Childhood Malnutrition in post-earthquake Haiti

 
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Jun 30, 2014

Childhood Malnutrition in Haiti - June 2014 Update

(Above) Cange, Haiti, A child suffering from malnutrition at the pediatric inpatient unit in Cange is fed  nourimanba by his mother.   Credit: Rebecca Rollins/PIH

 

While visiting patients in a rural village, a Partners In Health (PIH) community health worker spotted 14-month-old Lovena. Little Lovena had diarrhea, she was weak, and she had no appetite. With the encouragement of the health worker, her parents brought her to a PIH hospital. Her diagnosis was malnutrition.

This story is all too common. Malnutrition is a terrible disease that afflicts children in Haiti and around the world. It is a disease that stems from extreme poverty, but it is treatable and preventable. Thanks to your generous support, we are able to provide that treatment free of charge to children like Lovena. 

Lovena’s parents, who were very poor and lived about a two-hour walk from the hospital, didn’t understand the source of her sickness. It was severe acute malnutrition, caused by a shortage of the nutritious food toddlers require to grow up healthy. To help her recover quickly, we immediately provided Lovena with a ready-to-use locally produced therapeutic peanut butter packed with micronutrients, which we call Nourimanba.

She returned many times to the hospital to ensure she was healthy and growing. Recently, a doctor saw her for a simple cold and reported that she is now a healthy, active toddler. Without the treatment for malnutrition that Partners In Health provided, a simple cold could have easily killed her.

The prevalence of malnutrition in children around the world is unacceptable. It accounts for nearly half of all the deaths of children under 5 years old, which makes up a staggering 3 million deaths each year—or more than 8,000 every day.
These numbers are proof that we must do more to fight this needless suffering. Malnutrition is a sickness of poverty, and the children who are most affected often live in the most rural areas—far from health services and sources of steady
employment.

When I visit clinics in rural Haiti, up to half of the children I see are malnourished, placing them at much greater risk for other illnesses and even death. The effects, even if the child survives, can be long-term. Prolonged malnourishment can lead to cognitive and physical delays in development that make children less productive for the rest of their lives. These
setbacks make them less able to care for their own children, passing on the joint injustices of malnutrition and poverty.

With your help, Partners In Health has been fighting this disease in Haiti and in other countries we work to support. We’ve made great progress in the areas we serve, by using this simple innovation: therapeutic peanut butter packed with
micronutrients that we produce locally, to treat malnutrition effectively in clinics and in children’s homes. And we don’t stop at clinical care. In Haiti, we work with farmers to provide them with seeds and training to grow the peanuts for the Nourimanba peanut butter. Then, Partners In Health employs people to make the paste—a mixture of five
ingredients: peanuts, milk powder, vegetable oil, sugar, and vitamins. The product doesn’t require refrigeration and resists spoiling—making it the perfect treatment for children to take home with them to continue their recovery.

To save more lives, Partners In Health is scaling up production of Nourimanba in the same area our clinics serve in Haiti. Local production creates jobs, which helps the economy and prevents malnutrition.

Despite tremendous progress, we have more work to do. Partners In Health has committed to eliminating deaths of children under 5 years old from malnutrition in the areas we serve. This challenge will require reaching more of the most vulnerable families. It will require training more community health workers to identify children at risk, help
parents prevent malnutrition, and provide follow-up care in children’s homes. And it will require producing and distributing more therapeutic Nourimanba.  We hope that you continue to stand alongside us as we do whatever it takes to tackle this preventable illness. 

Thank you again for your support, 

Dr. Joia Mukherjee
Chief Medical Officer
Partners In Health

Feb 27, 2014

Malnutrition in Haiti: Feb 2014 Update

Photo: Rebecca E. Rollins/Partners In Health
Photo: Rebecca E. Rollins/Partners In Health
A young woman has her upper-arm circumference measured at Hôpital Universitaire de Mirebalais, in Mirebalais, Haiti, to help determine whether she's malnourished. 

Need to Know: MUAC and Malnutrition

Spend a day at any Partners In Health site and there’s a good chance you’ll hear a phrase you’re unfamiliar with. Perhaps it’s a clunky acronym or polysyllabic drug name. But don’t worry: Keeping up with the ever-evolving world of global health is hard, even for insiders. In Need to Know, we cut through the complexity and deliver the most pertinent and interesting information on a single subject. Today, we fill you in on mid-upper arm circumference.

