Port-au-Prince, Haiti -- The faces and cries of malnourished babies take every shape in the bustling children´s ward in Haiti´s General Hospital. A tiny, hand-sized newborn yawns in its makeshift incubator. A wide-eyed and skinny-ribbed boy wriggles restlessly in his cot. A yellow ribbon hangs from Beasline Roseus´ intricately plaited hair. The 14-month old infant sits on her mother´s lap. Her feet and limbs are swollen and puffy. She has Kwashiorkor, a severe form of malnutrition.
"We get Kwash babies every day," says Dr. Jessy Colimon Adrien, Chief of Pediatrics at the General Hospital. Haiti has the highest rates of infant and under-five mortality in the Western hemisphere. Poverty, civil strife and inadequate knowledge of proper diet are root causes of malnutrition in the country.
The IAEA has teamed up with the Haitian Ministry of Health to improve infant nutrition nationwide, using nuclear science. Together they are focusing on using the advantages of breast milk -- a healthy and cheap way to feed infants and protect their health. A series of studies that use stable (non-radioactive) isotopes will be run to know more about breastfeeding patterns in Haiti. The findings and recommendations will help the Government to better understand the causes of infant malnutrition in the country and formulate strategies to tackle it.
Dr. Lena Davidsson, Head of IAEA Nutritional and Health Related Environmental Studies Section, says severe malnutrition such as Beasline´s case is a medical emergency. "Many more children in Haiti are undernourished, but not to such a dramatic extent. These cases are the tip of the iceberg. They clearly highlight how vital good nutrition is during early life. The IAEA project focuses on how to improve the implementation of national policies to encourage exclusive breastfeeding for six months, as recommended by the World Health Organization," Dr. Davidsson said.
Beatrice says she breastfed Beasline for 11 months, but she also started to feed her porridge from 15 days old, believing she was doing the best thing for her baby. As a newborn, Beasline was also fed "the national mixture" called lock on three occasions. Lock is a black liquid made up of olive oil, butter and other ingredients, which many Haitians believe helps the newborn eliminate its first stools.
"Beasline´s case is common," Dr. Joseline Pierre Marhone, Head of Food and Nutrition in the Ministry of Health, and a child nutritionist says. "Culturally mothers do not believe that breast milk is enough for the baby and they try to introduce foods early like leafy tea, juice, crackers and porridge," Dr. Pierre Marhone says. Inadvertently it exposes the infants to bacteria and viruses causing diarrhoea and other infectious diseases.
"The lock is the worst," Dr. Pierre Marhone says. "When mothers start with the lock, we have diarrhoea and malnutrition."
Marasmus is the other form of severe childhood malnutrition that Dr. Pierre Marhone sees too often. "It´s caused by a lack of food and the child becomes emaciated. We usually see in it one to four-year olds," the doctor says.
"The IAEA studies will help us know how many mothers breastfeed exclusively. We will use the results to improve our policy," Dr. Pierre Marhone says.
The studies will use stable isotopes to measure the quantities of mother´s milk. It is a safe and non-evasive method. Mothers are given a dose of deuterium (also called heavy hydrogen) to drink in a glass of water. It mixes with the mother´s body water and is ingested by the baby via human milk. Over the next 14-days saliva samples are taken from the infant and mother. It will then show if the baby is consuming water or food from sources other than the mother´s milk, the intake of human milk, and the nutritional status of the lactating mother.
Through the Ministry of Health, the IAEA efforts are combined with other international organizations like UNICEF, the Pan American Health Organization/World Health Organization, UNICEF, USAID and the World Food Programme to reduce the infant mortality rate in Haiti.
Over the last 10 years, the IAEA has allocated around US$1.66 million to support the improvement of several national programmes on nutrition. By 2009, another $1.6 million is allocated for countries including Afghanistan, Haiti, Iraq, Eritrea, Madagascar and Burkina Faso on training staff and supplementary equipment to target the evaluation and reduction of child malnutrition.
IAEA Deputy Director General for Technical Cooperation, Ana Maria Cetto, says that Haiti, as one of the least developed countries in the region, has special needs. "We know their needs are much larger than we can ever offer. So we have to be very strategic in finding how best to support them in their development needs. Child nutrition is a key area," Ms. Cetto said.
Dr. Davidsson says results of similar projects in Brazil and Ghana have shown that by providing counselling and education about the benefits of exclusive breastfeeding to lactating mothers, the introduction of other foods and fluids into the diet of infants before six months can be delayed or minimized.
Fortunately, the prospects for Beasline are positive, Dr. Pierre Marhone says. A good quality diet will help her to recover quickly and develop normally. So too for the wide-eyed little boy with marasmus. "He needs good food and plenty of love," Dr. Marhone says, giving him a gentle cuddle.