Thousands of miles away, in a southeastern African country close to the size of Wisconsin, a pediatrician from St. Louis is leading a group dedicated to saving thousands of starving Malawian children with an ingredient likely found on your kitchen cabinet - peanut butter.
By treating malnourished children with a special diet of enriched peanut butter, Mark Manary, a professor of pediatrics at Washington University School of Medicine in St. Louis, and others are helping to keep children healthy and alive longer than ever before. In July, Manary published findings that showed 85 percent or more malnourished children will gain weight and remain healthy after receiving a peanut butter diet.
In Malawi, where, according to the Project Peanut Butter website, 70 percent of all children are malnourished, Manary's project to help heal starving children couldn't have come fast enough.
*A Doctor's Vision*
Manary's mission to help decrease poor nutrition among Malawian children began more than a decade ago during a year-long stay in Malawi when he witnessed the burden of malnutrition on the children of Malawi.
On his cell phone from a village in Malawi, Manary explained, Food in Malawi is scarce and when food is scarce, someone suffers.""
Children who are too old to breastfeed but too young to take mealtimes seriously are Malawi's most vulnerable. According to the Project Peanut Butter website, nearly 13 percent of Malawian children under the age of five die as a result of malnourishment.
""I'm not a nutritionist,"" Manary said. ""But, I looked around and decided, if we're to do something to make kids healthier, we must improve nutrition.""
Around the same time Manary was assessing the dire health of the kids of Malawi, the World Health Organization (WHO) was responding to Malawi's malnourished by hospitalizing and treating sick children with an enriched milk therapy. While milk therapy offered malnourished kids desperately needed vitamins and calories, the enriched milk required a lengthy sterilization process to reduce the risk of spoiling and could be administered to kids in the hospital only. Less than 50 percent of the malnourished children who received the enriched milk recovered from sickness.
Zach Linneman, a freshman at Washington University in St. Louis who works with Manary, said the low success of the enriched milk therapy wasn't that the product used to treat the children was harmful for the kids, but that malnutrition treatments in hospitals exposed children to infection and disease.
""In Malawi, where hospitals may have three kids to a bed, it is very difficult to avoid infection,"" Linneman said. According to Linneman, while the WHO standard of therapy looked promising on paper, it was less successful in practice. Recognizing where the standard therapy was failing to save kids, Manary got to work on a food-based product that children could receive at home.
*Why peanut butter?*
In 2001, Manary began Project Peanut Butter, a program that helps malnourished children in Malawi receive a supplement they can take home. The supplement is made from a blended combination of peanut paste, vegetable oil, milk powder, sugar, vitamins and minerals. The peanut butter supplement provides kids with a diet high in fat and protein content, calories and nutrients.
""[The peanut butter supplement] is everything the kids need to eat and they like it because it's sweet,"" Linneman said. Linneman also stressed the peanut butter treatment ""keeps the kids out of the hospital.""
Every two weeks, mothers of malnourished children will travel to the village hospital, health center or village health aid early in the morning to collect a supply of the peanut butter supplement. Each day, mothers are instructed to feed children one container of peanut butter.
The peanut butter supplement involves no preparation, can be stored in mild temperatures and, because peanut butter contains no water, which is necessary for bacteria to thrive, the supplement is largely protected from contamination.
*Sweet Success*
Early results of Project Peanut Butter revealed that nearly 95 percent of kids on the peanut butter diet recovered - a success rate nearly 50 percent higher than the previous WHO standard therapy.
""This stat really hits you over the head,"" Manary said. In order to treat more kids, ""we knew that we needed to figure out how to produce the supplement locally.""
With the help of local villagers, the University of Malawi and Baylor College of Medicine, Manary perfected a local recipe for the peanut butter supplement, established a centralized factory to produce peanut butter in mass production and put Project Peanut Butter into operation.
As Project Peanut Butter grows throughout Malawi, it continues to yield successful results. In Manary's latest study, the enriched peanut butter was distributed to malnourished children in 12 local villages throughout Malawi. More than 85 percent of children in study gained weight and remained healthy over time.
In total, ""we have a 90 percent recovery rate for tens of thousands of children,"" Manary said.
""Our findings show we are able to move from the research setting to an operational setting,"" Linneman said.
While the evidence shows Project Peanut Butter is helping to save starving children in poor communities, Linneman said additional studies will be needed to know whether enriched peanut butter will yield similar positive results in regions where malnutrition is a product of war or AIDS.
*Future studies*
In the future, Manary plans to continue to expand Project Peanut Butter, with an ultimate goal of embedding Project Peanut Butter as a national program in Malawi.
Manary compared the scarcity of food in Malawi to the game of spoons.
""In Malawi, you have one less spoon. There is not really enough food to go around,"" Manary said. Just like in the game of spoons where a quick response is key, Manary said one- to three-year old Malawians suffer the most because they are not as fast.
""We want a world where there is enough [for everyone] to eat,"" Manary said. ""Before then, we need to rescue [these kids].
