Project #2485

Childhood Malnutrition in post-earthquake Haiti

by Partners In Health (PIH)

Thanks so much for choosing to support Partners In Health and our work to combat pediatric malnutrition in Haiti.  We're happy to share progress made over the last year.

Partners In Health has strategically invested in Haiti’s Central Plateau over the past 25 years to comprehensively address the root causes of poverty and disease. Establishing a Nourimanba production facility in Haiti was critical to PIH's multi-pronged approach to addressing pediatric malnutrition. Our experiences in the last two years have clearly shown that as it gets to scale, the Nourimanba production facility will continue to  provide reliable, high-quality, and economical therapeutic food that also provides economic opportunity for Haitian farmers. This will have a transformative impact for children’s health in our service area. We are committed to treating the effects of malnutrition in the short term, while simultaneously contributing to an infrastructure that can support long-term food security.

In 2014, the facility produced 80,000 kilograms of Nourimanba. This exceeds our original goal of 60,000 kilograms for 2014, and was enough to to provide 1,650 full courses of treatment to severely malnourished children through 12 nutritional clinics.

We are now at a place where we can look beyond the first phase of start-up and focus on goal setting for the second phase of our five-year plan for launching the Nourimanba production facility. We deeply appreciate your partnership in this complex fight against malnutrition.


Jon Lascher/Partners In Health
Jon Lascher/Partners In Health

As you may already know, malnutrition is the number one underlying cause of death for children under five in Haiti.  Additionally, Haiti has the third highest rate of hunger in the world.  These are some of the reasons why Partners In Health's malnutrition initiatives in Haiti are so important -- and it is your support that enables us to continue growing our programs that save lives. 

Over the past year, Partners In Health and our sister organization Zanmi Lasante in Haiti have drastically scaled up the production of Nourimanba, a ready-to-use therapeutic food used to treat malnourished children.   In partnership with the Abbott Fund, we opened a state-of-the-art production facility, dramatically increasing the capacity for production of Nourimanba to reach more kids and save more lives.  Not only is this scale-up benefitting the patients who are prescribed RUTF, but also the local economy.  So far, it has created 35 new jobs (eventually this number will grow to 75-100), while also increasing the demand for peanut farmers in Haiti, as all peanuts are purchased locally. 

Thank you, again, for your support of our work to treat children with malnutrition in Haiti.  We could not do this work without you.

(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

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

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.


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.



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Organization Information

Partners In Health (PIH)

Location: Boston, MA - USA
Website: http:/​/​
Project Leader:
Laura Soucy
Annual Giving Coordinator
Boston, MA United States

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