It is like penicillin for starving children

Ready-to-use peanut-based paste brings children back from near death

Edesia photo.

Before Andre Briend, Dr. Mark Manary and Dr. Steve Collins, treating starving children in Africa was long and laborious. For more than 20 years, children were admitted to hospital or therapeutic feeding centres for at least a month and fed with a fortified milk powder, F100, that had to be mixed with clean water.

Briend had been experimenting with putting F100 ingredients in a bar but had not been able to produce one that would hold up in hot weather. Then, in the late 1990s, watching his son eat Nutella, Briend realized he could tweak WHO’s famine diet formula by replacing milk powder with peanut butter. That meant no water was needed to prepare the food.

Briend dubbed it “Nutella for the poor”, and it turned out to be a revolution in saving children from starvation - even when they seemed close to death. It also sparked another revolution because ready to use food packages meant mothers could treat their children safely at home. It also made it possible to manufacture the product in many African countries, creating jobs and strengthening local economies.

Plumpy’Nut was first manufactured in France by Nutriset, which specializes in the production of food products for relief efforts. Now, there are 19 UNICEF-approved producers.

But, just as with any other medical breakthrough, it had to be tested in the field first. Mark Manary, a pediatrician and professor of pediatrics at Washington University School of Medicare in St. Louis, Missouri, had been working in Malawi since 1994 and had a malnutrition ward full of dozens of children lying on mats. 

In 1999, after living in a village in Malawi for 10 weeks, he had concluded that the right therapeutic food had to be something that didn’t spoil, didn’t need to be cooked, was easy for mothers to give in small amounts to their children at home, and was energy dense.

Striking results

From 2000 to 2004, Manary and Briend tested various formulas with thousands of malnourished children in controlled clinical trials in Malawi. The results were striking: 95% of the children who received Plumpy’nut at home made a full recovery, far better than the 25-40% achieved with inpatient treatment.

“Manary emptied out the ward, sending his patients home with Plumpy’nut,” wrote the New York Times. “Many malnutrition experts were horrified. ‘It seemed dangerous to them, and it made them afraid,’ said Manary, who recalled that one eminent figure stood up at a conference and said, ‘You’re killing children.’” 

In 2002, when Dr. Manary and his family returned to the US from Africa to raise money to continue "the-RUTF-research-program", a woman at their church began referring to the "Peanut Butter Project". So when it was legally established as a nonprofit in 2004 and began producing RUTFs in Malawi, it was called Project Peanut Butter. It also has made RUTFs in Sierra Leone since 2009, and Ghana since 2013.

While Dr. Manary was field testing formulas, Dr. Collins was refining the community-based treatment model in Ethiopia. In 2000, as famine spread through the Horn of Africa, Concern Worldwide partnered with Collins’s humanitarian research organization, Valid, to set up a pilot program called Community-Based Management of Acute Malnutrition in one region of Ethiopia.

Community members were trained to recognize signs of malnutrition and how to administer Plumpy’nut in children’s homes, and monitored children through home visits. Concern and Valid set up extra monitoring to produce concrete data over the course of nine months.

“In emergencies such as famine, the standard goal for child mortality rates is 10%. The norm is often 20 to 30%. With the combined use of CMAM and RUTF, mortality rates were 4.5%. For a crisis like a famine, that meant an incredible number of lives saved,” Concern wrote.

Then Concern moved on to treat 25,000 children in Darfur, Sudan, and between 2002 until 2006, used CMAM and RUTF in a large-scale pilot in Malawi. In 2006, Concern and Valid published the field manual for community-based therapeutic care.

RUTF recognized

In 2007, the United Nations, World Health Organization, and World Food Programme recognized RUTF with home-based therapy as the standard of care for severely malnourished children worldwide.

That fall, Anderson Cooper reported on the powerful impact of Plumpy’Nut on the CBS program Sixty Minutes. “Niger has become Plumpy’Nut's proving ground,” he reported. “Two years ago this region had the highest malnutrition rate in Niger. But now, after widespread use of the Plumpy’Nut, it has the lowest.” In 2005, facing a disastrous famine in Niger, Doctors Without Borders had distributed Plumpy’Nut to 60,000 children with severe acute malnutrition. Of these children, 90% recovered completely, and only 3 percent died.

