Childhood malnutrition is a global scourge, the leading killer of children under five. But substantial progress has been made over the past two decades, in part because of work that began in 1985 when Mark Manary ’77, a newly trained pediatrician, and his wife, Mardi, a nurse, first encountered the problem at a mission hospital in Tanzania.
“I sat with those kids and began to see that their biggest problem was not getting enough to eat,” recalls Manary. “It was compromising their health in many ways.” Fewer than one-quarter of malnourished children recovered.
Over the following 15 years, Manary pursued potential treatments as he divided his time between frontline medical work in Africa and New Guinea, work in the US Public Health Service, and a faculty position at Washington University, where he had earned his MD.
When he began, milk-based formulas administered at hospitals were the standard of care, but he sought an economical, stable, easily produced nutrition source that could be administered at home. “I had to reach back into my chemical engineering background,” says Manary, who completed bachelor’s degrees at MIT in chemical engineering and chemistry.
Manary and his colleague André Briend developed a combination of roasted ground peanuts, powdered milk, vegetable oil, sugar, and vitamins that improved on products known as ready-to-use therapeutic food (RUTF). Manary conducted its first clinical trial in 2001 and presented an influential report to the World Health Organization and UNICEF in 2004.
That same year, Manary and his wife established the not-for-profit Project Peanut Butter to produce and distribute their RUTF, initially in Malawi and now in multiple African countries. In 2007, home-based RUTF therapy was internationally recognized as the standard of care for severe malnutrition, and Manary was honored with the World of Children Health Award and chosen as Academic Humanitarian Physician of the Year by the American Association of Medical Colleges.
“It turned out to be a good solution; it takes recovery rate percentages into the 90s,” says Manary. “When we first went to Malawi in 1994, 23 percent of kids there died before their fifth birthday. Today, with a national program for malnutrition, that’s down to 6 percent.”
Manary is the Helene Roberson Professor of Pediatrics at Washington University School of Medicine and a senior lecturer in pediatrics at the Medical College of Malawi. He and Mardi have two children and four granddaughters and divide their time between St. Louis and Africa.