SANSANE HAOUSSA, 4 September 2006 (IRIN) - Smearing creamed peanut around his face like any child tucking into a tasty treat, 17 month old Nigerien Samara Issa nibbles away at his Plumpy’nut bar, a wonder-food health workers say could help stamp out malnutrition.

Eating three bars of the rich peanut, dry milk, sugar, salt and mineral blend every day for the last week has already put an extra 5kg on Issa’s tiny frame, nudging him towards his optimum weight. Doctors with the World Vision NGO treating him said he could be out of the malnutrition danger-zone in two weeks.

Tasty Plumpy’nut is not just a hit with hungry kids. Health workers say that Plumpy’nut, or similar products, could go a long way to bringing down child mortality rates across the region.

“This will do for the worst malnutrition what prophylactics did for malaria,” said Jean Herve Bradol, president of the global medical NGO Medicins Sans Frontiers/France (MSF), after surveying the group’s medical work in Niger.

Every year more than 50 percent of Niger’s population slips into malnutrition to some degree, but widespread use of the Plumpy’nut bar this year has helped reduce occurence of the most severe life-threatening cases.

According to the World Bank, one in twelve children dies before its fifth birthday in developing countries, compared with one in 152 in high-income countries. In many West African countries more than one five children do not reach their fifth birthday.

In Niger, Bradol said MSF has treated 63,000 children with Plumpy’nut. The group’s success rate has been 90 percent, compared to around 30 percent using traditional “therapeutic feeding” units which require admitting sick children for weeks in hospital tents and health centres.

One of the benefits of Plumpy’nut is it is simple to administer. Children just have to be given a set number of bars to eat each day, and can be treated as out-patients.

Bradol said the number of children treated by MSF in Niger using the new product is almost 10 times higher than MSF has ever achieved in operations with equally widespread hunger.

“After 20 years working with medical emergencies, it is a shock for me to see what is possible with this food,” Bradol said. “Acute malnutrition is facing a revolution in terms of treatment.”

Limited by high cost

Other major NGOs working on food-relief contacted by IRIN, Save the Children and Action Against Hunger/Spain, are also using the bars in Niger, but not on such a scale as MSF.

The main problem, aid workers say, is the product’s high cost. At roughly four US dollars per kilogram, Plumpy’nut is at least three times more expensive than traditional therapeutic feeding.

MSF’s Bradol said cost should not be a factor. MSF has started giving Plumpy’nut to children with more moderate forms of malnutrition in Niger this year.

But the product’s creator, Andre Briand, now a children’s health medical officer at the World Health Organisation (WHO) in Geneva, cautions against this approach. “Cost is the major issue,” he said.

Briand said costs can be reduced by using local production, tapping into Africa’s extensive peanut plantations. A Plumpy’nut factory is being set up in the Nigerien capital, Niamey.

But Briand said nuts are only around 20 percent of the blend, and the dry milk component is what pushes the price up.

Michele Falavigna, head of the United Nations Development Programme (UNDP) in Niger said he is concerned about the ethics of creating a new dependency in poor countries, rather than working on long-term fixes.

“This product is good if it can be provided at discounted cost. But it can also be bad if the country comes to depend on its supply,” he said.

Falavigna said if countries like Niger are going to go down the road of mobilising expensive resources to treat severe malnutrition, the developed world should first make a commitment to provide the product in the long-run.

“The supply of Plumpy’nut must not be part of charity,” Falavigna said. “It must be an obligation.”