Deep in the mountains of southwestern Honduras, Maria Digna Ramos Mendoza spoon-feeds Plumpy’Doz, a peanut-based supplement, to her infant daughter.

Four other hungry children watch while either sitting on the dirt floor of their one-room hut or swinging from a hammock. Chickens, dogs and rats roam around the cluttered room, scavenging for their next meal.

Mendoza is part of a research study being conducted by professors and students at UNC, part of the University’s larger focus on international health.

Researchers aim to improve the growth and development of young infants in rural Honduras.

The Mathile Institute for the Advancement of Human Nutrition, a philanthropic organization founded by former Iams CEO and board chairman Clayton L. Mathile, funds the year-long project.

The study is also in conjunction with the U.S. nonprofit organization Shoulder to Shoulder, an organization founded and directed by UNC School of Medicine faculty member Dr. Jeffrey Heck.

Heck proposed the study in hopes of improving the well-being of the people his organization serves in the town of Santa Lucia and the surrounding villages of southwestern Honduras.

A glaring need

Santa Lucia is a tiny village nestled in the remote region of Intibucá. Lack of adequate infrastructure isolates these residents from the outside world, with the nearest large commercial center located eight hours away by car.

Moreover, permanent potholes and washed-out areas from torrential rains cover the gravel and dirt roads, creating a nearly impassable route.

Malnutrition affects a large percentage of this population due to the consequences of poverty and lack of sanitation.

The World Bank states that Honduras is the third-poorest country in the Western Hemisphere with a child malnutrition rate of 23 percent.

“However, poverty and malnutrition rates are thought to be as high as twice the national average in the rural remote areas of western Honduras,” Heck wrote in a 2007 study published in “Family Medicine.”

Making it happen

Because Shoulder to Shoulder was too small to undertake this research project, Heck contacted researchers at the Gillings School of Global Public Health for help.

UNC public health professors Margaret Bentley and Anna Maria Siega-Riz enthusiastically joined the research project as nutrition advisors. Both were eager to test Plumpy’Doz on this population, as they were not familiar with any similar study in Central or South America.

“I think it’s important to do this study here in Honduras because the work that has been done already testing this nutrition product has primarily been in sub-Saharan Africa,” Bentley said.

Bentley recruited 2004 UNC alumna Yanire Estrada to lead a team of 11 local and U.S. health promoters to provide educational sessions for the mothers and assess each infant’s health on a monthly basis.

Estrada’s team evaluates nearly 300 infants from 18 villages in both a control and intervention group. Heck insisted that both groups receive some beneficial subsidy for participating in the study, so every mother obtains food vouchers in addition to the educational sessions.

Estrada said they are educating the mothers on how to best utilize the food vouchers so that they can provide a balanced diet for their family. This, in turn, enables mothers to complement a healthy Honduran diet of rice, beans and tortillas with the nutritional supplement.

The intervention group receives Plumpy’Doz, a fortified lipid-based peanut butter spread, packed with essential nutrients including zinc, iron and vitamin A. The supplement is given to the infants three times a day in addition to their normal diet.

Looking forward

The goal of the study is to test whether this product has a positive effect on the growth and nutrition of Honduran infants. The researchers must also evaluate the acceptability of the product.

If the supplement proves effective, Shoulder to Shoulder plans to implement a larger-scale program to distribute it.

“This project also has scientific value that is international in its scope,” Bentley said. “And the community and its generosity in participating in this will benefit millions of children around the world, and I really mean that.”

Greg Reinhart, vice president of research and nutrition at the Mathile Institute, oversees the funding of the project. During his last visit to Honduras in June, he noted the willingness of the Honduran community to invest in this project.

To participate in the program, mothers have to attend monthly meetings, allow their children to be weighed and have blood drawn, and commit to feeding the supplement correctly.

“There are families that want to help themselves, and they eventually want to become independent,” Reinhart said.

A student’s perspective

Lane Erickson, a senior public health major at UNC, spent her summer in Honduras entering 24-hour dietary data recalls for the project.

“I was interested in it because it had to do with children and my passion for different third-world countries, Spanish and nutrition,” Erickson said.

She witnessed the consequences of malnutrition firsthand by seeing children’s bloated stomachs during home visits.

Other consequences of malnutrition are stunted growth and atrophy, also known as wasting. Bentley noted that stunting is more of a concern in this area.

“In this part of the world in Honduras we see rates of stunting that are 50 to 60 percent of the population and sometimes even more than that,” Bentley said.

Home connections

Despite Honduras’ unique conditions, Bentley continually draws connections to her other research at the University and considers how global health can be compared to local health. For example, she is currently involved in a project where researchers are studying obesity in North Carolina.

Bentley noticed the easy access to cheap, packaged snacks and soft drinks that exists in North Carolina also exists in Santa Lucia. Both are troubling, as Honduran mothers feed this junk food to their infants, causing chronic diarrhea and sickness.

“I don’t think about working overseas as working over there (with) no connection to North Carolina,” Bentley said. “Any problem that we have in North Carolina has a mirror image in another place.”

In addition to feeding sweets and sodas to infants, Estrada noted that the tradition of giving coffee to the baby prior to six months of age is also of growing concern.

Infants do not easily digest coffee, and many times the water used to make the coffee is not treated, both of which result in episodes of diarrhea.

Estrada has spent the past six months consulting with mothers to change these behaviors and educating them about the importance of hygiene and sanitation.

“What I am taking from this project is the fact that I went out there and reached out to the people who are really far away in rural villages … and actually having an impact in their lives and their behavior instead of just hoping to meet our personal project goals,” Estrada said.

Back in the mud hut, Mendoza stares lovingly as her infant begins eating Plumpy’Doz straight from the jar. Just six months ago, her daughter’s fragility deeply concerned her, but now she prides herself as she watches the color return to her child’s face.

“People stop me to ask what I am feeding my child because she is beginning to look so pretty,” Mendoza said. “She is developing extremely well now.”

View a slideshow, videos, interactive graphic and more information about the Honduras project.

Project

Nestled in a remote northern Honduras valley, Santa Lucia and the surrounding area are home to 20,000 rural inhabitants. These families rely solely on their agrarian skills for a subsistent living. According to UNICEF, over one-third of Honduran infants are malnourished due to this indigenous lifestyle. Four percent of Honduran children die before reaching five years of age, at a rate five times higher than that of U.S.

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