Ready-to-use therapeutic foods for malnutrition.

Médecins Sans Frontières has just released its ninth annual list, for 2006, of the top ten under-reported humanitarian stories. Eight of the ten arose from confl ict situations, but two are of more direct clinical relevance: malnutrition and tuberculosis. The three-part Lancet series on child development in developing countries, which ends today, has much to say about malnutrition, and its sister evil, poverty. The scale of the problem is huge. In a report last September in Food and Nutrition Bulletin, Steve Collins and colleagues estimated that, annually, 1·7 million children die because of severe acute malnutrition and 3·6 million die because of moderate acute malnutrition. The latest thinking to combat malnutrition is to move into community therapeutic feeding, which can cover larger populations than hospital-based programmes, does not tie up sometimes sparse hospital resources, and involves local communities directly. The Collins report is an overview of more than 23 000 individuals with severe acute malnutrition treated in the community in Malawi, Ethiopia, and Sudan in 2000-05. This community-based therapeutic care provides outpatient visits for acute malnutrition, and admission to hospital fi rst if the individual has serious complications. The feeding element involves use of ready-to-use therapeutic foods (RUTF), which are lipid-based pastes that are energy dense, resist bacterial contamination, and need no cooking. They usually contain milk powder, sugar, vegetable oil, peanut butter, vitamins, and minerals. In the three countries studied, coverage rates were 73% and almost 80% of individuals recovered. 73% of the severely malnourished children were treated solely in the community. The cost per year of life gained was US$12–132. Community-based programmes with RUTF seem to be the way forward. But milk powder often has to be imported, and peanuts can be contaminated with afl atoxin. So alternative recipes that use locally available grains and legumes are being fi eld tested. Local production will reduce the costs of RUTF, and provide an income for the local manufacturer and farmers. ■ The Lancet