No green signal for ready-to-use therapeutic food (RUTF) in India

Context:

• The Union Ministry of Women and Child Development (WCD) stated that use of ready-to-use therapeutic food (RUTF) for management of malnutrition is not an accepted policy of the Government of India.

Severe Acute Malnutrition (SAM)

• Severe acute malnutrition is defined by a very low weight for height.
• It is identified by visible severe wasting or by the presence of nutritional oedema which is characterized by swollen feet, face and limbs.

How can Severe Acute Malnutrition be treated?

• Children with severe acute malnutrition need urgent life saving treatment to survive.
• Previously, these children were only treated in hospitals where they received therapeutic milks along with medical care; and many more were never reached at all.
• But with the creation of ready-to-use therapeutic food (RUTF) however, the picture has changed dramatically.

What is Ready-to-use therapeutic food (RUTF)?

• Ready-to-use therapeutic food (RUTF) is a high-energy, micronutrient enhanced paste used to treat children under age 5 who are affected by severe acute malnutrition.
• RUTF is a packaged paste of peanuts, oil, sugar, vitamins, milk powder and mineral supplements, which contains 520-550 kilocalories of energy per 100 g.
• Additional ingredients may include nuts, legumes, grains and sweeteners to improve the taste.
• The paste is given to children aged between six months and six years, usually after a doctor’s prescription.

Pros of Ready-to-use therapeutic food (RUTF):

• This makes it a practical solution where cooking facilities and fuel are limited.
• RUTF has a long shelf life and is safe for use even in the absence of clean drinking water.
• The use of RUTF allows those children without medical complications to be cured right in their own homes and communities.

How it works?

• In this approach, community health workers are trained in early detection to recognize cases of severe acute malnutrition and provide RUTF and routine medical care.
• At the same time, health workers learn to recognize medical complications and refer those children to hospitals and health centres for further in-patient treatment.
• The impotance of the community-based approach is that early detection and early treatment leads to better rates of survival and the treatment of many more children.
• It also empowers communities and is much more cost-effective than in-patient treatment.

What are the cons of Ready-to-use therapeutic food for which India is reluctant to bring it into practice?

• Concerns have been raised that the use of RUTF may replace nutritional traditional practices and family foods.
• The government has no enough evidence for the long term benefits of RUTFs.
• Because once RUTF was stopped, children often slipped back into malnutrition.
• Moreover, RUTF may improve recovery slightly, but it’s not known that whether RUTF improves relapse, death or weight gain as the quality of evidence was very low.
• There is high cost involved in purchasing RUTFs packets which are not feasible for a longer run.
• There are chances of corruption by the intervention commercial exploitation beyond the treatment of severe acute malnutrition.
• Studies have proven that children who were given URTF found it too heavy to eat anything else afterward.

Usage of Ready-to-use therapeutic food (RUTF):

• RUTF was first introduced in situations of humanitarian emergencies during the early 2000s when access was a considerable barrier to expanding coverage of inpatient treatment.
• Its application within Community Management Of Acute Malnutrition (CMAM) – an inter-agency strategy supported by WHO, the World Food Programme, the UN Standing Committee on Nutrition and UNICEF – has resulted in a sharp rise in programme coverage and children treated successfully.
• Currently, 61 countries have some form of treatment for severe acute malnutrition with a community component available, compared to just 9 in 2005.

Malnutrition and India: an overview:

• India’s hunger situation is worsening with the county slipping from 97th spot in 2016 to 100th position in the latest 2017 Global Hunger Index (GHI).
• The report revealed that India’s hunger crisis is worse than all its neighboring countries.

What are the recent guidelines by World Health Organization on formulated supplementary food?

• According to the WHO guidelines:

1. Within populations with moderate wasting and stunting, formulated food supply should not be used until there is a more definitive evidence base, to avoid increasing the risk of overweight and obesity.
2. Some studies have found that rapid weight gain in infancy and childhood was also strongly associated with the risk of overweight or obesity in adolescence or adulthood.
3. WHO also recommends nutritional counseling by primary care workers to prevent nutrition-related illnesses.
4. The guidelines added that there may be a role for the provision of supplementary foods in settings where there is a high prevalence of wasting or food insecurity, at community or household level, stated the guidelines.
5. However, member states have been advised to put it in practice proven nutrition interventions relevant to their country.

What is the way ahead?

• There is a need for prevention and long term solutions.
• The solutions should involve dismantling unequal power structures, improving equitable access to health services and nutritious foods, promoting breastfeeding and optimal infant and young child feeding practices, improving water and sanitation, and planning for cyclic food shortages and emergencies.
• Ready-to-use therapeutic food (RUTF) can be useful for The Sustainable Development Goals which aims to end all forms of hunger and malnutrition by 2030.