Reversing malnutrition a spoonful at a time



Patricia Wolff, M.D., examines a young patient in her pediatric clinic in Cap Haitien, Haiti, while the girl's mother looks on. Wolff's clinic is often the only medical care available...
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Swollen bellies, orange hair, listlessness and dull eyes -- these are the traits of child malnutrition in Haiti, the poorest country in the Western Hemisphere and where roughly one of every three children is chronically malnourished.

To try to change that statistic, Patricia A. Wolff, M.D., associate clinical professor of pediatrics at Washington University School of Medicine in St. Louis, founded Meds & Food for Kids (MFK) in 2004, after she saw that medications and small amounts of the local staples rice, beans and corn weren't enough to nourish children back to health.

MFK works to combat childhood malnutrition and related diseases in northern coastal Cap Haitien, Haiti's second-largest city, by giving Ready-to-Use Therapeutic Food (RUTF) to malnourished children between 6 months and 5 years old. The mixture, known to Haitians as "Medika Mamba," or peanut-butter medicine, is a nutrient-rich mixture of peanuts, sugar, oil, vitamins, minerals and powdered milk. It is distributed in plastic containers for families to feed their children at home and can be stored for several months.

Children start to show visible signs of improvement about 1-2 weeks after receiving the peanut-butter mixture, becoming more active and growing new black hair. One course of the six-week treatment, which can be enough to renourish the child, costs under US$100.

MFK primarily targets toddlers -- a critical stage of development. In Haiti, mothers are responsible for providing food for the family, although many spend their days at the market selling produce or planting crops. While their mothers are away, children are expected to fend for themselves. Once home, mothers nurse infants, and older children eat what little food there is. Toddlers are often left out because they are too small and too weak to compete with older siblings for something to eat.

Following a full course of treatment with RUTF, children have more energy and are able maintain their health and weight on the standard diet of rice, corn and beans.

"If we dig the children out of the deep immunologic and nutritional hole they are in, they are not very likely to fall back in," Wolff said. "We can't treat all of the congenital diseases they have, but we can treat malnutrition, which makes the kids healthier, smarter, taller and better able to contribute to society."

The program stems from one started in 2001 by Mark J. Manary, M.D., professor of pediatrics at Washington University School of Medicine in St. Louis. Manary's Project Peanut Butter, which uses the same nutrient-rich mixture, fed 1,000 Malawi children in the first two years, and continues to nourish thousands of starving children in the southeastern African country. Researchers found that the RUTF, also known by its brand name, Plumpy'Nut, significantly reduced childhood mortality rates from malnutrition and related diseases.

In Cap Haitien, local employees produce the mixture using primarily Haitian products in a facility that MFK has already outgrown. To date, MFK has treated more than 700 children. It is currently treating more than 100 children, which requires 4,400 pounds of Medika Mamba a month. By the end of 2006, the group wants to produce more than 6,600 pounds a month, expand its distribution network and reach more of the thousands of malnourished children in the region. The organization is also preparing to supply the RUTF to another group at two other sites.

Tom Stehl, who is working toward a dual master's in business administration (MBA) and social work (MSW) at Washington University in St. Louis, has been involved with MFK for about a year and has visited Haiti three times this year to work with the project.

"Medika Mamba saves children's lives -- period," he said. "And let's not make any mistake about it, the kids to whom we distribute our Mamba are vulnerable, innocent and in desperate need of assistance. For them it's truly a matter of life or death."

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Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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