Hope for Hungry Children, Arriving in a Foil Packet
MARADI, Niger, Aug. 7 - In the crowd of riotously dressed mothers clasping wailing, naked infants at a Doctors Without Borders feeding center just west of here, Taorey Asama, at 27 months, stands out for a heart-rending reason: she looks like a normal baby.
A mother feeding the food supplement Plumpy'nut to her child in Tibiri, Niger. It is distributed to mothers of severely malnourished children.
Groups Aiding Niger (August 4, 2005)
Many of the others have the skeletal frames and baggy skin of children with severe malnutrition. The good news is that a month ago, so did Taorey.
"When she came here, she was all small and curled up," said her mother, Henda, 30. "It's Plumpy'nut that's made her like this. She's immense!"
Never heard of Plumpy'nut? Come to Maradi, a bustling crossroads where the number of malnourished children exceeds even the flocks of motor scooters flitting down its dirt streets.
At this epicenter of Niger's latest hunger crisis, Plumpy'nut is saving lives, perhaps including Taorey's.
Plumpy'nut, which comes in a silvery foil package the size of two grasping baby-size hands, is 500 calories of fortified peanut butter, a beige paste about as thick as mashed potatoes and stuffed with milk, vitamins and minerals. But that is akin to calling a 1945 Mouton Rothschild fortified grape juice.
Since the packets came into the hands of relief organizations during the Darfur crisis in Sudan, they have been revolutionizing emergency care for severely malnourished children who are old enough to take solid food, by taking care out of crowded field hospitals and straight into mothers' homes.
The prescription given to mothers here is simple: give one baby two packets of Plumpy'nut each day. Watch him wolf them down. Wait for him to grow. Which he will, almost immediately: badly malnourished babies can gain one to two pounds a week eating Plumpy'nut.
"This product, it's beyond opinion - it's documented, it's scientific fact," Dr. Milton Tectonidis, a Paris-based nutrition specialist for Doctors Without Borders, said in an interview here. "We've seen it working. With this one product, we can treat three-quarters of children on an outpatient basis. Before, we had to hospitalize them all and give them fortified milk."
Traditional malnutrition therapy hospitalizes the tots, nursing them to health with steady infusions of vitamin-laced milk. Then they are sent home with powdered milk formula to complete their recovery. It works well, but milk is costly, must be mixed from water and is prone to spoiling.
And when mothers prepare the formula with the dirty water all too common in impoverished villages, babies get sick.
In comparison, Plumpy'nut - the name melds the words "plump" and "peanut" - costs less than the milk formula, has a two-year shelf life and need not be mixed with anything. Its sealed packaging and thick consistency make it a poor home for disease-causing germs that thrive in milk.
Perhaps most revolutionary, however, is that mothers, not doctors, can give it to their toddlers. That not only reduces costs, but also frees the doctors to treat the sickest children, who often suffer not just from malnutrition, but also from diseases like malaria or dysentery.
The usual course of treatment is four weeks of Plumpy'nut, costing about $20, along with grain-based food like Unimix, a vitamin-packed flour that can be made into the porridge many Africans eat. But some children return to health in as little as two weeks.
The product is the brainchild of a French scientist, André Briend, who had labored in vain for years to concoct a ready-to-eat nutrition supplement, until serendipity - a bottle of the popular Nutella breakfast spread on his kitchen table - led him to try a paste instead using candy bars and other kinds of food. Later, Nutriset, a French company that specializes in making food supplements for relief work, began packaging the formula under the name Plumpy'nut.
For three months, Doctors Without Borders has been handing out week-long supplies of Plumpy'nut, 14 foil packets in a black plastic grocery sack, at its five outpatient feeding centers in Maradi and 21 centers elsewhere in Niger.
Not everyone gets it: newcomer babies are weighed and measured, and only those whose weight is dramatically below normal for their height qualify. Those who are too ill for outpatient care go to a nearby field hospital.
About 700 babies are being treated in Maradi, and about 130 more arrive for screening each day, of which perhaps 80 are accepted and given an ankle bracelet - their ticket, so to speak, good for a weekly trip to the center for more foil packs, bags of grain and cooking oil. Across the area of hunger in Niger, about 5,000 children spread across 32 feeding centers are being given the packets.
Theodore Bitangi, a 33-year-old nurse who oversees the Maradi feeding centers, says that the program is growing almost as rapidly as its patients.
"When they come in, the state they're in, they look like embryos. They're so small sometimes," he said. "And after taking Plumpy'nut, they look like real babies."
Mothers who have been feeding the paste to their babies would hardly disagree. "As soon as I got him home, he started eating it - every day, aggressively," Idrissa, 24, who has no last name, said of her 2-year-old son. "And after three days, I could see a big difference. The change was abrupt." Her son, who refused to open his eyes before starting the Plumpy'nut regimen one week ago, has added fat under his sagging skin and, when his packet is finished, cries for another.
"I don't know how to express it," Idrissa said. "I'm so happy."
Raham, 45, who has no last name, walks an hour each way to the clinic from her village, Madata, to pick up a weekly bag of Plumpy'nut for her year-old son, Safia Ibrahim. "It's no problem to walk that far," she said, "because it's for the health of my baby. And there's nothing to eat in our village."
One of the virtues of Plumpy'nut is that it can be made almost anywhere with local materials and a slurry of vitamins and minerals prepared by Nutriset. Versions of the same product are being manufactured in Malawi and in Niger's capital, Niamey, and Nutriset has welcomed the notion of local partners - from charities to women's groups - who might make Plumpy'nut under license or even as franchisees.
Which raises a question: if Plumpy'nut is good enough to give malnourished children in food emergencies, why not give it to the countless thousands of children in Niger who are hungry when the world's attention is directed elsewhere?
The United Nations reports that 150,000 children under age 5 in Niger are severely malnourished, and another 650,000 moderately malnourished - all together, about one in five. Malnutrition is a factor in 60 percent of deaths of children younger than 5 - and in Niger, more than a quarter of all children never reach their fifth birthday.
Fourteen packets a week times 150,000 children times 4 weeks is a lot of Plumpy'nut. But then, says Dr. Tectonidis, it is not the mathematics, or even the nutrition science, that is the hard part. It is keeping the world's eyes focused on solving Niger's everyday hunger problem once the television coverage of this crisis has ended.
"We know what's needed in terms of malnutrition," he said. "It's just the will that's lacking."
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