Ending Malnutrition: How New Tools are Reshaping Our Options on Hunger

The numbers are stark: each year nearly 20 million children suffer from severe acute malnutrition, and 5 million die. Could new tools change all this?
A child eating Plumpy’nut in an ACF nutrition program, Uganda.

The numbers are stark and heartbreaking: Every year, nearly 20 million children across the world will suffer from severe acute malnutrition. More than five million of them will die. Countless others will suffer permanent physical damage, including stunted growth and developmental delays.

But the outlook for these children does not have to be so grim. Organizations such as Action Against Hunger have made huge strides in learning how to treat acutely malnourished children.

The most promising tools in our arsenal today are Ready-to-Use-Foods (RUFs), a category of nutrient-dense nutritional products used in both the treatment and prevention of acute malnutrition. These revolutionary RUFs have already transformed the treatment of severe acute malnutrition, introducing a community-based outpatient model that empowers parents and eliminates the need for expensive medical facilities. Indeed, RUFs have proven to be so potent in treating acute malnutrition that Action Against Hunger is running field tests on how best to apply the same concept to prevention strategies, ensuring that fewer children ever progress to the severe acute stage of malnutrition.

From a Medical Treatment Model to Community-Based Care

Today, 963 million people struggle with malnutrition. The most vulnerable communities may be pushed over the edge into the acute, “wasting” form of hunger by natural disasters such as droughts or floods, or man-made disasters such as war and conflict. Irrespective of the cause, these disasters often result in sustained, severely restricted access to food. For children, whose developing bodies and brains require additional nutrients and energy, this kind of deprivation can cause permanent damage and even death.

Acutely malnourished children cannot be cured with regular food. Once their bodily systems begin to shut down, they require a therapeutic regimen to re-build lost reserves of micronutrients and calories at a rate that won’t overwhelm their vital functions. In the recent past, those who managed to reach our feeding centers were treated with a therapeutic milk formula, administered in “intensive care units” that were staffed around the clock by medical professionals with access to the clean water needed to dilute the product. But there were never enough facilities for all who needed treatment, and even those that did exist were not always accessible to families in remote regions.

Because of these hurdles only about 3 percent of children suffering from acute malnutrition received treatment in any given year. What relief agencies needed was a product that could be administered on an outpatient basis, by parents or other care givers. RUFs, micronutrient- and calorie- rich products that require no preparation and no refrigeration, fit that need.

Expanding the Ready-To-Use Revolution: Towards Prevention

Currently, the most widely-used therapeutic RUF is a product called Plumpy’nut, a peanut-based paste available in serving-sized foil packets that withstand heat and have a long shelf life. Plumpy’nut provides children suffering from the most serious form of acute malnutrition with all of the essential nutrients and calories needed to rebuild their strength and restore them to health. The success of therapeutic RUFs in crisis situations has encouraged the humanitarian community to adapt this tool to the pre-emptive treatment of children threatened by severe acute malnutrition—before they reach the crisis stage.

This new strategy deploys a Ready-to-Use Food called Plumpy’doz—a non-therapeutic version of Plumpy’nut—which delivers a similar dosage of micronutrients but with fewer calories and at a much lower cost per serving. Packaged in jars and served by the spoonful, Plumpy’doz is designed to supplement other food sources that provide some calories but are otherwise deficient in essential micronutrients.

“Strategic use of these foods can prevent children with moderate acute malnutrition from becoming severe acute cases,” says Marie-Sophie Simon, Senior Nutrition Advisor for Action Against Hunger.

In one application of this strategy, a “blanket” distribution of RUFs is provided to all children under the age of three in a food insecure area, before a full-blown crisis occurs. This approach proved successful in Niger, where a six-month-long RUF distribution resulted in a significant decline in mortality. Moreover, researchers found that malnourished children whose natural growth had been delayed had resumed a normal growth curve, and that they had built up a reserve of essential nutrients that would provide long-term protection from acute malnutrition and other diseases.

In February of 2009, Action Against Hunger will launch its first broad RUF prevention project in East Africa. Funded in part by the Richard and Rhoda Goldman Fund, this intervention will provide Plumpy’doz to all children in the project region under three, as well as more targeted distributions to severe and moderate cases among kids aged three to five—approximately 5,000 in all. The project will include a rigorous research component to collect data on participants’ nutritional status before and after the intervention.

Permanent Solutions to Global Hunger?

RUFs are important, highly effective tools in helping families survive food crises, but they will not solve the problem of world hunger. Lasting solutions require integrated strategies to address the underlying conditions that prevent communities from thriving. Access to clean water and adequate sanitation facilities must be improved. Sustainable agricultural techniques to enhance food production must be implemented. New approaches to securing food security must be explored. And these strategies must all be adapted and refined to meet the specific needs and conditions of each community around the world where children suffer from malnutrition.

“What RUFs do is buy time for vulnerable children while we work with their communities to transform conditions that made them vulnerable in the first place,” says Nan Dale, Executive Director of Action Against Hunger. “They help us get past the crisis stage so that the hard work can begin.”

Multimedia Resources

Watch a special report from 60 Minutes on Ready-to-Use-Foods: