The miracle food saving the lives of malnourished children
What is RUTF?
Ready-to-use therapeutic food (RUTF) is a specially formulated peanut-butter paste or biscuit with the power to bring a malnourished child from the brink of death to full nutritional recovery in just 4 to 8 weeks. It has a 90% success rate in healing children from severe acute malnutrition (SAM), the deadliest form of hunger that accounts for 400,000 child deaths per year. With this medicinal food, Action Against Hunger’s programs treated 355,000 children with SAM in 2023 alone.
International food standards for RUTF ensure that each single-dose packet has the right evidence-based combination of nutrients to make recoveries happen. It is nutrient dense and soft enough to be consumed by a 6-month-old child. The recipe for RUTF includes:
- Milk or other dairy products.
- Legumes and seeds, such as peanuts, lentils, chickpeas, etc.
- Fats and oils.
- Vitamins and minerals
- Carbohydrates like cereals
- Food additives for texture, stability, and extended shelf life
RUTF is incredibly effective at saving the lives of malnourished children. This has been demonstrated time and again through rigorous research, and RUTF is endorsed by the World Health Organization as the standard of care for outpatient-based treatment of severely malnourished children. Still, approximately 19 million children under the age of 5 suffer from SAM. With RUTF, we can stop these deaths from happening and give children like Halima a chance to do what they should be doing – growing, learning, and playing.
What makes RUTF special?
RUTF has special properties that allow it to bypass several challenges that plague other malnutrition treatment efforts:
Challenge #1: Food Intake
When a child has SAM, their body stops being able to process a normal diet. Trying to suddenly feed them can be dangerous, and sometimes fatal, due to a complication known as refeeding syndrome. Food needs to be carefully prepared and meet certain specifications to avoid this. With RUTF, however, 9 out of 10 children respond well to treatment, safely processing the food and healing until they are ready to handle a normal diet again. Another intake issue is that children with SAM may exhibit a disinterest in food – a common symptom of malnutrition. Sometimes, they have too little energy to eat a meal. RUTF’s small serving size and tasty flavor are helpful for making the formula easy and enjoyable for children to eat.
Challenge #2: Storage
Transporting food while keeping it fresh can be a major hurdle for treating children with SAM, especially those living in rural communities or regions with extreme temperatures. RUTF has a shelf-life of two years and does not need refrigeration even after it has been opened. It comes in single-dose foil packets that reduce the risk of contamination, keeping it safe and healthy.
Challenge #3: Access to treatment facilities
Prior to RUTF, SAM treatment always required several weeks in a hospital with professional equipment and supervision because in-patient SAM treatment formulas need to be mixed with water. Access to safe drinking water can be limited, so it is essential for children receiving this kind of treatment to stay at the hospital and ensure that the formulas stay bacteria-free. However, hospitals are sparse in many areas affected by high levels of hunger and malnutrition. The nearest hospital can be hundreds of miles away from families, making it impossible for people to access care. For the few who can make the journey, they need to leave behind other children, farm animals, and crops, which could jeopardize a year’s worth of food and income.
RUTF is the solution for SAM treatment in hard-to-reach areas. Ready-to-use formula does not need to be mixed with water and can be safely administered at home. Action Against Hunger partners with community health workers who live in remote areas and can distribute RUTF and medicine to children who need treatment. This greatly expands Action Against Hunger’s scope of reach and opportunities for lives to be saved.
History of RUTF
Action Against Hunger has been a pioneer in innovating SAM treatment from the beginning. In 1993, we helped develop F100, the first therapeutic milk formula to treat malnourished children in hospital settings. After using this formula for a few years, our teams in Somalia noticed room for improvement in the treatment process. This led to the creation of F75, a “starter” formula used for treating children who have SAM and medical complications. Its main goal is to stabilize a child’s metabolism and electrolytes. Once stabilized, the child can switch to F100, which helps bring the child back to a healthy weight. These two therapeutic milks became the gold standard for SAM treatment and are still commonly used in hospitals today. However, both formulas required water and professional supervision, which meant many children with SAM were unable to get safe treatment. Thus, scientists developed the first RUTF, called Plumpy’Nut, in 1996. Initial studies found that at least 90% of children could be treated effectively with RUTF. Over 70 national governments have adopted the Community-Based Management of Acute Malnutrition (CMAM) approach using RUTF.
