Expanding the Ready-to-Eat Revolution: New Tools Target Malnutrition
The nutritional product “Plumpy’nut” has received some media attention recently. Despite the cute name, this product has shown considerable promise when it comes to tackling childhood malnutrition. As a “ready-to-use-therapeutic-food,” or RUTF, it is a nutritional product that could have a significant impact on the 19 million children who suffer from severe forms of acute malnutrition around the world: a tiny percentage—only about 3%—of them ever receive treatment, resulting in as many as 5 million childhood deaths each year.
Ready-to-use-therapeutic-foods (RUTFs) already provide a partial solution by helping aid organizations like Action Against Hunger reach larger numbers of undernourished kids than before. Expanding the use and availability of these products—along with other non-therapeutic ready-to-use-foods (RUFs)—could provide further gains in the prevention and treatment of childhood malnutrition.
From Therapeutic Milk to Ready-To-Use-Therapeutic-Foods
Huge strides were made 13 years ago when Action Against Hunger piloted the first ever therapeutic milk formula used in the medical treatment of severe acute malnutrition. Prior to 1994, one in four children with severe acute malnutrition did not survive treatment. Their bodies too weakened to recover, they would die despite the availability of food and medical attention. It wasn’t until the development of specialized nutritional products like the milk formulas F-100 and F-75 that mortality rates began to drop significantly. And drop they did—by 75%, a revolutionary advance by any standard. These novel products were made widely available, thanks in large part to the refusal of Action Against Hunger’s Scientific Committee to patent the formula they’d created, thus making it available to all humanitarian NGOs treating malnutrition.
A second revolution began some 10 years ago, and is only now coming to fruition. The advances achieved with the milk formulas are being multiplied as nutritional products evolve. The F-100 milk formula is still a miracle drug, but its use is circumscribed by its “hospital” setting. It must be diluted with clean water and administered at very specific intervals by medical professionals on 24 hour shifts—sometimes through nasal drips, as severely malnourished children can’t actively participate in feeding. This framework, while essential for malnourished kids with medical complications, limits the application of this wonder-drug: it’s a simple function of staff size, geographic reach, and the space limitations of any given field hospital. RUTFs have altered this equation to some degree.
Building on Action Against Hunger’s field experience, scientists worked to develop a new formulation that could be used outside of the hospital framework. They succeeded in creating a “ready-to-use” version of the milk formula that replicated its therapeutic nutritional value, but with added benefits. This new RUTF requires no preparation before being eaten, no dilution with water (thus avoiding contamination from unclean water sources), requires no refrigeration, possesses a long shelf-life, and can be stored virtually anywhere—making distribution more convenient for our beneficiaries. This ready-to-use version was named “Plumpy’nut” and is the most widely used RUTF to date.
With the development of this new product the fight against malnutrition could be carried out beyond the confines of our therapeutic hospitals. It was now a question of developing appropriate “outpatient” treatment protocols for testing and administering this new product. Our colleagues at Concern Worldwide and Valid International pioneered these efforts, and the resulting tests proved just as effective as the cure rates in our therapeutic hospitals. The shift towards community-based care had begun, thanks to this innovation in treatment.
Calling on the International Community to Prioritize Childhood Malnutrition
The use of RUTFs and RUFs is an essential component of a much broader strategy targeting malnutrition. As vitally effective tools for both treatment and prevention—boosting malnourished kids’ diets with enriching micronutrients and strengthening their physical development during the crucial first three years of life—their use should be broadly expanded.
Institutional donors, private foundations, and governments should recognize the importance of ready-to-use-therapeutic-foods and pledge to make them widely available to the estimated 19 million severely malnourished children around the world. This in turn calls for modifying malnutrition strategies in the field to ensure local production of RUFs and regular access to medicines like RUTFs. If properly supported, these nutritional products could allow for a scaling-up of prevention and treatment efforts.
As amazing as these products are, they are only short-term solutions to hunger. Real solutions lie in the long-term development of community-based capacities that foster health and independence among vulnerable communities. Dependence on nutrient-dense commercial products is not an end in itself, but as a lifesaving stop-gap, it’s hard to beat. Saving lives, preventing the ravages of malnutrition, and getting families back on their feet remain the primary goals, and we need every possible tool to help us get the job done.
- In its 2008 Series on Maternal and Child Undernutrition, The Lancet identifies 55 million children with acute malnutrition, including 19 million who suffer from severe acute malnutrition. This leading medical journal estimates that between 3.5 and 5 million children die each year from malnutrition-related causes.
- The 3% figure cited is from MSF’s “Food Is Not Enough” campaign, 2007.
- The World Health Organization’s World Health Report 2005 cites malnutrition as an underlying cause in 53% of all deaths among children under five years old. The Inter-agency Group for Child Mortality Estimation reported 9.7 million childhood deaths for 2005-06.