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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 140-141
Challenges for ready-to-use therapeutic food in the Indian context


Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune - 411041, India

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Date of Web Publication18-Jul-2013
 

How to cite this article:
Pandve HT, Fernandez K, Chawla P S, Singru SA. Challenges for ready-to-use therapeutic food in the Indian context. Ann Trop Med Public Health 2013;6:140-1

How to cite this URL:
Pandve HT, Fernandez K, Chawla P S, Singru SA. Challenges for ready-to-use therapeutic food in the Indian context. Ann Trop Med Public Health [serial online] 2013 [cited 2014 Sep 30];6:140-1. Available from: http://www.atmph.org/text.asp?2013/6/1/140/115200
Sir,

Malnutrition is estimated to contribute to more than one-third of all child deaths, although it is rarely listed as the direct cause. Lack of access to highly nutritious foods, especially in the present context of rising food prices, is a common cause of malnutrition. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition. A recently developed home-based treatment for severe acute malnutrition (SAM) is improving the lives of hundreds of thousands of children a year. Ready-to-use therapeutic food (RUTF) has revolutionized the treatment of severe malnutrition providing foods that are safe to use at home and ensure rapid weight gain in severely malnourished children. The advantage of RUTF is that it is a ready-to-use paste which does not need to be mixed with water, thereby avoiding the risk of bacterial proliferation in the case of accidental contamination. The product, which is based on peanut butter mixed with dried skimmed milk and vitamins and minerals, can be consumed directly by the child and provides sufficient nutrient intake for complete recovery. It can be stored for 3-4 months without refrigeration, even at tropical temperatures. [1],[2]

Malnutrition is not a new problem in India, nor is SAM. In India 48% of children under 5 years of age are stunted and 43% are underweight; almost 8 million suffer from SAM. Several scientists and activists have expressed reservations regarding using an imported RUTF in India. [3] As per Working Group for Children Under Six (2009) which is a joint effort of Jan Swasthya Abhiyan and the Right to Food Campaign, the current thinking that a centrally produced and processed RUTF should supplant the locally prepared indigenous foods in treatment of SAM ignores the multiple causes of malnutrition and destroys the diversity of potential solutions based on locally available foods. Many locally produced/producible foods that are culturally acceptable and relatively low cost have been used for SAM in India for many decades by reliable academic and medical institutions, as well as by nongovernmental groups but these foods have been completely ignored. The authors argue that although there are few formal studies documenting the efficacy of local recipes, there is plenty of anecdotal evidence of success. Furthermore, the fact that preexisting attempts have not been properly studied, analyzed, and documented by research and expert bodies on nutrition, is a matter of concern. The authors also ask why it has been permitted to introduce an alien product at such large scale without investigating the relative merits and demerits of the local foods that are already being used in India. [4] The local availability of the necessary ingredients limits the use of RUTF in some settings, and further investigation of alternative ingredients is needed to overcome this limitation. [2] Only market availability of RUTF will not secure the food for children in households because the cost factor will become the major constraint for poor people. This commercially prepared food like RUTF for treatment of SAM, a condition seen in poverty-stricken children, will be a paradoxical situation. The costs and availability of ingredients must be assessed at a local level. [2],[5] The absence of intervention which is based only on observational studies conducted in disaster situation, the scaling up of commercially available RUTF in India will not be a rationale method of management. Therefore, there is need for research in innovative product formulation and of course the operational issues to establish its efficacy and cost-effectiveness in Indian context are also warranted. [5] Considering the havoc played by the breast-milk substitutes and infant food industry in the past, concerns regarding RUTF cannot be considered to be totally unfounded. At the same time, one cannot neglect the urgent need to have a therapeutic food for children with SAM. Ensuring that RUTF is distributed only through public health programs for the management of children with SAM would help assuage some of these concerns. Simultaneously, there is a need for research aimed at developing indigenous infant foods that would provide equivalent weight gain and ensure early recovery from severe acute malnutrition. [3]

To conclude, though RUTF seems to be a solution for management of malnutrition, various concerns mentioned above need to be addressed prior to make it a community-based intervention in the Indian context.

 
   References Top

1.Malnutrition, Child and adolescent health and development. Available from: http://www.who.int/child_adolescent_health/topics/prevention_care/child/nutrition/malnutrition/en/index.html [Last accessed on 2011 Aug 24].  Back to cited text no. 1
    
2.Manary MJ. Local production and provision of ready-to-use therapeutic food (RUTF) spread for the treatment of severe childhood malnutrition. Food Nutr Bull 2006;27 Suppl 3:S83-9.  Back to cited text no. 2
    
3.Bavdekar SB. Severe acute malnutrition: Time for urgent action. J Postgrad Med 2010;56:61-2.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Working Group for Children Under Six. Should India use Commercially Produced Ready to Use Therapeutic Foods (RUTF) for Severe Acute Malnutrition (SAM). Soc Med 2009;4:52-5.  Back to cited text no. 4
    
5.Tambe MP, Kakrani VA. RUTF for SAM-A Paradox. J Community Health 2009;11:4-5.  Back to cited text no. 5
    

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Correspondence Address:
Harshal T Pandve
Department of Community Medicine, Smt Kashibai Navale Medical College, Narhe, Pune - 411041
India
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DOI: 10.4103/1755-6783.115200

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