Action Against Hunger’s first intervention was launched in 1979 to help Afghani refugees in Pakistan.
Now, Action Against Hunger’s goal is to get lifesaving food to as many children with SAM as possible, no matter where in the world they might be. Our teams have been researching ways for malnourished children in hard-to-reach locations to receive treatment. For example, our pilot studies in Mali, Mauritania, Niger, Kenya, and Pakistan introduced the concept of community health workers who could bring treatment to people rather than having people come to clinics. The pilots demonstrated that community health workers could successfully treat severely malnourished children in their own homes, eliminating the need for centralized treatment at a facility. Half of the world’s population lives 3 or more miles away from the nearest medical clinic, so community health workers like Janet Mwendo have a critical role in saving the lives of children with SAM. Action Against Hunger actively advocates for these local heroes and researches the work they do. In 2020, our innovative malnutrition model using RUTF by community health workers at the home-level was endorsed in WHO’s new guidelines on screening, detecting, and treating malnutrition in communities.
In Ethiopia, a community health worker distributes RUTF to two children.
The WHO’s 2020 guidelines also partially adopted modified RUTF dosages, a topic Action Against Hunger has been a leader in advancing knowledge on. Through a project called ComPAS, Action Against Hunger identified a new system for treating children with malnutrition. The new system treats moderate malnutrition and severe acute malnutrition as a spectrum rather than two distinct conditions, reducing complexities and increasing efficiency in use of resources. The ComPAS model lowers the cost of malnutrition treatment by about 12%, meaning more funding could go toward saving lives.
Future of RUTF
Thirty-five years ago, there was no common cure for severe acute malnutrition. Now, we have RUTF, a miracle product that saves hundreds of thousands of lives each year. Yet, the work is not done. Malnutrition is responsible for half of child deaths globally, and only 25% of the world’s malnourished children are reached by the current approaches to treatment. Sadly, the main barrier to treatment is cost. Further innovations are essential to make RUTF more cost-efficient—so we can reach more children with the lifesaving treatment they need.
One way Action Against Hunger is working to make that happen is by partnering with RUTF manufacturers, such as Edesia Nutrition, to develop and test new formulations of the product. These new formulations, or “Novel RUTF”, include alternatives proteins to replace milk powder, the most expensive ingredient currently used in RUTF. Plant-based proteins, such as soy and maize, are possible replacements that could be more locally available than milk and at a lower cost. If trials are successful, the cost of RUTF would be lowered. Additionally, relocating production to food insecure countries would require less shipping and import costs. Finite resources could be used to treat more children with the same amount of funding.
A child with her mother receives Plumpy’nut in Niger.
Action Against Hunger is also conducting groundbreaking research into microbiomes to reduce the number of children who are stuck in a vicious cycle of repeated episodes of malnutrition. Relapse into malnutrition can occur to between 30 and 50 percent of children. Relapse is common because malnutrition does long-lasting harm to the gut health of children, making it difficult for them to maintain a healthy weight even after recovery. If we can enhance RUTF with key microbial communities, we could heal the child’s microbiome during SAM treatment and prevent relapses from happening. This is difficult work – microbiomes are highly complex and varied across regions – but the potential it holds for saving lives is monumental. We are partnering with microbiome experts at OpenBiome to analyze samples from across Action Against Hunger global sites to increase our understanding of healthy microbiomes in malnutrition-impacted areas of the world. This information can guide the enhancement of RUTF with microbial communities in an optimally targeted and effective manner, promoting the recovery and long-term health of children who have been impacted by SAM.
The aim of all of our innovative work is to improve ways to anticipate, prevent, and treat malnutrition so that more children can lead healthy and productive lives. The more cost-effective and holistic RUTF treatments are, the more communities can be free from hunger.
Together, We Can End Hunger
A life can be saved for as little as $150. With your support, our teams can bring a child from a medical crisis to full health in as little as 45 days.
