The images of the child on the screen were striking. An infant named Suleiman; on the left, he was just a sack of skin and bones, severely wasted. On the right, he was a normal, healthy boy. The transformation had taken only 8 weeks. The difference? Specially formulated Ready-To-Use Therapeutic Foods (RUTF) certified and approved by UNICEF for the treatment of children suffering from severe malnutrition.
Ready-To-Use Therapeutic Foods are simple and innovative
RUTF is a mixture of peanuts, sugar, oil and milk powder fortified with vitamins and minerals. The ingredients are ground into a smooth paste and packaged in ready-to-eat packs.
This simple yet innovative product is transforming the treatment of malnutrition and was the purpose of a Nutrition Market Workshop facilitated by the Private Health Sector Alliance of Nigeria in collaboration with UNICEF.
My collegues and I at Solina Health—we represent CHMI in Nigeria—have been encouraging stakeholders to commit to the production of quality therapeutic foods in Nigeria, by Nigerian partners. We think this will improve provision and availability of quality nutritional services to those in need.
These foods can help reverse malnutrition, a huge health and development challenge
The malnutrition landscape in Nigeria is dire. Stanley Chitweke, UNICEF's Chief Nutrition Officer, explained that over one million Nigerian children are at risk. Malnutrition contributes to over 50% of under-five mortality, with the greatest prevalence in the northern part of the country. About 250,000 Nigerian children are in need of RUTF for severe acute malnutrition annually.
To reverse this situation, UNICEF supported 30 sites to provide Community-Based Management of Acute Malnutrition Services in 11 Northern Nigerian states in 2009. Today, there are 495 facilities providing malnutrition management services to treat malnourished children in the same region.
RUTFs have been the major driver of the success of malnutrition management. Traditional malnutrition therapy hospitalizes infants, treating them with steady infusions of vitamin-enriched milk. Children are sent home with powdered milk formula to complete their recovery. However, in most rural areas, safe drinking water is hard to come by and when the formula is prepared with dirty water, babies fall sick and jeopardize their recovery.
Herein lies the brilliance of RUTF: it requires no preparation, is safe to use, can be eaten directly from the package and is easily administered at home by the caregiver. The mother just squeezes the package into the child's mouth. It’s no wonder RUTFs like Plumpy’Nut™ have been hailed a miracle product!
Why not produce these miracle products in Nigeria?
However, the effectiveness of RUTF is limited since they are not produced in Nigeria. Because these malnutrition management programs are anchored on the availability of RUTF, without RUTF there is no effective malnutrition management at the community level. The total number of children treated with RUTF in Nigeria has grown from 6,901 in 2009 to about 600,000 in 2013. In 2012, delays in procurement from source countries, clearance, shipping, and storage logistics resulted in severe stock outs and put severe pressure on the mandate to treat malnourished children.
Only 20% of the global production of RUTF occurs in program countries where therapeutic foods are used to treat malnutrition. We feel that programmatic nations cannot continue to depend on therapeutic foods manufactured in other countries (usually developed nations) for their supply. Knowledge needs to be transferred and production scaled up to programmatic countries to ensure sustainability. As Nigeria is a country with a high burden of malnutrition, the local production of RUTF is a logical next step; it will increase availability, acceptability, access, and efficiency in supply, and lower costs.
My assessment? The Nutrition Market Workshop was able to galvanise private sector companies, public sector agencies, and international donors to commit to the local production of RUTF. This will, no doubt, strengthen the nation’s fight against malnutrition and its devastating effects on infants. It would be a shame if infants like Suleiman succumb to malnutrition due to lack of access to life-saving therapeutic foods.
Photo of Issiakou, a healthy baby boy in the Sahel region of Nigeria, taken by UNICEF/Benedicte Kurzen. A DFID-supported UNICEF program has helped his community become more resilient in times of drought.