Rescuing Children from Acute Malnutrition

Rescuing Children from Acute Malnutrition

Westchester , United StatesHaiti
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Start-Up
Budget: 
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

HUFH is a medical humanitarian organization committed to improving the quality and sustainability of health care in Northern Haiti.

About Project

Problem: What problem is this project trying to address?

Globally, malnutrition is the most important risk factor for illness and death. Even prior to the 2011 earthquake in Haiti (poorest country in the Western Hemisphere), almost 1/4 of children faced chronic hunger and for 1/5, malnutrition was a significant problem putting them at-risk for poor mental and physical development. Rural children suffer from an extreme lack of adequate nutrition: 1 in 10 is estimated to suffer from acute malnutrition; 1 in 14 will die before age 5. Children are more apt to be well nourished during breastfeeding (mothers’ nutritional status a determining factor) but once breast feeding is interrupted, they suffer from a lack of macro and micronutrients. Though breastfeeding initiation is relatively high in Haiti, only 41% of children are breastfed at 6 months.

Solution: What is the proposed solution? Please be specific!

Malnutrition is a leading cause of death and a risk-factor for: stunted growth, infection, interference with brain growth, and decreased cognitive abilities and learning. We propose to rescue children from acute malnutrition by implementing a proven low-cost ($65/child), low-tech, 2-pronged intervention in Boise de Lance, a small rural farming community in Haiti. The target population is children 6 months – 5 years (and families) who present to the Open Door clinic. The solution is based on: (1) improved nutrition through a refeeding treatment program for children (6 − 8 week duration), followed by education about nutrition and food for families; and (2) workforce development, including: enhanced training by Medika Mamba (MM) of a local RN, and new training by Hands up for Haiti of a local health care worker, using a curriculum developed and used internationally by Partners in Health, and/or one used by the Haiti Health Ministry.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

The model (and medical its protocols) was established by Medication and Food for Kids (MFK), a non-profit organization working in Haiti since 2003 and our partner since 2011. “Medical Protocols for the Home-based Treatment of Childhood Malnutrition using Medika Mamba (MM), a Ready-to-Use Therapeutic Food (RUTF)” includes: Program Objectives; Necessary Equipment; Admission Criteria; Definition of Serious Complications; Grading Odema; Procedure if Failure to Gain weight; Discharge Criteria; Activities for Visits; Medication for Visits; and Educational Messages for Visits. Accompanying documents are: Guide for Taking Anthropomorphic Measurements; Admission and Discharge Criteria (Weight for Heights Charts); Weight Gain Tables; Dispensing Guide for MM; and Contract in Haitian Creole. The RN will screen children, register those 2 SD below weight for age, track growth parameters, enter data electronically into a registry, and counsel families. Registered children will get an allotment of RUTF, a best practice-therapy − Medika Mamba (MM) or “Peanut butter medicine” in Haitian Creole (ground roasted peanuts, powdered milk, cooking oil, sugar, vitamins, minerals), and families will get weekly counselling. A health care worker will provide classes in Nutrition & Food, including macro and micro nutrients, good choices based on local availability, hygienic handling and safe cooking (paramount to avoid malnutrition associated with parasitic and bacterial infections in water and food). The model has shown positive outcomes in Haiti, e.g., Haiti Village Health in Bod de Limbe.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Other programs exist in less rural areas of Haiti, and other solutions are utilized (e.g., targeting chronic malnutrition and lack of food sources). Our innovative program involves a unique geographic area not yet addressed by government programs/NGOs. We work with the Cap Haitien Health Network (60+ NGOs) partnering to improve health care in northern Haiti by sharing information/resources among those in medical care, health promotion/education, and sanitation. We work directly with MFK, whose mission is to locally develop, produce, and distribute highly nutritious foods and educate Haiti’s providers and the Government about its virtues. Due largely to MFK’s efforts, Haiti’s Health Ministry formally adopted RUTF into its national protocols for the treatment of childhood malnutrition.
Team

Founding Story

I have walked through the streets of the village of Bois de Lance, and found myself surrounded by 20 children. No one has shoes, their bellies are distended from worms, and many are unclothed. In my half century on this planet, and more than 28 years as a practicing pediatrician, I have never seen such pervasive and severe poverty other than in pictures of faraway places. These children deserve better – they deserve the basic right of nourishment. How can they be expected to learn and be productive if they are hungry and frail? The most basic needs are not being met. We can’t improve their lives until we can feed them, teach them to feed themselves, and ultimately grow. My “aha” moment came when I learned about RUTF that was being used in Africa, i.e., Plumpy Nut. This peanut butter enriched food is produced at low cost, requires no refrigeration, and provides the nutrition to stop acute malnourishment when employed.
About You
Organization:
Hands up for Haiti
About You
First Name

Jill

Last Name

Ratner

About Your Organization
Organization Name

Hands up for Haiti

Organization Country

, NY, Westchester

Country where this project is creating social impact

, XX

How long has your organization been operating?

1‐5 years

The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..

