Food is Not Enough: Without Essential Nutrients Millions of Children Will Die Group Calls for Increased and Expanded Use of New, Innovative Nutritional Products
CBS's 60 Minutes on ready-to-use foods.
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Underweight prevalence and population density of underweight children Doctors Without Borders/Médecins Sans Frontières (MSF) is calling for increased and expanded use of nutrient dense ready-to-use food (RUF) to reduce the five million annual deaths worldwide related to malnutrition in children under five years of age. Current food aid, which focuses on fighting hunger—not on treating malnutrition—is not doing enough to address the needs of young children most at risk.
What is therapeutic ready-to-use food?
Commercialized therapeutic RUF takes the form of a peanut/milk-based paste with all nutrients essential to treat severe acute malnutrition. It comes in individually wrapped airtight foil packets, that are resistant to bacterial infection and easy to distribute. The product has a long shelf life, making it easy to store, transport and to use in hot climates as an efficient way to provide milk to children under three.
"It's not only about how much food children get, it's what's in the food that counts," said Dr. Christophe Fournier, president of MSF's International Council. "Without the right amounts of vitamins and essential nutrients in their diet, young kids become vulnerable to disease that they would normally be able to fight off easily. Calls for increased food aid ignore the special needs of young children who are at the greatest risk of dying."
RUFs, which come in individually wrapped rations, contain all the necessary nutrients, vitamins, and minerals that a young child needs. This dense therapeutic food, which has milk powder, sugars, and vegetable fats, can be produced and stored locally and transported easily, and requires no refrigeration, making it ideal for use in hot climates. It allows a child to recover from being malnourished and catch up on lost growth. Being easy-to-use, mothers—not doctors and nurses—are the main caregivers, meaning far more children at risk can be reached.
"In Somalia we are giving acutely malnourished kids packets of ready-to-use food and we see them gain weight and begin thriving within a couple of weeks," said Dr Gustavo Fernandez, MSF head of mission in Somalia. "RUFs are practical to use in places like Somalia where security is very bad. General food distribution is also needed, but it is not going to be very effective to treat kids under three years old."
Severe acute malnutrition in early childhood is common in large areas of the Horn of Africa, the Sahel, and South Asia -- the world's "malnutrition hotspots." The World Health Organization (WHO) estimates that there are 20 million young children suffering from severe acute malnutrition at any given moment and MSF estimates that only three percent of them will receive RUF in 2007.
Therapeutic RUF for only severely malnourished children, as current WHO, World Food Program, and UNICEF guidelines recommend, is too restrictive. Given its nutritional benefits, RUF has the potential to address malnutrition at earlier stages and is far more effective than fortified blended flour, which is normally distributed. MSF is piloting a program using a modified RUF as a supplement to prevent children from becoming acutely malnourished.
"Instead of waiting for kids to get gravely ill we decided to act earlier," said Dr. Susan Shepherd, MSF medical coordinator, Maradi, Niger. "We are piloting a program that gives RUF to all children under three in at-risk communities so that they get the nutrients that are missing in their normal diet."
Through this early treatment or prevention approach in Niger, MSF is providing mothers with small containers of RUF as a supplement to their normal diet. Early results from this ongoing project, which is reaching more than 62,000 children, indicate that RUF is significantly more effective than the traditional approach of supplying fortified flours and cooking oil to mothers of young children.
MSF is calling for donors and UN agencies to urgently speed up the introduction and expansion of RUF. This is going to take a new allocation of funds to cover the cost of €750 million (approximately $1.05 billion) to reach the most vulnerable. But it will also take a realigning of food aid strategies with existing and newly developed products that have the nutrition needed to cure malnourished children.
MSF has been treating malnutrition with therapeutic RUF since the first products became available in the late 1990s, and in 2006 treated more than 150,000 children with acute malnutrition in 22 countries.
What MSF is calling for: Ministries of Health and those that support them need to address the critical issues that prevent 97% of children suffering from severe acute malnutrition from getting life-saving treatment. Donors need to review the quality of food aid addressed towards malnutrition in children under the age of three, and refocus their efforts away from fortified blended foods towards providing RUF with superior nutrient value, ease-of-use and effectiveness. UNICEF and WFP must ensure RUF is available in adequate supplies; this will mean both fundraising and finding solutions for sustainable production. WHO must support countries to implement their new growth standards, develop recommendations for effectively treating non-severe malnutrition and promote controlled and operational research to replicate and expand on promising experiences of RUF. Ministries of Health, academic nutritionists and other organisations working on malnutrition must implement projects to further document the benefits of therapeutic RUF beyond the treatment for severe malnutrition. Researchers, producers and users of RUF must work together to develop new products, adapted for use in the early treatment and prevention of child malnutrition, but also, for other uses such as for maternal nutrition to prevent low birth weight.
