, “We know that every year is a bad year for the young children in Niger when it comes to malnutrition;” what is needed are “ways to avoid having to develop last-minute, chaotic, huge, and very expensive emergency programming.”
Need to Know takes a closer look at the global malnutrition epidemic, the unexpected role that U.S. food policy plays in perpetuating it and some new ideas for improving nutrition for those who need it most.
Watch the full episode. See more Need To Know.