Innovation
How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Cost.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

The goal is to implement a program to effectively treat acute malnutrition in children ages 6 months − 5 years in Boise de Lance, and train and employ a health care worker who will teach nutrition and safe food handling/cooking to families after treatment of acute malnutrition. She will also serve as our community liaison. We will pilot the intervention in this site, and then expand to other nearby communities. The area was targeted because of its rural nature and lack of health care facilities. We have worked extensively here, and have relationships with the village leaders/elders. Our goal is realistic. MM has proven effective in treating malnutrition; within 6 weeks of starting treatment, 85% of children recover, far better than the 25% survival rate with other milk-based treatments.

What has been the impact of your solution to date?

HUFH has been operating for 2 years but MFK, founded by Dr. Wolffe, Professor, Clinical Pediatrics Washington University Medical School, has been operating in Haiti since 2003. MFK (see https://mfkhaiti.org) is a registered non-profit in the US and NGO in Haiti, and out partner for this pilot. Our intervention is based on MFK’s success in using the gold standard, RUTF(MM) to treat malnutrition, based on its proven Medical Protocols. The treatment takes 6−8 weeks (25 pounds of MM) and within 6 weeks, 85% of children recover, far better than the 25% survival rate with older milk-based treatments. We expect similar results in Boise de Lance, where we have already identified a nurse administrator and health workers to be trained, and have established partnerships with local medical providers and facilities, and community leaders. In particular, the Open Door Missionary has established a clinic, feeding station, and school, which provides a safe, secure environment for our project.

What is your projected impact over the next five years?

We propose to enroll at least 20 children (7 families) in Year 1 in the village of Bois de Lance, our pilot site (population younger than 5 years, approximately 2,188). In years 2-5, we will expand the target population by identifying other implementation sites where need is greatest. We expect to reach at least 100 children, 25 families)over a 5-year period. We expect that by training health care professionals, and in turn educating vulnerable families about nutrition and food, we will see a significant decline in malnourished children in each new implementation site, and contribute to Haiti’s skilled workforce. We will also collaborate with other organizations, such as Sonje Ayiti and A Thousand Acres who are addressing farming practices to identify and encourage better food sources.

What barriers might hinder the success of your project? How do you plan to overcome them?

Predisposing barriers: poor physical access due to lack of transportation, inadequate roads; poor education about macro/micro benefits of food; and inadequate pre-natal care (→ low birth weight, nutritional deficiencies). We will employ already identified local health care workers (with on the ground training), who will disperse door-to-door and in areas not abutting roads, and screen/treat children, and educate /counsel families in the clinic. Program barriers: poorest/ most malnourished families may not present to the clinic; families will not maintain adequate nutrition/food source after initial treatment; RUTF will be inappropriately used by other family members (the child will not gain appropriately). Counselling and education by respected peers will address barriers.

Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact

A growth parameter, no longer in the malnourished range, sustained after treatment and follow-up.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

Screen all children who present to the Open Door clinic in Bois de Lance

Task 2

Enroll children who meet MFK’s admission criteria; track/monitor growth and weight

Task 3

Enroll families in follow-up educational program; track/monitor growth and weight every 3 months

Now think bigger! Identify your 12-month impact milestone

Community outreach by health care worker; and involvement by farmers/ producers in the nutritional part of the program

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

Teach local health care workers and conduct ongoing quality improvement supervision

Task 2

Identify additional food sources in the community

Task 3

Partner with local leaders to improve water supply and natural resources

Sustainability
Tell us about your partnerships

To maximize achieving our goals, we work with the Cap Haitien Health Network (60+ NGOs) as well as local/elder leaders. And, Open Door Missionary has established a clinic, feeding station, and school, which provides a safe, secure environment for our project. Most directly, we work with MFK, whose mission is to develop, produce, and distribute highly nutritious foods and educate Haiti’s healthcare providers and the Government about its benefits. Haiti’s Health Ministry has formally adopted RUTF into its national protocols for the treatment of childhood malnutrition.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

We are targeting one pilot location because we want to identify what works and what doesn’t. Ongoing program scrutiny and revision is paramount to ensuring goals are met. By rolling it out one community at a time, we can make adjustments, identify other appropriate sites (e.g., Shada Clinic), and train more Haitian personnel. Based on statistics for the country as a whole, the population <15 years of age is about, 6,560. Assuming an even age distribution, the population < than 5 years is about 2,188. If 1 in 10 is suffering from acute malnutrition, our overall target is 200 children.

What type of operating environment and internal organizational factors make your innovation successful?

HUFH, an organization of 40 doctors, nurses, and humanitarians, is dedicated to making changes in the health care of Haitians through mobile clinics and educational efforts. We have “buy in” from the local village leaders, including the church Pastor. We have met with MFK representatives who, based on a site visit, have identified this as a very worthy site. We have a beautiful facility in the clinic, with locked safe areas for storage of the products/goods needed. The intervention will be based on MFK’s established and proven Medical Protocols. The Project Director, Jill Ratner, MD, has 28 years of pediatric experience and has traveled/worked in Haiti extensively on 5 trips over the last 2 years. Our Board supports this project and will provide ongoing personnel to ensure it flourishes.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list
randomness