What is it?

Mid-upper arm circumference, often shortened to MUAC, is a measurement that allows health workers to quickly determine if a patient is acutely malnourished. PIH, as well as many other organizations, measures the circumference of a patient’s arm at the midpoint between his or her shoulder and elbow.

Why is it important?

The burden of malnutrition is staggering. According to a recent series of articles in The Lancet, more than 3 million child deaths every year are associated with malnutrition. Put another way, nearly half of all children who die each year die because they don’t have access to enough of the right food. Our health workers in Haiti, Malawi, Lesotho, and Rwanda, among other locations, encounter malnourished patients every day. MUAC provides a fast and effective first-line screening method.

How do you make the measurement?

There are specific paper MUAC bands that are color-coded. If the girth of the patient arm falls within the green part of the band, it indicates that the patient is not malnourished. A measurement that falls within the yellow part of the band indicates that the patient may be at risk of malnutrition. Lastly, the red portion of the band indicates that the patient is severely malnourished and at risk of death. Some bands include a fourth color, orange, which indicates the patient is moderately malnourished.

What happens after the measurement is taken?

Well, that depends on the measurement. Generally, if a child is malnourished, we provide treatment with ready-to-use therapeutic food, commonly known as RUTF. These foods are high in fat and protein and fortified with the vitamins and minerals necessary to treat severe acute malnutrition. A few weeks of treatment with RUTF can bring about significant improvements. PIH will often take steps to improve the long-term food security of patients’ families. This might include enrolling people in job training, delivering food assistance, or providing materials for farming.

Malnutrition is a complex problem. Is a paper arm band all you’re using in the fight against it?

Absolutely not. MUAC is an immensely helpful tool but it’s not foolproof. For instance, a simple arm measurement doesn’t tell us whether a patient has kwashiorkor, or protein malnutrition. Furthermore, the accuracy of MUAC diminishes as the child ages. That’s why we’re constantly devising and implementing new ways to alleviate the root causes of malnutrition and catch malnourished children earlier. In Malawi, for instance, we partnered with TOMS to combine the distribution of new TOMS shoes with malnutrition screenings. This approach has allowed us to screen more than 1,000 children, including 70 in need of malnutrition treatment. Meanwhile, in Haiti, we’re deploying mobile health clinics that travel into isolated regions to find patients who have the hardest time accessing medical services.  MUAC is merely one part of a comprehensive strategy that helps us make proper diagnoses and act accordingly.

Dec 4, 2013

Childhood Malnutrition in Haiti - Dec. 2013 Update

CBS NEWS/CHRISTINA RUFFINI
CBS NEWS/CHRISTINA RUFFINI

Thank you so much for supporting Partners In Health and our Childhood Malnutrition project in Haiti.  With your help, Partners In Health (in partnership with Abbott Laboratories)  recently began operations at a new, state-of-the-art Nourimanba factory, where not only is nutrient-rich therapeutic peanut butter produced for children in Haiti, but also where jobs have been created for locals.   We are thrilled to share the following article published by CBS news on November 14, 2013:

Raising hope, with peanuts, in Haiti

(CBS News) In Haiti's rural provinces, life is sparse, even by local standards. Malnutrition is rampant, and 78 percent of the population survives on less than two dollars a day.

Adremene , however, is the exception. In a country with more than 60 percent unemployment, she has a full-time job. Gracia makes something called Nourimanba, a peanut-based malnutrition cure.

Not only does her work help save starving children, it allows her to support two of her own.

"Just having a stable job is wonderful, for the money and to be able to send my kids to school," she said through a translator, in her native Creole.

  When CBS News visited the Nourimanba project 18 months ago, the facility where Gracia and about 20 other women worked was incredibly basic; everything -- from sorting and roasting, to grinding and jarring -- was done by hand, in a stuffy, windowless room.

 But this summer, the doors opened on a brand new, state-of-the-industry processing plant. The facility includes automated machinery, clean rooms, and a lab to test quality control.

More importantly, the plant meets international food processing standards -- a first for Haiti's central plateau.

