Health workers in Africa have made great strides treating severe malnutrition thanks to a therapeutic food called Plumpy'Nut. Yet India – which has its own child malnutrition problem – has blocked importation of the product. So Indian doctors are now concocting their own locally made version.
Inside a small shack in Mumbai's largest slum, Dr. Evelet Sequeira struggles to coax a 3-year-old girl onto a baby scale.
Sequeira is with a local aid organization called SNEHA that wants to know how many children in the slum have slipped from a stage of moderate malnutrition to what's known as severe acute malnutrition.
"She looks malnourished," says Sequeira, lifting the girl into her arms. "If you can see the hands and feet — very thin, a potbelly. So she must be on the borderline."
Eight million children in India suffer from severe acute malnutrition, according to the Indian government.
But when it comes to treating those children, India lacks what many consider one of the best tools available: so-called ready-to-use therapeutic foods. These are the type of pre-packaged, protein-rich nutritional products that have brought "a revolution in the treatment of severe malnutrition" to Africa, says Stéphane Doyon of the group Doctors Without Borders.
That revolution was led by the most well known therapeutic food, Plumpy'Nut, made by the French company Nutriset. It's a patented concoction of peanut butter and micro-nutrients that allows severely malnourished children to be treated at home instead of at a hospital.
Doyon says that means aid workers have been able to treat far more kids than ever before in countries such as Ethiopia and Niger.
"As a matter of fact, the number of children treated every year [for severe malnutrition] in Niger is 300,000," he says. Before Plumpy'Nut, he adds, this number of children "was not even treated in the [whole] world."
With that kind of success in Africa, the United Nation's children's organization, UNICEF, shipped Plumpy'Nut to India in 2009 to help with malnutrition here. But that move sparked controversy.
Plumpy'Nut is not authorized for the treatment of malnutrition in India, and some doctors feared that dependence on a foreign import would come at the expense of the kind of locally produced food that Indian families prepare at home.
In response, the Indian government banned Plumpy'Nut and forced UNICEF to send its stock back to Europe.
Dr. Vandana Prasad of the Public Health Resource Network — which fought the use of Plumpy'Nut in India — says she's not opposed to therapeutic foods altogether, just those made by big companies outside of India.
"Why can we not produce it here?" she asks. "If we can use a local process — using, you know, local products — we see no reason not to."
Back in the Mumbai slum, that's exactly what Makrand Surve is doing — he's blending together a peanut butter paste that looks like Plumpy'Nut but is made from local ingredients. He stands over a mixer in a small production kitchen.
"Once the mixing is done, it's put through the grinder again," he says. "We're making a new batch almost every week."
But before this "made in India" product can be used to treat malnutrition, it has to be tested. So doctors at a hospital near the slum are conducting a trial of about 200 children.
Dr. Mamta Manglani, who leads the study, says so far it has shown that therapeutic food can be just as effective in India as it has been in Africa.
"We have been now looking at some interim results," she says. "And the type of weight gain we have observed, the children do not lose weight again if they are treated with medical nutrition therapy."
Full results of the trial are due in December. If they show sustained improvement, Manglani says, that will help convince Indian politicians that therapeutic food — made in local production kitchens — has a role to play in India.
Dr. Evelet Sequeira, of the aid group SNEHA — who works with Manglani – believes that a large-scale rollout with the help of the government could eradicate severe acute malnutrition, at least among India's youngest children, in just five years.
"I see a vision where it's there all over the country," she says. "And these smaller production units can be set up anywhere."
Others have an even grander vision.
While imports of Plumpy'Nut are banned in India, there's no reason India can't export its product. Some see a future where this country could become a major producer of low-cost ready-to-use therapeutic foods used all over the globe.
This story was produced with assistance from the International Reporting Project.