US paediatrician Dr Mark Manary ignored the WHO's recommended milk-based regime to treat malnourished children in Malawi and created his own bacteria resistant, nutrient rich and easily made food source. As Maria Tickle writes, the recipe wasn't entirely new—it was peanut butter.

Sometimes the most complex of problems require a simple, almost obvious solution. Take treating acute malnutrition among millions of African children for example.

For decades the standard treatment for malnourished children involved being hospitalised for six weeks and fed a milk-based formula. However, even with intervention many of these children would still die.

Those that did survive often ended up back in hospital after only a matter of weeks at home. As a result less than 40 per cent of patients fully recovered, the rest either relapsed or died.

At a large meeting once I remember the most respected academic in malnutrition stood up and pointed at me and Andre [Dr Manary’s research partner] and said “You! You people over there you’re killing children!” Dr Mark Manary

This was the tragic state of play when American paediatrician Dr Mark Manary arrived in Malawi on a Fulbright Scholarship in the early 1990s.

‘Milk is a wonderful food but when you let it sit out for four hours as inevitably happens in those situations it becomes a perfect medium for bacteria, a way to spread infections,’ Dr Manary explained.

‘Children get diarrhoea and children are spreading germs between each other and that’s the genesis of why these children were doing so badly.’

The pediatrics chief of the Malawi University’s medical school tried to dissuade Dr Manary from taking on the heartbreaking challenge of treating severely malnourished children – in Malawi one child in eight dies of starvation. But Manary would not be deterred. It was a stubborn move that was to save more than half a million lives.

Dr Manary saw improved results when using a milk-based formula with added potassium, but knew there still had to be a better way.

‘As a doctor taking care of those kids in the hospital you always went home at night biting your fingernails because you knew you’d come in the next day and someone would tell you, “Three of them died last night and we don’t know what happened”.’

The breakthrough came in 1999 when Dr Manary spent 10 weeks in a local village, watching the community’s daily struggle to survive on subsistence farming.

He realised any nourishment had to be bacteria-resistant, easy to make (from ingredients sourced locally), and contain sufficient fats and nutrients to jolt the system out of shutdown.

For Dr Manary, an American, the answer was obvious—peanut butter.

In 2001, he field-tested a peanut butter-based formula for Malawian mothers to take home to feed their children.

‘We did three clinical trials sequentially in 2001, 2002 and 2003, and the results were dramatic. The last trial had a few thousands kids in it, and the international community was working there in a famine year,’ said Dr Manary.

‘[The recovery rate was] 46 per cent for standard therapy. Mothers feeding their own children peanut butter food at home were getting 81 percent recovery.’

Dr Manary’s recovery rate is now an average of 90 per cent. However, at the time it was a controversial move that was met with outrage by some of his medical colleagues.

‘At a large meeting once I remember the most respected academic in malnutrition stood up and pointed at me and Andre [Dr Manary’s research partner] and said “You! You people over there you’re killing children!" Because, [the academic argued] how could you send children away from medical care when they were so sick? But that was exactly what they needed.’

Peanut butter saves children Saturday 28 September 2013 Listen to RN First Bite to discover how a revolutionary peanut butter formula is helping malnourished children and saving lives. More This [series episode segment] has image,

In 2005 Project Peanut Butter was born—an unlikely name for a program that has saved more than 800,000 children from starvation.

The formula, called chiponde by locals, is simple. It’s a mix of ground roasted peanuts, dried milk, vitamins, minerals, vegetable oil and sugar.

The not-for-profit organisation headed by Dr Manary manufactures around 1000 tonnes of the peanut-based formula each year in Malawi and Sierra Leone, using local labour and locally-grown peanuts from roughly 6000 farmers.

The formula is then distributed via mobile clinics throughout Malawi, Sierra Leone and Ghana, with women and their children often walking for days to access their stock of chiponde.

Dr Manary said that while this therapy treats acute malnutrition, the effects are also long-lasting. The peanut butter formula gives children a nutritional buffer that helps them survive illnesses like malaria, which are a part of life for children in Africa.

Because of Dr Manary’s work, this therapy is now standard care world-wide and has since been endorsed as the best way to treat severe malnutrition by the World Health Organization, United Nations and UNICEF.

While all food allergies, including peanut allergies, are on the rise in Western countries, Dr Manary said there has never been an allergic reaction to peanuts among the children they have treated.

Peanuts have been an integral part of the West African diet for hundreds of years, brought to Africa from South America. According to Dr Manary, peanut allergies simply don’t exist among African children.

‘Food allergy is caused by not being exposed to food in the first year of life then being exposed to it later. So the way to create a lot of food allergy is to feed babies monotonous bland diets. Really this is a first world condition,’ he explained.

‘In Africa we don’t have that problem because people feed children a full array of food soon after six months, and in addition to that malnourished kids don’t have the strength to make an allergic reaction to anything.’

According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), the delayed versus early introduction theory, along with hygiene hypothesis, are two proposed explanations that have not been proven in studies.

However, it is worth noting that ASCIA encourages parents to introduce solid foods, including foods previously thought to be risky like peanuts and egg, from four months of age.

Dr Manary still spends much of the year in Malawi and says he hopes to expand the project to other African countries. His goal is to save two million children by 2015.

Find out more at RN First Bite and Project Peanut Butter.