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On February 19, USAID posted a "Report on Final Development of an Emergency Food Product" link

From my understanding, the US government can now finally solicit bids for the manufacture of ready-to-use food supplements. Finally, finally, finally!

Many of you may remember a 60 Minutes segment that talked about Plumpy'nut and Doctors Without Borders (MSF) experience with it. IMPO, it seems that the US government is finally ready to buy similar products.

disclaimer: I'm interested in hearing MSF's opinion on these newly approved USAID emergency food products. (i imagine the USAID food supplements may be problematic in regards to taste and maybe other stuff...and of course it's absurd to provide food aid but to only buy that food from US producers!)

Some experts say that over 6 million children under-five die from malnutrition each year [source].

Here's a little history on the treatment of severe malnutrition and the development of these new life-saving measures:

Aid organizations like MSF say the paste, a so-called ready-to-use therapeutic food (RUTF), has revolutionized care for malnourished children. Plumpy'nut has a long shelf life, it does not need to be mixed with water--a major risk with standard treatments based on milk powder--and it is simple for mothers to give to their children at home. Perhaps best of all, children love the sweet, sticky stuff.
Until a few years ago, the standard treatment for severe malnutrition was F100, a milk powder fortified with dozens of vitamins and minerals... It needs to be reconstituted with clean drinking water and consumed almost immediately. Left unrefrigerated for a few hours, it turns into a bacterial soup that can cause infectious diseases. That's why F100 is administered only in special nutrition "hospitals"
Lescanne had experimented with Mars-like bars that had almost the same composition as F100; the problem was that they melted easily. Briend found his inspiration in a jar of Nutella, a hazelnut spread that his children loved; the duo developed a [new] paste consisting of roasted, ground peanuts combined with vegetable oil, milk powder, sugar, and a mix of minerals and vitamins.
Plumpy'nut can last for up to 2 years without refrigeration and does not spoil even after the package is opened.
In June of 2007, four United Nations agencies, including WHO and UNICEF, issued a joint statement advocating home treatment with RUTFs for severely malnourished children who don't have other illnesses.
UNICEF, the biggest buyer in the world, may purchase as many as 8000 tons in 2008 and expects global production to grow to at least 50,000 tons by 2011

[source: Science. "The Peanut Butter Debate." 322:36-8, 10/3/2008. subscription only]

revolutionary treatment for those starving to death

So, back to the USAID report, which details the development and testing of

three prototype rations...modeled after the Institute of Medicine’s publication for a High-Energy, Nutrient-Dense Emergency Relief Food Product [more info on this IOM publication below].... The [two] bars are grain-based rations that have been compressed into easy-to-consume rectangular bars that can also be crumbled up, dispersed in water and served as a porridge or gruel. The paste was developed to be consumed as is, right out of the pouch.
[the developer] has successfully completed development, commercial producibility demonstration and shelf-life validation of all three prototypes (rice bar, wheat bar, and paste). These products meet all USAID contractual agreements...The USAID product requirements were drafted based on the IOM report, "High-Energy, Nutrient-Dense Emergency Relief Food Product," with minor changes in the required macronutrient ratios and serving sizes in order to retain functional properties (i.e., retention of paste flow properties) and meet minimum macronutrient requirements (i.e., daily ration size of 500g to ensure adequate protein consumption).

This USAID final report is so important because it opens the door for USAID to solicit bids for US suppliers of these food items. Quoting from the aforementioned 2001 report by the Institutes of Medicine:

The bulk of medium- and long-term food relief contributed by USAID has traditionally been in the form of commodity foods. However, USAID and DOD also participate in rapid, short-term food relief operations that require special high-energy, self-contained food products not currently manufactured in the United States. Such products constitute the vanguard of food relief and are designed for use over the normally short period of time needed to establish a more permanent, stable, food-based relief pipeline. Because of legislative restrictions on the use of some federal appropriations, only limited purchases of such products can be made by USAID from food manufacturers outside the United States. The availability of science-based technical specifications for use in calls for bids from U.S. food manufacturers, therefore, is of the essence not only to allow procurement of the most appropriate product, but also to do so in the United States.

So, I don't want the significance of this report to be lost on us.


Finally, MSF believes that moderately malnourished children should be given these ready-to-use food supplements, whereas some other people involved in malnutrition think they should be reserved for severely malnourished people due to the relatively higher cost, and others are awaiting results from the field.

BTW, UNICEF has begun implementing this approach in Somalia [1] and MSF has had good scientific results with this more widespread approach in Niger [2].

  1. UNICEF. "An innovative approach to prevent child malnutrition in Somalia." 12/31/08.
  1. MSF. "New Study Shows Dramatic Effect of Food Supplements on Child Malnutrition." 2/19/09.  

Going to MSF-USA's webpage on malnutrition, you'll see that they feature info on some new international food aid standards:

"Fortified blended flours based on wheat or corn plus soy that are so widely used no longer meet the new minimum criteria that the WHO experts have just set for young kids," said Christophe Fournier, President of the MSF International Council.
The newly recommended animal source foods will make nutrition programs for children much more expensive. MSF estimates that it will cost 3.5 billion euros annually to adequately address moderate malnutrition worldwide.

And in a NYT article a year ago, an MSF pediatrician said:

Children shouldn’t have to deteriorate to the point of severe malnutrition to "qualify" for ready-to-use food, which is far more nutritious than the fortified blended flours prescribed and supplied by the United States and other international donors for moderately malnourished children. Yes, ready-to-use food may cost more, but it provides the milk that fortified flours do not.

The United States is the largest single donor of food aid in the world, but it doesn’t provide enough of what young children really need. As the farm bill progresses through Congress, there has been much debate on improving the delivery of food aid. But Congress must also address the quality of this aid.

If ready-to-use food is distributed more widely and replaces blended flours, fewer children will die of malnutrition. It’s what the children staring at us in those harrowing images need and deserve.

[source: NYT. "Instant Nutrition" by Susan Shepard, 1/30/08.]


For posterity, here is that 60 Minutes story, updated in June 2008:

Originally posted to distraught on Fri Feb 27, 2009 at 01:19 PM PST.

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