India’s healthcare system is in dire need of a vital upgrade is a no-brainer. For years, the institutions and stakeholders have toiled hard to formulate the magic formula which could redress the never-ending problem of Severe Acute Malnutrition (SAM) prevalent among Indian children. Though the existing healthcare interventions have been in place and working in tandem with multiple stakeholders, the jury is still out on their effectiveness to deal with SAM. The issue of micronutrient deficiency has been prevalent and known, but not satisfactorily tended to by the institutional healthcare system. One of the crucial reasons for widespread U-5 malnutrition is attributed to inequitable access to balanced nutrition sources. These then make the group vulnerable to different infections and diseases, thus trapping them in a vicious cycle of malnutrition and ailments[3].

Extraordinary scenarios like these – 1 in every child in India is afflicted with severe wasting – requires cost-effective, yet implementable solutions, which can be scaled according to tailored requirements of each state/region[2]. A right step in this direction is the provisioning of various therapeutic food options like Ready-To-Use packages (RUTF). These energy-dense formulations are often at the core of nourishing the children, since they are fortified with critical macro- and micro-nutrients like vitamins and minerals, in addition to proteins and carbohydrates. It ensures that the target population achieves a rapid weight gain in a matter of 6 to 8 weeks if an adequate provision of RUTF pastes is done and enough incentivisation is in place[1]. These are a critical element in dealing with the impending SAM scenario. Given the low ratio of hospital beds/population in India, it is not only a recommended but viable alternative to attend uncomplicated SAM children with appetite in place.

Some other reasons usually impede early treatment regime for children, especially in hospitals. Time expended in travel, high cost of treatment, typically as Out of Pocket Expenditure rather than institutional medical insurance, and long treatment duration often pushes families into indebtedness. In this scenario, the safety net created through RUTF is something which can’t be overlooked. The commitment to redress malnutrition in a larger community setting often comes as a blessing in disguise for the family, who can carry on their subsistence activities, taking care of the child in CMAM setting. When complemented with other components like essential medicines, in-patient treatment and other nutrition sources, RUTF has been proven to be successful in various country settings similar to India.

Considering there is always a threat of water contamination and bacterial infections, RUTF comes in handy as it need not be mixed with water and can be taken without further preparation. Since the scourge of SAM has a history of afflicting everybody irrespective of his/her socio-economic background, the relevance and usage of RUTF need to be seen and appreciated in a much wider context. Given that Indian subcontinent has a variety of climatic zones, RUTF is often climate resistant and can be kept without refrigeration for up to 4 months. This safety factor is essential to gain wider acceptability of RUTF in the Indian context that often becomes difficult, considering the demographics and health parameters change from one region to another.

Since institutional care of SAM children may not always be feasible, especially in rural settings, home-based care is recommended by healthcare experts the world over. RUTF being energy and protein intensive becomes an essential ingredient during a child’s rehabilitation phase. Using RUTF, it was found that there were fewer relapse cases, better recovery, a higher rate of weight gain
and hence reduced mortality rates. It is predominantly clear if the RUTF satisfies the daily nutritional requirements of the child[1].

There have been some genuine concerns of over-reliance on RUTF as a primary source of nutrition. Also, provisioning RUTF on a large scale may require a dedicated funding mechanism rather than banking on purchase by the afflicted population. Such concerns notwithstanding, it is time therapeutic foods like RUTF are implemented at a larger scale, taking heart from the positive, encouraging results derived from implementation in certain Indian states. Time is ripe for taking this exercise to the next level, to garner the “low-hanging” fruits, and handle malnutrition effectively.

References

1.  https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009000.pub3/full
2. https://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/
3. https://www.unicef.org/media/files/Position_Paper_Ready-to-use_therapeutic_food_for_children_with_severe_acute_malnutrition__June_2013.pdf
4. https://motherchildnutrition.org/malnutrition-management/info/rutf-plumpy-nut.html#Local%20production%20of%20RUTF