Just over a decade ago, a French doctor invented a treatment for severely malnourished children that had a revolutionary, life-saving impact.
The product goes by different names in different parts of the world, such as Plumpy'Nut, Nourimanba and Chiponde. It's basically peanut butter with some added ingredients: dried milk, oil, sugar, and essential minerals and vitamins.
It's been so successful that some public health officials now are pushing to expand its use. It wouldn't just be a treatment to save a life, but a snack to keep kids healthy in the first place.
There's one catch: The proponents of this strategy still have to show that it really works.
And that's why, in a clinic in the city of Cap-Haitien, on the northern coast of Haiti, 16-month-old Renande Raphael is getting laid out flat in a wooden box so that nurses can measure how much she's grown.
After getting measured, Renande will get something else: a pile of little foil-wrapped snacks. Enough to eat one every day for a month. She's been getting them for the past six months.
Sherlie Jean-Louis, a nurse with a quiet voice and a huge smile who's helping to run this trial program, explains that the packages contain about four teaspoons' worth of peanut paste that's been fortified with lots of essential nutrients, such as zinc, iodine, iron and lots of vitamins.
It's a smaller version of the more famous peanut butter product that's used to treat children who are suffering from severe malnutrition.
But Sherlie Jean-Louis explains that the children who come here have been doing just fine, probably because they've been breast-feeding.
Still, they're at risk for malnutrition. This is one of the poorest neighborhoods in Cap-Haitien. And the children now are vulnerable. They're getting a little older and shifting to other foods, often inferior ones, nutritionally speaking.
Renande Raphael's mother, Guerlandie Joseph, says that the nurses have been giving her advice about what food to buy for her child. They've been urging her to get milk, eggs and vegetables.
But it's hard to follow that advice, she says. Those foods are expensive, and she doesn't have much money. So they mostly eat rice, beans and corn.
Lora Iannotti, a specialist in international nutrition at Washington University in St. Louis, helped set up this trial program in Cap-Haitien.
This is "a critical period" for children, she says, because many of the effects of malnutrition at this young age — from 6 to 18 months — are irreversible. "If a child is stunted, meaning that they lose height during that period, they never recover the height that was lost," she says. There can also be permanent effects on the brain.
Twenty percent of children in Haiti suffer stunting, Iannotti says. In Guatemala and some countries in Africa, it's about 40 percent.
Iannotti is monitoring the children in this trial program in Cap-Haitien, comparing them to a similar group of children who aren't getting enriched peanut butter — to see whether this daily snack reduces rates of stunting.
If her data show that it has a positive impact on health and growth, she says, "then the idea is, we move more into the rural areas of Haiti, where malnutrition is a bigger problem. And then, ideally, we move toward national coverage."
Similar experiments are under way in several other countries as well. They could be the first steps toward turning enriched peanut butter from emergency treatments into routine supersnacks.
Some experts, though, are raising flags of caution.
Mark Manary, who is also at Washington University but in the med school, has been a big booster of using enriched peanut butter for treatment of severe malnutrition. He's been disappointed by the results of the trial programs so far that have attempted to prevent malnutrition.
"Unfortunately, they have not worked very well," he says. Nobody really knows why the approach hasn't worked better.
Others in public health complain that the peanut butter packages are being pushed, in part, by private companies that make them. These critics worry that glitzy, foil-wrapped packets could distract people from local, low-tech nourishment, or from breast-feeding.
In an ideal world, we wouldn't rely on packages of enriched peanut butter, Iannotti points out. We'd be helping parents get good food nearby: non-packaged food like eggs, milk and meat.
But as Guerlandie Joseph, the mother in Cap-Haitien, explained, that just doesn't always happen. In this less-than-ideal world, Iannotti says, if little packages of fortified peanut paste can help nourish children through their most vulnerable time of life, the payoff would be huge.
RENEE MONTAGNE, HOST:
This morning, we're starting a series of stories about peanut butter - not your average peanut butter; a life-saving kind. It's mixed with some added nutrients, and it's revolutionized the treatment of severely malnourished children around the world. It's been so successful, there are moves to expand its use so it won't just be a treatment to save a life, but a snack to keep kids healthy in the first place. Sounds good, but some experts aren't so sure. And NPR's Dan Charles traveled to Haiti for this report.
