What Is ReadytoUse Therapeutic Food?
ReadytoUse Therapeutic Food (RUTF) is a nutrientdense, pastelike formulation designed to treat severe acute malnutrition (SAM) in children aged six months to five years. Unlike traditional therapeutic feeds, RUTF is shelfstable, does not require cooking or water, and can be consumed directly from the packet.
RUTF is usually made from a blend of peanuts, vegetable oil, milk powder, sugar, and a vitaminmineral premix (the F75/F100 standard). The final product provides approximately 500550 kcal per 100g, delivering the energy and micronutrients required for rapid weight gain.
Why RUTF Is Critical in the Fight Against SAM
Severe acute malnutrition is responsible for an estimated 500,000 child deaths each year. Prompt, effective treatment can reduce mortality to less than 5%.
- Rapid weight gain: Children typically gain 510g/kg/day while on RUTF.
- Communitybased management: RUTF enables treatment at home, reducing the need for costly inpatient care.
- Ease of use: No preparation, no refrigeration, and no risk of contamination from unsafe water.
- Acceptability: The taste and texture are generally wellliked by children, improving adherence.
Composition, Safety, and Nutritional Profile
RUTF is carefully formulated to meet the WHO specifications for therapeutic foods. A typical composition looks like this:
| Ingredient | Typical % of total weight | Key nutrients supplied |
|---|---|---|
| Peanut paste | 5565% | Protein, healthy fats, vitaminE |
| Vegetable oil | 1520% | Energydense fats, essential fatty acids |
| Milk powder | 1015% | Highquality protein, calcium, vitaminB12 |
| Sugar | 510% | Rapidly absorbable carbohydrates |
| VitaminMineral premix | ~2% | Iron, zinc, vitaminA, vitaminD, folic acid, etc. |
Safety is ensured through:
- Heattreatment of the peanut paste to eliminate aflatoxinproducing molds.
- Strict qualitycontrol procedures at manufacturing facilities.
- Packaging that prevents moisture ingress and microbial growth.
Implementation in CommunityBased Management of Acute Malnutrition (CMAM)
RUTF is a cornerstone of the WHOs CMAM protocol, which follows four steps:
- Screening & admission: Rapid MUAC or weightforheight measurement identifies SAM cases.
- Outpatient therapeutic feeding: Eligible children receive a daily ration of RUTF (150200g) for 68 weeks.
- Medical care: Treatment of infections, anemia, and other complications while the child receives RUTF.
- Followup & discharge: When the child reaches a weightforheight >2zscore and shows no edema, they are discharged with nutrition counseling.
Key operational points:
- Supply chain: Centralized production, regional warehouses, and lastmile distribution via NGOs or health ministries.
- Training: Community health workers must learn dosage calculation, counseling, and monitoring of weight gain.
- Monitoring & evaluation: Weekly weight checks, documentation of adverse events, and programlevel indicators (e.g., recovery rate, default rate).
Challenges and Emerging Solutions
Despite its proven efficacy, scaling up RUTF faces several obstacles.
1. Cost and Funding
RUTF costs roughly US$0.50$0.70 per 100kcal. Bulk procurement, local production, and innovative financing (e.g., resultsbased financing) are being explored to lower price.
2. Supply Chain Disruptions
Remote areas may experience stockouts. Solutions include buffer stocks, satellite warehouses, and use of mobile phonebased inventory systems.
3. Allergies and Cultural Acceptability
Peanut allergy, though rare in most lowincome settings, requires alternative formulations (e.g., soybased RUTF). Community sensitization and tastetesting help improve acceptance.
4. Quality Assurance
Ensuring low aflatoxin levels is critical. Onsite rapid test kits and thirdparty audits are increasingly used.
5. Transition to Sustainable Diets
Longterm food security depends on moving from therapeutic foods to householdlevel nutrition. Integration with agricultural programs, nutrition education, and cashtransfer schemes support this transition.
Further Reading and Resources
- World Health Organization Guidelines for the Management of Severe Acute Malnutrition
- UNICEF ReadytoUse Therapeutic Food (RUTF)
- Global Alliance for Improved Nutrition Nutrition Solutions and Research
- FHI 360 CommunityBased Management of Acute Malnutrition Resources
For program managers seeking technical assistance, contact your national nutrition unit or the nearest UNICEF office.
