Below is the email I received from Kelli M. Donley, Program Director at Esperanca, in response to the questions I asked in Part I and Part II of this series:

Dear Elie,

Hi there! I am going to try to answer your questions to the best of my
knowledge. I hope this helps:

These questions apply to your malnutrition programs in Mozambique and
Nicaragua (except where noted):

– Is the problem “receiving enough food” or receiving the right types of
food (Mozambique)?

Both. There is not enough food in Mozambique at the moment because of
poverty, the way the population has changed with the civil war, etc. Also,
the food they are able to grow is limited. Where we work, it is
predominantly swap. So, they grow corn, rice and millet, but have little
variety to the fruit and vegetables they are consuming.

In Nicaragua, poverty and environmental concerns have limited the diet and
access to a balanced diet.
– What does Esperanca teach community members? Which foods to plant? How to
cultivate and plant them?

In Mozambique we focus solely on three areas: cholera, malaria and HIV
prevention and treatment. Our partnering agency in this country – Care for
Life – has a small farm where they teach small animal husbandry, improved
seed cultivation, improved environmental techniques to prevent erosion, etc.

In Nicaragua, we have seed banks that promote long-term growing of healthier
crops. We also focus on environmental concerns, as in how to prevent soil
erosion. I like to think our midwifery training program also helps minimize
malnutrition by working with pregnant women to teach them to breastfeed and
why it is important.

– How often do they hold classes and how long each does each last?

This varies by country and by community. These classes are run by the
nonprofits we partner with in the country.
– How well do community members retain and implement what they’re taught?

They regularly attend courses and are putting this knowledge to use
immediately in their communities. One would hope they are retaining a lot of
it.
– What nutrients do the foods contain and how does this match up to the
nutrients community members likely lack?

I do not have this information to share with you. I can tell you that meat
and dairy are extreme luxuries in both areas. Fresh fruit and vegetables are
often limited in scope and supply.
– How effectively does this program reduce malnutrition of specific
nutrients?
– What effect does this have on the outcomes (e.g., mortality rate, general
health, I.Q.) of community members?
– How many people do they help?
– How much does this program cost?

Our programs are not broken down into these sorts of statistics for
analysis. We have general overhead costs for each project. We reach 11,000
people in Mozambique and 30,000 in Nicaragua each year. One would hope we
are improving their quality of life and their life-spans, although we do not
employ any sort of researcher to determine this. It is all through
word-of-mouth and monthly reporting from our field officers that we see
results.

I also have some questions about programs to fight malnutrition in general:

Again, I don’t have the information to answer these specific malnutrition
questions. I hope what I’ve provided will be of some use!

– What specific nutrients are people missing that affect them? Without
knowing this, there’s no way to decide (regardless of the type of
intervention listed above) which nutrients are the most important. Is it
vitamin A? Iron? Iodine?
– What happens because of each type of deficiency (e.g., anemia because of
lack of iron, blindness because of lack of vitamin A, death)? How likely are
each of these outcomes given a particular deficiency? Understanding this
will help me decide which sort of program is most appealing to me – not a
fully scientific/objective decision, since my view of the “good life”
affects which disorders I most want to address.
– In what region do the people most affected live? What age are they? Any
special circumstances (i.e., pregnant women)? Before focusing on helping a
group of people, I think it’s important to know what other obstacles they
face. I want to help people for which malnutrition is the main (or a
significant) obstacle to living a full, happy life. If the people face many
more obstacles (e.g., other diseases, war, etc.) helping them here may not
do as much good.