Anyone can say without much analysis that children in our country, topographically and biologically very rich and with a wonderful mix of innumerable rich food cultures, should have never been undernourished. Lets look at the wasting statistic—prevalence among children in 1975 (6 percent) has doubled in 2006. Why is it increasing, despite the overall development that has occurred and despite mountains of resources spent on nutrition programs?
Approaches to managing acute malnutrition are often debated in the development industry. Some skew toward distributing ready-made products that might help recovery among affected children while others argue for enabling communities to utilize local foods. Both posit themselves strongly with bagfuls of literature reinforcing their viewpoints. Obviously, in a world that hosts several thousand health-related journals, one can even manufacture “evidence” out of a selection of articles to one’s liking.
A French (for profit) manufacturer came up with a brilliant product branded plumpy nuts (there are several similar products now). It is a nicely made peanut butter fortified with vitamins and minerals. This medicinal food (called Ready to Use Therapeutic Food – RUTF in generic terms) when fed to wasted children will improve their nutritional status dramatically. This ‘vitaminized’ monkey nuts butter has found its place in developing countries. It was tried in several countries of South-East Asia without successes as anticipated. Some countries wanted to produce local and non-commercial therapeutic food preparations. Some others crossed swords against organizations who proposed to distribute the nutty butter into their communities and got the products to be taken elsewhere.
The product entered Nepal in 2008/9. At the moment, half a dozen districts having high prevalence rates of wasting among children are undergoing pilot test of the use of fortified peanut butter to feed children who are suffering from wasting. Children in treatment period improve nutritionally. After that, they return to the same societal and family circumstances surrounded by the same economic distribution system as it were before the treatment period.
RUTF has demonstrated nutritional gains among fed children in pilot districts of Nepal. Mothers are amazed. Health workers are happy. Program managers and their supporting hands are also getting joyful.
The extent to which our country’s wasting prevalence goes down depends on whether we can implement sustainable solutions founded on indigenous good practices prevailing in our beautiful communities and families.
Two issues have emerged internationally. In resource poor settings, where homes have dark and humid corners, the production of aflatoxins (toxic chemical produced by fungus when certain fatty foods go rancid) is likely. Second, when donor support ultimately ceases, will governments be able to purchase expensive RUTF coming from corporate giants? Withdrawal syndrome may occur when beneficiaries are already attracted to freely distributed RUTF.
One of the alternatives is prevention. In the long run, broad social and economic interventions aimed at prevention will produce much needed and lasting solutions. Why we say this? Because data tells of economic and social disparities in health and nutrition indicators. For example, prevalence of extreme wasting (-3SD) is three times as high in poorest 20 percent of Nepali population (3.2 percent) as what is among the richest 20 percent (1.2 percent). Treatment is necessary. And it should also be highlighted that treating under nutrition (or any other health problem) is among the last links on the long chain of managing the problem. As everything has its place and its share of resources to be spent on, shall we think again on the way we spend our monies on nutrition works? What do you advise?
In a recent South East Asia regional meeting, several international organizations discussed together to find a workable way out of the debate in managing acute malnutrition. Prevention of malnutrition by addressing its determinants, and treating existing or emerging children affected by acute malnutrition through promotion of local food preparations was very much highlighted in the common concluding points. The extent to which our country’s wasting prevalence goes down depends on whether we can implement sustainable solutions founded on indigenous good practices prevailing in our beautiful communities and families.
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