RUTF: The peanut paste that packs a punch

January 12, 2017
Written by Kristin Myers
Photo by Kieran McConville

What is ready-to-use therapeutic food and how is it helping millions of children recover from malnutrition? We bring you the origins of RUTF.

Each year, one simple innovation saves countless children’s lives. It’s called ready-to-use therapeutic food (RUTF), and it gives malnourished children the vital nutrients they need to recover. But what is RUTF exactly?

The exact composition of a RUTF can vary, but it’s generally a nutrient- and energy-rich peanut-based paste that helps treat dangerous nutritional deficiencies in children, particularly children suffering from severe acute malnutrition. This is a life-threatening condition that requires urgent treatment, and is defined by a very low weight for height and a visible severe wasting (loss of muscle and fat).

Small child eating from RUTF packet

Bak Kuol eats ready-to-eat therapeutic food at Mayom Primary Health Care Unit in South Sudan. Photo: Crystal Wells

For decades, treatment for children with acute malnutrition had to be administered by medical professionals and largely took place in clinics. It was resource-intensive, expensive, and centralized, and as a result, millions of children (especially those who lived far from clinics) died unnecessarily. RUTFs helped to change all that by providing a treatment that could be safely administered by community health workers and even parents at home. RUTFs have already saved the lives of millions of children, and the development of one of most well-known RUTFs, Plumpy’Nut, is wrapped up in Concern’s own history.

Malnutrition is 100% preventable, yet almost half of all deaths of children under five — a total of around three million worldwide — are linked to malnourishment.

Treating malnutrition

Malnutrition has many causes, but in essence it means a person is not getting enough food, not getting the right types of food (i.e. they’re missing out on essential nutrients like protein or iron), or are unable to properly absorb the nutrients they need (for example because of sicknesses like diarrhea).

Malnutrition is 100% preventable, yet almost half of all deaths of children under five — a total of around three million worldwide — are linked to malnourishment. Though this figure is still much too high, rates of malnutrition have been on the decline in recent decades, in large part because of innovations piloted by Concern Worldwide and other humanitarian organizations.

The therapeutic feeding center model was ultimately ineffective, and coverage failed to reach the scale needed to stop needless deaths

During the hunger emergencies of the 1980s and 1990s, the prevailing treatment for children with severe malnutrition involved around-the-clock care at centralized therapeutic feeding centers (TFCs). Back then, children were treated with therapeutic milk, which required on-site hygienic preparation with clean water. Because of the need for 24-hour medical staffing, there were not many therapeutic feeding centers available, and they were often too far from many communities they were meant to serve.

A nurse looks at a child

Nurse Sr Walsama checks a malnourished child in the Dowa region of Malawi in 2002. Photo: Pieternella Pieterse

Even if a community member could reach a clinic, children were required to be accompanied by a caregiver — generally their mothers — for the duration of their treatment, meaning that moms were away from their household and other children for weeks at a time. Additionally, these centers often only opened during emergencies, closing shortly thereafter.

With RUTF, it was possible to try a different approach in treating malnutrition: community-based therapeutic care

With so few therapeutic feeding centers open and available, children usually didn’t receive any treatment for malnutrition until their case was severe. Recovery rates were low for a variety of reasons, for example, moms frequently withdrew their children before they received full treatment as they needed to return home to work. Infection was also a risk in the crowded patient wards. Given all these factors, the TFC model was ultimately ineffective, and coverage failed to reach the scale needed to stop needless deaths.

A change in approach

So how do we treat malnutrition when there is no access to a health center? Well, that’s where ready-to-use therapeutic food comes in!

Clocking in at 500 calories per packet, the high-energy paste provided all the nutrients required for recovery from severe acute malnutrition.

Girl being fed

Ten-month-old Adut Ayii Garang is fed RUTF by her mother in Nyamel, Northern Bahr el Ghazal in South Sudan. Photo: Kieran McConville

The first peanut-based RUTF, Plumpy’Nut, was developed jointly in 1996 by the French Institute of Research for Development and the manufacturer Nutriset. Clocking in at 500 calories per packet, the high-energy paste consisted of peanuts, oil, sugar, milk powder, and vitamin and mineral supplements, providing all the nutrients required for recovery from severe acute malnutrition. Most importantly however, it was formulated to have a long shelf life and didn’t need to be mixed with clean water. Another key innovation: it could be eaten straight from the packet, no cooking required.

Armed with RUTF, it was possible to try a different approach in treating malnutrition: community-based therapeutic care, or CTC. The main strategy of CTC was to bring care as close as possible to communities in need. The community-based approach recognized that not all malnutrition cases were the same; many children who weren’t experiencing any medical complications could be treated in their own homes.

Piloting CTC

At the time, community-based therapeutic care was brand new, and though it was believed it would work, its effectiveness was not proven until Concern Worldwide and humanitarian research organization Valid International partnered to create a pilot program.

A young boy eating

Hospitalized due to malnourishment, a young boy eats food supplements funded by Concern in Lilongwe, Malawi in 2002. Photo: Pieternella Pieterse

In 2000, food insecurity and famine swept through the Horn of Africa, threatening millions of people in Ethiopia. Therapeutic feeding centers could not provide the necessary coverage to all who were severely malnourished. Unable to treat the thousands in critical need using the traditional methods, Concern Worldwide engaged in a small pilot of CTC, calling it community-based management of acute malnutrition (CMAM).

Worldwide, CMAM reaches more than 70% of malnourished children in over 70 countries

Community members were trained to recognize the signs of malnutrition — using tools like MUAC tape — and to administer Plumpy’Nut in children’s homes. Children were monitored through home visits by these trained health workers.

The results of the pilot were positive, showing that the effectiveness of CMAM was as good as, or better, than the previously used treatment plans.

Arm measured with MUAC tape

Seven-month-old Chan Akeen Akeek has his arm measured with MUAC (middle upper-arm circumference) tape to indicate current nourishment levels. Photo: Kevin Carroll

Taking CTC global

With one successful pilot on the books, Concern followed up with a larger program in Darfur, Sudan a year later, treating 25,000 acutely malnourished children (some severely so), achieving similarly positive results.

With just small packets of peanut paste, millions of acutely malnourished children have been treated through the CMAM approach by Concern Worldwide and others

From 2002 until 2006, Concern Worldwide used CMAM again in its first large-scale pilot in Malawi. The program yielded excellent outcomes in treatment, coverage, community acceptance, and cost effectiveness. In 2006, Concern and Valid published the CTC field manual, and in 2007, the World Health Organization, UNICEF, and the World Food Programme issued a joint statement recognizing CTC as a best practice, setting in motion a transformation in approach that is now global.

A child eating from a RUTF packet

Yak sits with his mother, Achara, and eats ready-to-eat therapeutic foods at Mayom Health Care Unit in Aweil West County, Northern Bahr el Gazal, South Sudan. Photo: Crystal Wells

With just small packets of peanut paste, millions of acutely malnourished children have been successfully treated through the CMAM approach by Concern Worldwide and others.

Along with other RUTF products, Concern continues to use Plumpy’Nut to this day and operates CMAM programs in nine countries. Worldwide, CMAM reaches more than 70% of malnourished children in over 70 countries.

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