Dr. Iannotti, MFK featured in Washington University Record (1/28/10)

To read the story at the Washington University website, click here.

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Brown School professor survives Haiti earthquake
Shifts focus to preventing further public health disaster

The Record
By JESSICA MARTIN
jessica_martin@wustl.edu
January 26, 2010

Two days before the Jan. 12 earthquake that devastated Haiti, Lora Iannotti, Ph.D., nutrition and public health expert from the Brown School at Washington University in St. Louis, traveled to Port-au-Prince and Leogane, Haiti, to continue her research about undernutrition and disease prevention in young children. The massive tremor changed her focus from research for the future to survival, with her team helping children in the aftermath of the quake.

On Jan. 15, Iannotti, who has been working in Haiti since 1990, was evacuated back to the U.S. “I started to focus on the major public health aftershocks of the earthquake,” she says. “If we think carefully now about what this phase will bring, many more lives will be saved.”

Iannotti says that there are some immediate actions that can be taken to prevent more lost lives and protect livelihoods.

 

“Priority should be given to sufficient supplies of both drinking water and water for washing, and to optimal sanitation conditions for the prevention of diarrhea,” she says. “Oral rehydration therapy and zinc should be widely available to help those who succumb to diarrhea to recover.

“Care should also be given to the kinds of foods delivered to people, ensuring that not only basic energy needs are met but also micronutrient nutrition is addressed. Ready-to-use supplemental and therapeutic foods like Medika Mamba in Haiti are dense in both calories and micronutrients and resistant to bacterial contamination, and consequently, should be used for preventing undernutrition and recovery from severe malnutrition.”

Medika Mamba is a nutrient-rich mixture of peanuts, sugar, oil, vitamins, minerals and powdered milk made locally with locally produced ingredients. It is distributed in plastic containers for families to feed their children at home and can be stored for several months. It is typically given to children between 6 months and 5 years old. After starting to eat the ready-to-use therapeutic food, children start to show visible signs of improvement about 1-2 weeks. The cost of six weeks of treatment — enough to return a child to health — is less than $100 in U.S. currency.

Patricia Wolff, M.D., associate professor of clinical pediatrics at Washington University School of Medicine in St. Louis, provides Medika Mamba, or peanut-butter medicine, to malnourished children in Cap Haitien, Haiti, on the north coast, through her nonprofit organization, Meds & Food for Kids. Wolff, who divides her time between St. Louis and Haiti, returned to Cap Haitien soon after the earthquake to oversee the continued production of Medika Mamba.

Public health realities in Haiti

Deaths due to diarrhea were already high in Haiti, but with the earthquake there is tremendous potential for increases. “One-quarter of Haitian children are stunted with low height-for-age and over one-fifth are underweight with low weight-for-age,” Iannotti says. “We know now with certainty that undernutrition predisposes children to dying from infectious disease, especially diarrheal diseases. Being underweight doubles a child’s risk of death due to diarrhea, and for those severely malnourished, this risk increases by 3.4 to 9.5 fold.

“Sanitation conditions and access to clean water will deteriorate and increase the risk of cholera outbreaks and acute diarrhea and dysentery from E. coli, salmonella, and other pathogens,” she says.

According to Iannotti, another pre-earthquake statistic foreshadows more silent public health menaces.   In Haiti, over 70% of children less than 2 years are anemic; nearly half (46%) of women of reproductive age are anemic.

“Anemia in developing countries usually results from a lack of iron in the diet, parasitic infection including helminthes and malaria, and chronic inflammation,” she says. “Blood loss also causes anemia. Anemia can have many short- and long-term health and livelihood consequences, such as compromised cognitive and physical development in young children, poor birth outcomes in pregnant women, and in severe cases, increased risk of mortality in certain populations.”

Education and socio-economic development are vitally important over the long-term

The health and well-being of Haitians will depend on long-term commitments to improving public health problems such as nutrition, education and poverty reduction.

“One of the most difficult scenes to witness the morning after the earthquake were the fallen schools,” she says. “Most immediately, it was hard to imagine their descent and agonizing to both see and imagine what lie beneath. Now, with some distance and time, I am also reflecting on what this means for the later phases of this crisis. In a country where one in five people receive no education at all and only 40 percent make it through primary school, the implications of even more lost education is depressing.

“Education is linked to every positive health and livelihood outcome. Restoring these buildings and creating educational opportunities must be a priority.”