‘Wonder’ treatment on front line of UN battle against acute malnutrition

As thousands of desperately malnourished children from famine-wracked Somalia pour into United Nations refugee camps in Kenya and Ethiopia, small sachets of a peanut-based paste are often all that stands between them and almost certain death.

Procured by the UN Children’s Fund (UNICEF) and the UN High Commissioner for Refugees (UNHCR) and used in feeding programmes by implementing partners in the camps, these so-called ready-to-use therapeutic food (RUTFs) are the first line of defence in saving these youngsters, combining peanut-based paste with sugar, vegetable fat and skimmed milk powder and enriched with vitamins and minerals.

“This really is the only hope for some of these children,” UNICEF emergency nutrition specialist Erin Boyd told the UN News Centre today. “Depending on the severity of their condition, the recovery can be impressive with a rebound to a normal status within six to eight weeks.”

RUTFs have the added benefit that the children do not have to be hospitalized for the duration of the treatment, but can be treated in the family setting. “Children with a good appetite and no medical complications will be able to go home and return to feeding programmes each week and receive more RUTF according to their weight and progress,” Ms. Boyd said.

But it is not only in sudden-onset crises such as the current Somali refugee influx that RUTFs are life-saving. Children in countries where acute malnutrition is rife, are being treated outside hospitals in their own communities, not by doctors but by health workers and eventually caretakers at home.

In the past, when the children were treated at specialized centres, “we were only able to reach maybe 10 per cent of all the children who were affected,” UNICEF Senior Adviser on Micronutrients Arnold Timmer said. “Nowadays we have examples where are able to reach 70 per cent and even more.

“Ready to use therapeutic food is a life-saver for children who are at risk of dying, at serious risk of dying. It contains all the nutrients and all the vitamins and minerals that the child needs and if this child takes these products it will almost certainly recover.”

There are several manufacturers of RUTF including the French company Nutriset, manufacturer of Plumpy’Nut; Compact, manufacturer of EezeePaste; and several other providers, including Hilina manufacturer in Ethiopia. Since early 2000 there has been a vast improvement in the outlook for acutely malnourished youngsters.

“Because of the way it has been introduced in health services and in the community we see that more children are reached at a much earlier stage of their condition,” Mr. Timmer said, noting that mothers are now recognizing the symptoms of acute malnutrition much earlier and children can be treated much earlier, giving them a much higher chance of survival.

“Because of this we are able to reach many more children than traditionally when this was hospital-based. Because then, the children had to be identified, they had to be referred to those hospitals or those facility-based treatments, and mothers have to go with the child, stay there, they cannot take care of the other children at home.”

That meant that there was often a high default rate as children dropped out of the programme, left hospitals and went home with their mothers to no treatment at all.

In the Ethiopian famine of 1992, when RUTFs did not exist, many more children died. “Easily five per cent of the children under treatment (with therapeutic milk without the added vitamins and minerals) would not make it because of the severe condition they were in. Today, the death rate can be as low as one per cent,” Mr. Timmer said.

Back on the front lines of the current crisis, UNICEF said today that it was working with local authorities to set up a therapeutic feeding centre in the Kenyan border town of Liboi to ensure that Somali families have access to life-saving health and nutrition services as quickly as possible.

“Many Somali families who cross into Kenya at Liboi do not realize they must walk another 100 kilometres before arriving at the refugee camps in Dadaab,” UNICEF Kenya Representative Olivia Yambi said. “The health of some malnourished children crossing at Liboi is so precarious that they simply cannot wait until they get to Dadaab for treatment.”

Earlier this week, the UN declared a famine in three more areas in drought-ravaged Somalia, bringing to five the number of regions in the Horn of Africa country where acute malnutrition and starvation have already claimed the lives of tens of thousands of people.

In the Dadaab complex of refugee camps in Kenya, whose mainly Somali population has swelled to nearly 380,000 in recent months, including 40,000 arrivals last month alone, the UN High Commissioner for Refugees (UNHCR) has reported alarmingly high rates of acute malnutrition.

Another UNHCR-supported camp complex deep in the Ogaden desert in eastern Ethiopia's Dollo Ado district, one of the remotest regions in Africa, is already sheltering more than 118,000 Somali refugees and more are pouring in daily, with work under way to provide refuge for 40,000 more people.

As Mr. Timmer put it on the 15th anniversary of the introduction of RUTFs into the arsenal of weapons to fight acute, life-threatening malnutrition: “It is a revolution. We have to see it as a revolution… and it’s also really quite tasty.”