DAN CHARLES, BYLINE: It's no fun getting laid out flat in a wooden box, so somebody can measure how tall you are - even if you're a 16-month-old child.
(SOUNDBITE OF BABY CRYING)
CHARLES: We're in an outside corridor of a hospital in the city of Cap-Haitien, in Haiti. And all this weighing, and measuring, is an attempt to find out whether a new idea for how to provide better nutrition to young children, really works. This child is here for routine checkup. But then she'll get something else - a pile of little, foil-wrapped snacks; enough to eat one every day, for a month.
SHERLIE JEAN-LOUIS: (Foreign language spoken)
CHARLES: Sherlie Jean-Louis, a nurse with a quiet voice and a huge smile who is helping run this trial program, explains the packages contain about four teaspoons' worth of peanut paste that's been fortified with other essential nutrients - iodine, zinc, vitamins. It's similar to a more famous peanut butter product - the kind that's now used to treat children who are suffering from severe malnutrition.
JEAN-LOUIS: (Foreign language spoken)
CHARLES: But, Sherlie Jean-Louis explains, the children who come here have been doing just fine, probably because they've been breast-feeding. Now, though, they're vulnerable. They're getting a little older; they're shifting to other foods - maybe not the foods they really need. For instance, Renande Raphael, the 16-month-old girl who's so unhappy about getting measured - her mother, Joseph Guerlandie, tells me the nurses have been giving her advice about what food to buy for her child - food like milk, eggs and vegetables.
JOSEPH GUERLANDIE: (Foreign language spoken)
CHARLES: Is it hard to follow the advice?
JOSEPH: (Through Translator) Yes, it's difficult.
JOSEPH: (Through Translator) Foods are expensive, and we don't have the purchasing power.
CHARLES: So we eat mostly rice, corn and beans, she says. Lora Iannotti, a specialist on international nutrition - at Washington University, in St. Louis - helped set up this trial program in Cap-Haitien. She says children at this age - from 6- to 18 months - really need more than rice and beans.
LORA IANNOTTI: It's a critical period.
CHARLES: It's especially critical, she says, because many of the effects of malnutrition at this young age, are irreversible.
IANNOTTI: So if a child is stunted - meaning that they lose height, during that period - they never recover the growth that was lost.
CHARLES: There can also be permanent effects on the brain. Twenty percent of all children in Haiti suffer stunting, Iannotti says. In Guatemala and some countries in Africa, it's at least 40 percent. And Iannotti would love to know whether that extra package of enriched peanut butter - just one a day - will be enough to prevent stunting among the children in this trial program. She's monitoring those children, following their progress. If the program seems to work, public health officials in Haiti might expand it.
IANNOTTI: If we show that there is a positive impact on health and growth - in particular, height - then yes, the idea is that we now move more into the rural areas of Haiti, where malnutrition is a bigger problem. And then ideally, we do - we move toward sort of national coverage.
CHARLES: Similar experiments are under way in several other countries, too. They could be the first steps toward turning enriched peanut butter from an emergency treatment into a routine super-snack.
Now, some experts say - not so fast. Mark Manary, who's also at Washington University, has been a big booster of using this sort of food to treat severe malnutrition. But he's been disappointed by the results of other trials - similar to the one in Haiti - aimed at preventing malnutrition.
MARK MANARY: Unfortunately, they haven't worked very well. So I'm not a wholesale enthusiast of the prevention.
CHARLES: They're not sure why the kids eating the packets didn't do much better. And other public-health experts say the peanut butter packets are being pushed, in part, by private companies that make them. These critics worry that glitzy, foil-wrapped packets could distract people from local, low-tech nourishment. Lora Iannotti - from Washington University - says in an ideal world, we wouldn't rely on packages of enriched peanut butter. We'd be helping parents get good food from nearby; non-packaged food.
IANNOTTI: Eggs, milk, meat.
CHARLES: But as that mother in Cap-Haitien told me, it just doesn't always happen. And some experts say in our less-than-ideal world, if little packages of fortified peanut paste can help nourish children through their most vulnerable time of life, the payoff would be huge.
Dan Charles, NPR News.
MONTAGNE: And this afternoon on ALL THINGS CONSIDERED, Dan reports on an attempt to make this super-nutritious peanut butter in Haiti, to create much-needed jobs.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.