"Haiti, after the earthquake, has been one negative story after the next, and now we have a very positive story coming out of a region of Haiti that has lacked economic opportunity for centuries," said John , who manages this project for the non-profit Partners in Health.

PIH is the largest non-governmental healthcare provider in Haiti. Last year, its facilities treated 2.8 million patients nationwide. Four years ago, PIH teamed up with Chicago-based healthcare company Abbott Laboratories, bringing private sector knowledge to what had already been a successful, public-sector program.

Kathy Pickus, head of Abbott's philanthropic ventures, said the partnership has allowed the Nourimanba project to thrive and expand far beyond what was initially thought possible.

"This facility has caused a ripple effect in terms of growth and development," Pickus said. "It's creating jobs that we couldn't anticipate, and it will do even more so, as we start to increase demand."

The new plant has drastically increased production, churning out more than 6,000 kilograms -- about 6.5 tons -- of Nourimamba in just the first few months.

To meet its new demand, the facility needed to bring in more raw materials, namely a larger supply of local Haitian peanuts, which isn't always available.

The peanut crop in Haiti is small and unpredictable. Although most rural Haitians depend on small-scale, subsistence farming, there is very little formal agricultural training. The majority of farmers go it alone, and many of them fail.

"When we first started looking at the equation in terms of how many peanuts we'd need for Nourimanba to meet demand, as well as to think about a commercial strategy going forward, we realized we had to make an investment in the peanut sector," Pickus said.

With the help of agricultural consultants Tecnhoserve, PIH and Abbott started training about 200 local Haitian farmers in how to grow larger, healthier peanuts.

Dan Schmidz, a nutritional scientist with Abbott, said that, as the supply chain expands, so will the industrial impact.

"It's creating a micro economy," he said. "We're already seeing sort of the evolution of a peanut industry, which doesn't exist currently in Haiti."

Before he joined the program, peanut farmer Gustave Esteme said things were terrible. Now, after being taught how to cultivate and space his plants, he said he's growing three times as much -- enough to feed his seven children three meals a day instead of two.

"With the program, it's really much better," he said. "I will stay with it until the end of time."

Haitian peanut farmer Gustave Esteme (pictured with his family) said new agricultural methods have helped him increase his crop yield substantially.

 The increased crop production has also brought small business opportunities. From couriers to collection centers, local entrepreneurs are taking advantage of the larger yields.

Joseph Roland used to be a teacher, but with the help of a micro-loan and training from Technoserve, he traded in his blackboard for a gas-powered tiller. Most Haitian farmers still use oxen and wooden plows, but Roland's machine is faster and more effective.

"With this program, we help many people," he said. "I make more money, and I make a bigger difference tending the soil than I did in the classroom."

Although Nourimanba is given out for free at PIH clinics, the new production plant has the potential to make peanut butter and other commercially-sold foods. The hope is that profits from those items will eventually fund the facility, allowing the plant and the resulting industry to become self-sustaining.

"Every aspect of this project is important," said Lascher. "It's going to help farmers; it's going to help children get therapeutic food; and it's also providing jobs and training that never existed in this region."

Jobs that, hopefully, will continue to grow along with the crops.

Links:

Sep 5, 2013

Childhood Malnutrition in Haiti - Sep. 2013 Update

A malnourished child is weighed.
A malnourished child is weighed.

Thank you so much for supporting Partners In Health’s Childhood Malnutrition Project in Haiti on globalgiving. I am excited to share with you a letter from our Chief Medical Officer, Dr. Joia Mukherjee, which provides an update on this important work: 

I want to tell you a story about a little girl in Haiti.

While visiting patients in a rural village, a Partners In Health (PIH) community health worker spotted 14-month-old Lovena. Little Lovena had diarrhea, she was weak, and she had no appetite. With the encouragement of the health worker, her parents brought her to a PIH hospital. Her diagnosis was malnutrition. 

This story is all too common. Malnutrition is a terrible disease that afflicts children in Haiti and around the world. It is a disease that stems from extreme poverty… but it is treatable and preventable.  And thanks to your generous support, we are able to treat patients like Lovena every day.  

Lovena’s parents, who were very poor and lived about a two-hour walk from the hospital, didn’t understand the source of her sickness. It was severe acute malnutrition, caused by a shortage of the nutritious food toddlers require to grow up healthy.

