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Three teaspoons a day to keep starvation at bay?

A mother and her malnourished child in Beletweyne, Hiiraan region of central Somalia.
(Abdullahi Salat/IRIN)

Ready-to-eat blended food has revolutionised the treatment of children who are acutely malnourished. In a pilot project, the UN Children's Agency (UNICEF) will use a similar product not to treat, but to prevent malnutrition in conflict- and drought-ridden Somalia.



In the biggest trial of Plumpy'doz, a variation of Plumpy'nut, a ready-to-use therapeutic food (RUTF), UNICEF plans to reach 100,000 children by mid-January.



Plumpy'doz is similar to Plumpy’nut in that it is possible to treat a child at home, without refrigeration, even where hygiene conditions are poor.



Somalia has one of the world’s highest levels of malnutrition, with Global Acute Malnutrition rates of an estimated 18.6 percent, topping 20 percent in some areas, and 28 percent in displaced people’s camps in Bossaso, northeast Somalia. Anything over 15 percent can be regarded as an emergency.



In the trial, children between six and 36 months old will receive three teaspoons of the paste of milk powder, sugar, peanut paste, oil, minerals and vitamins three times a day for eight months. Unlike Plumpy'nut, Plumpy'doz is a supplementary food, which comes in jars and is dispensed before children become malnourished; it has the same amount of micronutrients but a quarter of the calories.



Proper nutrition in the first three years is critical for the long-term health and growth of the child, as recent studies have shown.



"We are not saying that we can cull [eradicate] malnutrition, which is a complex problem, with Plumpy'doz, [but] we hope to make a difference to thousands of children in Somalia, where access to quality complementary food for young children remains difficult due to drought, extreme poverty and in addition high food prices," said Fitsum Assefa, UNICEF's nutrition specialist for Somalia.



A worsening drought, the global food crisis and a falling currency pushed the cost of imported cereals in Somalia up by almost 400 percent in 2007/2008, according to the Food and Agriculture Organization (FAO). Somalia is behind Zimbabwe in the countries worst hit by food inflation, according to Assefa. Milk and water are scarce.



Besides handing out Plumpy'doz to mothers, UNICEF will promote exclusive breastfeeding, a natural immune booster up to six months, and breastfeeding with complementary food for two years. Only 13 percent of Somali infants younger than six months are exclusively breastfed, according to UNICEF.














Photo: Georgina Cranston/UNICEF
Packets of Plumpy'nut in a warehouse: UNICEF will use Plumpy'doz, a variation of Plumpy'nut, in a pilot project to prevent malnutrition in Somalia

Effectiveness debate



However, there is a lack of scientific evidence to back the effectiveness of ready-to-use foods (RUSFs) in preventing malnutrition. The World Health Organization (WHO), which initiated debate on the use of RUSFs to prevent malnutrition in 2008, has underlined the need for clinical trials.



"It was decided that any new RUSFs [...] as effective as any other existing RUSFs in aiding growth [and] reducing morbidity can be used, but simultaneously organisations should also hold clinical trials to test efficacy in carefully controlled circumstances," said André Briend, a WHO official and inventor of Plumpy'nut.



No clinical trials of Plumpy'doz have been undertaken.



UNICEF decided to go ahead with the intervention following the findings of the pioneer trial by Médecins Sans Frontières (MSF) of Plumpy'doz in Niger in 2007.



In that trial, 62,000 children between six and 36 months in the district of Guidan Roumdji in the Maradi region were given Plumpy’doz. The NGO did not record a peak in malnutrition during the lean season from May to September as it usually did, said Stéphane Doyon, leader of MSF’s nutrition team.



After the trial, a national nutrition survey conducted by the World Food Programme and UNICEF in Niger recorded the lowest levels of malnutrition in the country in Guidan Roumdji, further strengthening MSF’s belief that the intervention worked.












[Somalia] A mother holds her malnourished child to be examined by a doctor in Hargeysa, Somalia, May 2006. An estimated 40,000 children in the Horn of Africa risk of dying of malnutrition in the coming months as a result of prolonged regional drought, whi

Malnourished child in Hargeysa, Somalia.
IRIN
[Somalia] A mother holds her malnourished child to be examined by a doctor in Hargeysa, Somalia, May 2006. An estimated 40,000 children in the Horn of Africa risk of dying of malnutrition in the coming months as a result of prolonged regional drought, whi
http://www.irinnews.org/
Wednesday, April 13, 2005
A matter of life and death for 40,000 children - Unicef
[Somalia] A mother holds her malnourished child to be examined by a doctor in Hargeysa, Somalia, May 2006. An estimated 40,000 children in the Horn of Africa risk of dying of malnutrition in the coming months as a result of prolonged regional drought, whi


Photo: IRIN
A doctor examines a malnourished child in Hargeisa: UNICEF plans to reach 100,000 Somali children by mid-January in the biggest trial of Plumpy'doz, a ready-to-use therapeutic food

However, there have been some questions around the technical basis of the Niger trial, which was not held within a controlled environment. The children’s total calorific intake was not monitored. "It was not a clinical trial; I am sure someone will hold a clinical trial. We are satisfied with our findings which will be published soon," said Doyon.



The policy-making UN Standing Committee on Nutrition formally endorsed the RUTF approach in 2007, saying it could be used to treat three-quarters of children with severe acute malnutrition.



The use of RUTF for prevention, rather than treatment has only just begun. After their Guidan Roumdji trial, MSF rolled out Plumpy’doz in the whole Maradi and neighbouring Zinder regions. Agencies are considering its use in Sudan.



Cost issues



Critics of the peanut paste cure have often said Plumpy’Nut and Plumpy’doz are too expensive, milk powder being the most expensive ingredient.



"Plumpy'doz is not that expensive – it costs 17 US cents per day or $1.17  a bottle," said Doyon. But the costs add up as a child could use a bottle a week for three years. Scientists are looking at cheaper options, using soya instead of milk, he explained.



Manufacturing the paste locally could also help bring down costs. The paste is being made in several African countries such as Niger, Ethiopia, Malawi, Tanzania, the Democratic Republic of Congo, Kenya, Ghana and South Africa.



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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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