Re: [pronut-hiv] Safe water and malnutrition in children (3)

["Basil Kransdorff" <basilb@iafrica.com>]

Dear Stella,

Access to clean sterilized water is of course a 
key critical requirement to health.  This goes without saying.

The argument that we must deny human beings life 
giving nutrients just because an hypothesis is 
made that clean water is not available is not a 
logical argument that I understand.  I am sick 
and tired of the poverty - enough is enough.  As 
long as we do not make people nutrient replete so 
that they can become functional human beings - 
the cycle of poverty will continue.  Solutions 
are all about priories and mobilizing available 
resources. So lets all focus on ensuing people 
have access to safe clean water for drinking 
eating and cleaning and also lets focus on 
ensuring people become nutrient replete. If we 
need to use the latest scientific understandings 
to ensure this becomes a reality - then lets do it now.

Half solutions will not work. Only clean water 
and no nutrition is as disastrous as nutrition 
without clean water. Just because people are poor 
is not an argument that I hear  that we must deny 
them access to drugs and medical support.  Good 
nutrition is a scientific reality that is 
possible using the latest nutritional sciences 
and understandings. Clean water is also a 
scientific reality that is a possibility using 
known well tested techniques.  Both are cheaper than a coke a day.

So lets stop these ludicrous approaches that 
argue one is more important than the other and 
lets get on with the job of ensuring both are a 
fundamental right all people have access 
to.  Only then will we see functional human 
beings that will be able to take responsibility 
for ensuring poverty becomes 'history'.

Basil Kransdorff

--- Stella Mundi wrote:

