The Plumpynut Paradigm Shift: Treating Severe Malnutrition v 2.0
It would be an under-statement to say that Haiti is a hungry country. Population growth, deforestation, and a weak economy are just a few reasons. Hunger also contributes to instability in Haiti - building a functional democracy that can endure over the long term is a challenge when many do not know where their next meal is coming from.
Anyone who has visited Haiti knows that malnutrition is a major problem. The absence of adequate nutrition when young impedes long term physical and mental growth. In its severe form, it is life threatening. Malnourished children are more likely to get sick with, and die from, an infectious disease. But malnutrition alone can kill. Malnutrition is therefore a medical and a public health issue.
But it is also an ethical and moral issue. Malnutrition is treatable although we have traditionally done a poor job of doing so. This is starting to change and for the better. In fact, we are on the verge of a major paradigm shift, a new way of thinking entirely, on treating malnutrition.
The old conventional wisdeom was that every severely malnourished child had receive inpatient care in a special facility and receive special care from specialized caregivers.
The reality is that, given the right food, 85% of severely malnourished children will recover. The remaining 15% who have complications (such as a disease) do need inpatient care. A number of non govrnmental organizations with extensive field experience realized that, with this being the case, severe malnutrition could be treated in the community instead of the clinic.
This new strategy is called community based therapeutic feeding which combines community mobilization with Ready to Use Foods, of which plumpynut (let's call it 'plumpy' from here on out) is the best known. The French love their Nutella, and Plumpy was inspired by it. Nutriset, a French company that specializes in food supplements, designed a high protein, high energy peanut based paste which is put into a foil wrapper which can be torn and then eaten from. Speaking from experience, the taste is not at all bad.
The wrapper is key. Previously powdered milk was used. In an environment with unclean water (like Haiti), this can be dangerous. It had to be prepared in hygienic conditions. In a hot country (like Haiti), the milk will spoil quickly. The foil keeps the plumpy fresh, uncontaminated, and easy to store in boxes.
If a child does not have complications, the family will be given a supply of plumpy (and usually a little extra as it will likely be shared with other siblings). This way, the child can stay at home with the parent(s) instead of being left in the clinic.
The results can be spectacular. Study after study has shown that plumpy is extremely effective in rehabilitating children who are severely malnourished. This has led some NGOs such as MSF to argue that, as malnutrition is life threatening, plumpy should be considered as an essential medicine rather than a food.
Initially dependent on a single company, numerous countries are building factories that can produce variants of plumpy. In Haiti, for example, Project Medishare is building a factory that will produce a culturally appropriate blend of corn and beans. This approach will not depend on importation, uses readily available agricultural products, and bolsters the economy as well. Other NGOs in Haiti have been experimenting with ready to use foods as well.
This paradigm shift was driven by NGOs. The international organizations were behind the curve, but have now embraced it. UNICEF and UNHCR both use plumpynut in a number of sites, which will hopefully continue to grow thereby allowing them to promote better health and save lives with the populations they serve.
Plumpy, by itself, will not solve the underlying causes of malnutrition. It does, however, give us a powerful tool for restoring health and protecting the lives of vulnerable children in Haiti and other countries like it throughout the world.
Read a CNN Anderson Cooper report on plumpy by clicking here
Curious to learn where plumpy is being used? You can view the "Plumpynut in the Field' site by clicking here
Want to learn more about community based therapeutic feeding? Take a look at the website of FANTA, an NGO widely respected for its work in this area.
Welcome your thoughts on this or any other nutrition related issue.