To help her recover quickly, we immediately provided Lovena with a ready-to-use locally produced therapeutic peanut butter packed with micronutrients, which we call Nourimanba.

The child had many follow-up visits to the hospital so we could ensure she was healthy and growing. Recently, a doctor saw her for a simple cold and reported that she is now a healthy, active toddler. Without the treatment for malnutrition that Partners In Health provided, a simple cold could have easily killed her.

Malnutrition is a sickness of poverty, and the children who are most affected often live in the most rural areas—far from health services and sources of steady employment. When I visit clinics in rural Haiti, up to half of the children I see are malnourished, placing them at much greater risk for other illnesses and even death. The effects, even if the child survives, can be long-term. Prolonged malnourishment can lead to cognitive and physical delays in development that make children less productive for the rest of their lives. These setbacks make them less able to care for their own children, passing on the joint injustices of malnutrition and poverty.

With your help, Partners In Health has been fighting this disease in Haiti and in other countries we work to support. We’ve made great progress, but we have an ambitious goal—to eliminate all deaths of children under 5 years old from malnutrition in the areas we serve.

We use a simple innovation, a therapeutic peanut butter packed with micronutrients that we produce locally, to treat malnutrition effectively in clinics and in children’s homes.

We don’t stop at clinical care. In Haiti, we work with farmers to provide them with seeds and training to grow the peanuts for the Nourimanba peanut butter. Then, Partners In Health employs people to make the paste—a mixture of five ingredients: peanuts, milk powder, vegetable oil, sugar, and vitamins. The product doesn’t require refrigeration and resists spoiling— making it the perfect treatment for children to take home with them to continue their recovery.

Your support has helped us to accomplish a new standard of high-quality care for the poor, the elimination of this tragic cause of needless death, and a true chance at a productive life for thousands of children.

Dr. Jean Louis Romain, a Haitian pediatrician, has seen countless cases of malnutrition since he began working with us in 2005. He said that children’s parents often don’t understand the signs of malnutrition. More importantly, mothers of children with malnutrition often feel ashamed that they don’t have the means to feed their children, and they avoid seeking care for fear of judgment from the providers or fellow patients.

“It’s a sickness that comes from want,” Dr. Romain said. “They feel ashamed.”

After treatment for the children and support for the parents, however, Dr. Romain said that the parents’ attitudes change, and their experiences benefit their communities.  Families spread the word about preventing malnutrition and receiving care. The children’s parents also receive comprehensive health care and social support through Partners In Health. This helps ensure they can be as productive as possible in providing for their children so that the cycle of poverty and malnutrition does not repeat itself.

“They see that there’s a possibility for their children to live happily. They understand they don’t have to become gravely sick, and they know they can come to the hospital earlier for help,” Dr. Romain said.

With your continued support, we will be able to reach, support, and treat more of the most vulnerable children and their families.

 

With gratitude,

Joia Mukherjee

Chief Medical Officer, Partners In Health

Jun 10, 2013

Childhood Malnutrition in Haiti - June 2013 Update

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Thank you for your generous support of Partners In Health and our Childhood Malnutrition in Haiti project on globalgiving.  We are excited to share a selection of photos taken by Rebecca Rollins in Cange, Haiti, documenting our work to eliminate unnecessary suffering and death by providing free comprehensive health care for children, including treatment of malnutrition. With many other child-centered programs in the poor communities where PIH works, we offer children the same essential rights and services that have virtually eliminated deaths from common childhood ailments in rich countries.  We are deeply grateful for your support in making this work possible. 

1) December 10, 2012, Cange, Haiti, Steve is a three year old orphan living on the campus at Cange. His mother brought him to the clinic sometime around September 2012 for treatment for malnutrition. He was admitted and recovered, but his mother never returned.  

2) and 3) December 10, 2012, Cange, Haiti, Children at the Cange malnutrition clinic are measured, weighed and fed.

4) December 10, 2012, Cange, Haiti, A child suffering from malnutrition at the pediatric inpatient unit in Cange is fed nourimanba by his mother.  


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Laura Soucy

Annual Giving Coordinator
Boston, MA United States

Where is this project located?

Map of Childhood Malnutrition in post-earthquake Haiti