>   Basil Kransdorff wrote:
>   ??The argument that it is not the product that is not safe but
>   potential contamination of water  that is the reason that such a
>   solution cannot be used is not in my view a  valid approach to
>   addressing the problem?
>
>   Access to a clean and safe source of water is 
> an important factor to take into consideration 
> when promoting any type of supplement for 
> infant feeding.   It is not just about the 
> energy and nutrient density of the supplement. 
> If access to safe water is limited, which is 
> often the case in most settings in Africa, and 
> if the supplement has to be reconstituted with 
> water,  the supplement should NOT be 
> introduced/promoted. Diarrhea is one of the 
> first causes of child mortality in Africa and 
> contaminated water and food contribute to 
> this.  When addressing malnutrition, we should 
> have UNICEF framework of malnutrition (feeding 
> practice + care + hygiene) in mind.  Most 
> people in resource limited settings cannot afford all these supplements.
>
>   Stella
>
>   -------------------------------------------------------
>   Hi Nathan,
>   I refer to your quote - I guess the major draw back of these
>   supplements is the fact that they need to be reconstituted with
>   water, which may not safe and one of the
>   reasons people are going for plumpy nut (which given its high fat and
>   sugar content probably has a low water activity level and is less
>   prone to bacterial contamination
>   This issue you raise is in my view not a valid argument because
>   people need water daily to survive.
>   Arguing that the water might not be safe is NOT an argument NOT to
>   utilize a piece of good technology and an approach that has the
>   ability to deliver solutions to nutrient deficiencies in the form of
>   a pre-cooked food that requires water for reconstitution. I have
>   been given this argument by OXFAM who argue that they are not able to
>   fund good nutrition in the form of a pre-cooked nutrified food that
>   requires reconstitution with water because of the issue you raise.
>   The argument that it is not the product that is not safe but
>   potential contamination of water that is the reason that such a
>   solution cannot be used is not in my view a valid approach to
>   addressing the problem. If one takes this argument to its ridicules
>   conclusion - why not argue and tell those unfortunate victims of
>   poverty that they must also STOP drinking water in case the water is
>   contaminated. It is not an argument that a product like PLUMPINUT -
>   just because it does not require reconstitution that somehow it will
>   have a low CFU count. CFU counts are a product of how the raw
>   materials are prepared mixed and packaged. Any nutrient dense food
>   is liable to be contaminated in the production process. Peanuts are
>   an ideal source of contamination especially if the products used are
>   not properly controlled to ensure only 1st grade peanuts must be
>   used. The point is - bacterial contamination is not just caused by
>   reconstitution - it is also created by the choice of raw materials
>   and their preparation and how they are packaged. What is more
>   important is what they contain and once again - like a scratched
>   record - WHY add large quantities of refined sugar?
>   We manufacture a peanut butter nutrified with 28 nutrients. We DO
>   not add 30% sugar. We focus on bio-availability of the nutrients and
>   therefore make a big issue on the form of the nutrients we add. The
>   product is NOT sold as a miracle RUTF food (see CNN) that can
>   address malnutrition - it is a line extension that can deliver
>   nutrients that have clinical data to show it is a product that can
>   support and address nutrient deficiencies. The product has very low
>   CFU counts - not because it does not need to be reconstituted but
>   because of the way it is prepared.
>   Basil Kransdorff
>   At 12:42 PM 12/6/2007, you wrote:
>   >George,
>   >
>   > There are a number of companies that make nutritional support products
>   >that we use here in the U.K. and as health professionals we do not
>   >necessarily endorse the products, in fact against our code of conduct to
>   >endorse one product over another as state registered dieticians.
>   >
>   >However we do have the range of products available to prescribe
>   >controlled within the NHS by the Advisory Committee on Borderline
>   >Substances.
>   >http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Pharmaceuticals/ACBS.
>   >htm. Maybe there needs to be similar consensus amongst the nutritional
>   >community at large as to which products would be preferred to be used
>   >for malnutrition programmes.
>   >
>   >Also although some companies have done significant damage in developing
>   >countries through aggressive marketing of their products I do not feel
>   >that this is the forum to debate why companies listed on the stock
>   >exchange main ethical responsibility are to it's share holders rather
>   >than the greater community they work in. If they did not make profits
>   >they would be out of business and we would not have their products to
>   >use.
>   >
>   > Anyway back to the question at hand "which is best approach to
>   >supplement moderately malnourished HIV-infected children?"
>   >
>   > There are a number of products other than e-pap or plumpy Nut that are
>   >available that I have had the experience of using while working in South
>   >Africa that have not been mentioned in this forum.
>   >
>   >http://www.diva.co.za/product_info.php?product=Nutri-mil
>   >
>   >The complete range
>   >
>   >http://www.diva.co.za/product_category.php?cat=Supplemental
>   >
>   >I guess the major draw back of these supplements is the fact that they
>   >need to be reconstituted with water, which may not safe and one of the
>   >reasons people are going for plumpy nut (which given its high fat and
>   >sugar content probably has a low water activity level and is less prone
>   >to bacterial contamination).
>   >
>   >Bacterial contamination is a huge problem when it comes to
>   >reconstituting feed was demonstrated earlier this year in a study by
>   >Marino et al S Afr Med J. 2007 Jul;97(7):534-7.
>   ><http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&T
>   >ermToSearch=17805457&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pub
>   >med_ResultsPanel.Pubmed_RVDocSum> . They concluded 'Ready to use
>   >infant feeds are sterile and are recommended for use in all hospitalised
>   >infants. The results of this study indicate that even when milk is
>   >prepared in a controlled environment there is significant bacterial
>   >contamination of paediatric infant feeds post production.'
>   >
>   >I look forward to hearing of other potential solutions to this problem
>   >and to further lively debate.
>   >
>   > Nathan Billing
>   >
>   >Specialist HIV Dietitian
>   >
>   >Chelsea and Westminster NHS Foundation Trust
>   >
>   >Direct Line Tel: 020 8746 8176 or
>   >
>   >Tel: 020 8846 1000 Bleep 4150
>   >
>   >
>   >----- George Carter wrote:
>   >
>   >
>   >Ross Labs is owned by Abbott which manufactures the Ensure.
>   >
>   >
>   >
>   >Then there is always Nestle, another DEAR friend of the African
>   >
>   >people. See, e.g., http://www.ibfan.org/english/news/press/
>   >
>   >press15may01.html
>   >
>   >
>   >
>   >They make Nutren which is little better than the Ensure sugar/water/
>   >
>   >bad fat fiasco. And claim a doctor is needed to figure out who to
>   >
>   >give this garbage to.
>   >
>   >
>   >
>   >and another here:
>   >
>   >http://www.babymilkaction.org/CEM/compapr00.html
>   >
>   >
>   >
>   >and yet another--
>   >
>   >http://www.westonaprice.org/children/tricks.html
>   >
>   >
>   >
>   >Quote: The baby food industry has used and needs health professionals
>   >
>   >to endorse, distribute and sell its products. According to an Abbott
>   >
>   >Labs publication, "As the voice of Abbott, Abbott Topics can be a
>   >
>   >positive force molding the physicians' opinion of Abbott. In effect
>   >
>   >we are striving to make the physician a low-pressure salesman of
>   >
>   >Abbott."
>   >
>   >
>   >
>   >These companies really do not seem to give a damn who or how many
>   >
>   >they harm or kill as long as profits, profits, profits are increasing
>   >
>   >exponentially to keep the parasites on Wall Street happy. I'm
>   >
>   >grateful to the moderators for having galvanized me into examining
>   >
>   >these practices more carefully. I think it behooves everyone on this
>   >
>   >list to be extremely doubtful of claims made by second rate salesmen
>   >
>   >from the industry that has sought so assiduously to cause enormous
>   >
>   >suffering and death by blocking access to generic HIV and other
>   >
>   >medications. (A happy note: Pharmaceutical company Matrix
>   >
>   >Laboratories said it has received tentative approval from the US Food
>   >
>   >and Drug Administration (FDA) for Tenofovir Disoproxil Fumarate
>   >
>   >tablets, used for the treatment of HIV infection.)
>   >
>   >
>   >
>   >Realizing that the US and European "private sector" has nothing to
>   >
>   >offer Africa and developing nations but more rape, let us return to
>   >
>   >the discussion with renewed vigor on local, sustainable and healthful
>   >
>   >programs of nutrition for children and mothers with and without HIV
>   >
>   >infection. I think the data from this past year's Retrovirus
>   >
>   >conference further underscored the safety and practicality of
>   >
>   >exclusive breastfeeding for HIV+ mothers, where and whenever that is
>   >
>   >feasible.
>   >
>   >
>   >
>   >George M. Carter
>   >
>
>