This report had some powerful repercussions, and one of them led to manufacturing Plumpy’Nut in the US. Navyn Salem was in Tanzania in 2007, visiting a hospital, when she heard a mother crying inconsolably over the loss of her child, who had starved to death.

“I remember hearing that voice and the anguish and sadness and I thought, this should not happen in this day and age,” she told the Providence Journal in 2018.  “We know how to prevent this. Malnutrition is one hundred percent preventable.” She vowed to come back to Tanzania with solutions, and then she saw Anderson Cooper’s report.

She went to Paris and asked Nutriset for permission to manufacture the miracle food. For three years, her Power Foods factory produced 3,000 metric tons of Plumpy’Nut that was distributed within Tanzania and eight bordering countries. Then, in 2009, she moved her operation back to the US, opening up a nonprofit factory in Providence, Rhode Island, and renaming her company Edesia, after the Roman goddess of food, 

The Plumpyfield

Edesia employs 97, hailing from 26 countries. Andrew Kamara, Edesia’s director of logistics and distribution, fled civil war in his native Sierra Leone, in West Africa, in 1997. For three years he lived in a refugee camp in Guinea, eventually making it to Ghana before resettling in Connecticut in 2001. “Many of us have been through the hardships of being a refugee,” Kamara says of his coworkers. “We’ve gone through periods of malnutrition ourselves. We’ve seen kids dying of malnutrition in the field. [So], I understand the urgency of getting the products to the field. I know that every second is crucial in saving the life of a child.”

Edesia is a member of a network of independent producers of Ready-to-use Therapeutic and Supplemental Foods known as PlumpyField, who manufacture locally, in countries and regions where Plumpy’Nut and other products are most needed – Ethiopia, Niger, Burkina Faso, Sudan, Madagascar, India, Haiti, and Nigeria.

Since 2010, partnering with humanitarian aid organizations like USAID, UNICEF and the World Food Programme, Edesia says it has saved 22 million lives and serves 5 million children annually. In November 2023, Edesia launched the Make Malnutrition History matching campaign, thanks to a transformative Bezos Family gift, aiming to do “for malnutrition what penicillin did for infections”.

Hershey’s partnership
Hershey, the chocolate company, has long partnered with Project Peanut Butter to provide nutrition to children in Ghana and Cote d’Ivoire, where it sources much of its cocoa. Farms in Ghana and Côte d'Ivoire together produce nearly 70% of the world's cocoa.

Just before Christmas in 2014, the Hershey Company provided a major donation to support PPB’s newest factory in Kumasi, Ghana, which will be able to produce approximately 20,000 peanut-based RUTFs each day, enough to treat approximately 48,000 children each year. 

It takes nearly 150 packets to treat one child, and the product has a 95% success rate... 

Starting in January 2015, Project Peanut Butter mobilized a mobile clinic in the central region of Ghana to distribute RUTFs to local children, funded through an additional $50,000 contribution from Hershey and its employees through a matching gifts program. 

Since 2015, Hershey has partnered with Project Peanut Butter to make ViVi, a peanut-butter-based nutritional supplement, that is distributed by schools in Ghana and Côte d'Ivoire to nearly 50,000 children a day.

In late 2021, Hershey rescued more than 1 million servings of RUTF that was sitting, abandoned, in a warehouse in western Africa due to disruptions caused by Covid-19. The company devised a plan to purchase and transport 1.1 million servings to children through a Côte d'Ivoire-based non-governmental organization, The Children of Africa Foundation.

References:

Cheaper recipe for treating hungry children The New Humanitarian, Feb. 24, 2009

Meet Mark Manary, founder of Project Peanut Butter. Feast, Sep 3, 2023

Using peanut butter, Manary helps pregnant moms University of Georgia, Apr. 29, 2016

Andre Briend. Science Heroes.com

A wonder ‘food’ for the world’s children UNICEF Explainer.

RUTF and CMAM: How A Simple Peanut Paste Became A Humanitarian Revolution. Concern USA, Aug 26, 2022

The Peanut Solution. New York Times Magazine, Sep. 2 2010

Meet the mom of 4 on a mission to end world hunger and malnutrition. Today, Nov. 12 2021

Edesia Assembles Ready-to-Use Remedy for the World’s Hungriest PBN, Mar. 15 2019