The Peanut Butter Project
Its ooey, gooey, good:
Ninety-three percent of children who received the peanut butter mixture recovered fully, reaching 100 percent of weight for height.
In addition to surviving, they were thriving.
MARK J. MANARY, MD
THE OUTCOME FOR STARVING CHILDREN WAS DISMAL when Mark J. Manary, MD, began studying malnutrition in Malawi, Africa. The most severely malnourished were treated with milk diets at inpatient feeding centers. Back at home, they resumed eating the traditional dietcorn dough boiled over an open fire and mixed with beans or green vegetables. Only a fourth of these children recovered fully.
This is happening all over sub-Saharan Africa and
other poor places in the world, and no one really follows up with these
kids, says Manary, an associate professor of pediatrics in the division
of emergency medicine.
Manary consulted a French nutritionist working with the international group, Doctors Without Borders, who was developing recipes involving peanut butter. In January 2001, Manary started the yearlong Peanut Butter Project at Queen Elizabeth Central Hospital, Malawis largest health care facility.
Children treated for malnutrition in the Peanut Butter Project
were discharged with packets of a peanut butter mixture to eat three times
a day for the following five weeks. The conveniently packaged mixture
included peanut butter, vitamins, minerals, sugar and vegetable oil.
When children like Milika start the program, they
look like very small, ill babies that you have a hard time being hopeful
about, says Manary. After treatment, Milika began to walk and play
like other healthy children.
Manary was pleasantly surprised with the studys results. I thought the recovery rate would definitely be better than 25 percent, he says, but when it was 93 percent, I thought, This is really quite impressive.
Six months later, children who were fed the peanut butter mixture continued to develop normally, indicating the special food is only necessary when children are critically ill.
Alan L. Schwartz, PhD, MD, the Harriet B. Spoehrer Professor and head of the Department of Pediatrics, says Manarys studies are changing the way people think about childhood nutrition.
Marks work has the potential to better the lives of thousands of children in the developing world, says Schwartz.
Working together as doctor and nurse at a rural hospital in Tanzania, Manary and his wife, Mardi, first visited Africa in 1985. Additional short work stints in Africa followed over the next few years. In 1994, Manary spent a year in a faculty exchange program at the University of Malawis College of Medicine. It was then that he became interested in the problem of severe malnutrition.
Using dietary therapies such as adding large amounts of potassium to childrens diets, Manary and his staff decreased the case fatality rate from 40 to 10 percent in local children.
When he returned to the School of Medicinehaving developed significant research interests and ties to colleagues in MalawiManary knew he wanted to return to the country for a part of each year. He now travels to Malawi several times a year, staying for a few weeks. Mardi and the couples two children, Megan, 14, and Micah, 12, often accompany him.
The majority of Malawians make their livings by farming, usually on a couple of acres. Extended families live together in homemade mud and thatch buildings, grow their own food, and spend time each day searching for firewood and collecting water. Electricity and modern transportation are not a part of their lives; most people have never ventured more than 30 miles from home.
Most children in Malawi dont become malnourished until
they are between 18 and 30 months oldthe time frame in which breastfeeding
stops, says Manary. Because food is scarce, most families eat just once
or twice a day, gathering around a pot and grabbing pieces of a corn dough
mixture. So a two-year-old who just stopped breastfeeding a month
ago may be right next to his
Ill children are taken to one of the countrys 100
inpatient feeding centers, established solely for the treatment of starving
children. Those designated as severely malnourished are referred to Queen
Elizabeth Central Hospital, home of Manarys Peanut Butter Project.
The mothers of the children who received the peanut butter
mixture were surprised at the results. After the standard treatment for
malnutrition, children typically survive and return home but show no growth.
Those who received the peanut butter mixture did much better.
Once they determined the treatment was working, Manary and his staff began to produce the peanut butter mixture themselves (peanuts are grown locally) using a large mixer in a corner of the clinic room.
Manary now plans to conduct studies similar to the Peanut Butter Project in district, rural and mission hospitals throughout Africa. He has the backing of two international groups the World Health Organization and the U.S. Agency for International Development both of which have contacted him about continuing and expanding the Peanut Butter Project.
Manary believes his studies may change the way children in the developing world are fed, possibly in as little as five years.
Our goal is to make this type of treatment available to everyone whos interested, he says. If we can do that, it will mean that Ive done my job successfully.