what is un Ready-to-Use Therapeutic Food (RUTF)
A Ready-to-Use Therapeutic Food (RUTF) is a special food, poor in water, with advanced nutritional properties. It is presented as a paste that is directly squeezed into the mouth from the packaging, or dispensable in cups with spoon. It is a mix of ingredients that aim to meet the nutritional requirements of children aged 6 months to 5 years, affected by Acute Severe Malnutrition (MAS): in fact, it is a set of pathological conditions associated with insufficient nutrition taken through the power supply. In its original version, the RUTF consists of peanuts, skimmed milk powder, palm oil, rapeseed oil, soy lecithin, impalpable sugar and a mix of mineral salts and vitamins. Unfortunately, the high cost of skimmed-milk powder affects more than a third of the total price of the finished product. In addition, the intolerance that babies show to milk after weaning and its unavailability on the African and Asian markets make local RUTF production very problematic.
Why use a RUTF
Severe Acute Malnutrition is a clinical framework that may have some degrees of complication. In its most serious forms, the immune system of the patient is affected so much that he is exposed to many infections, including the most dangerous dysenteries that are among the major causes of death in African and Asian children below five years old. The RUTF is a valuable ally of fieldwork humanitarian workers, as it allows decentralized treatment of the less serious cases of the MAS, directly in the villages. This allows a decongestion of hospitals that, therefore, are able to handle the most serious cases. In addition, RUTF can also be used in hospital follow-up directly at home, i.e. in the post-treatment phase of the most serious cases, in order to avoid relapses in the short term. The data from the various trials carried out in recent years show a considerable recovery of MAS patients treated with RUTF compared with those fed with traditional humanitarian products.
How to use a RUTF
The original RUTF has the remarkable advantage to be employed directly in theaters of need, since it doesn’t need preventive preparation. It can be administered to small patients directly from the pack or, if prepared locally, from the jar within which it is contented. Admission to RUTF therapy is by the measurement of the baby’s middle upper-arm perimeter: if it is less than 110 mm and child does not show any special complications requiring specialized treatment, the small patient can be treated at home with RUTF from 4 to 8 weeks, with an amount of 200 kcal / kg body weight / day; if the brachial perimeter, on the other hand, is greater than 110 mm, it is not necessary to treat with RUTF. The use of an indicator that is so easy to measure has been the clinical breakthrough in the use of RUTFs, as it allows rapid diagnosis by the health personnel, instead of other previously adopted anthropometric parameters that require extremely advanced statistical calculations.
Statistics on RUTF usage
Classical RUTFs are distributed by UNICEF in Low Income Countries. Although there is a local franchise production, it is actually never really taken off because of the high production costs and the license to pay to the Nutriset, the owner of the patent. In fact, RUTFs come from more than half of the global volume produced by Europe, the USA and Asia; only less than half is manufactured in Africa. RUTFs have seen a dizzying expansion in their use since their introduction in 2001, the year of their invention. It has gone from 2,000 tonnes in 2001 to over 35,000 tons in 2017. The price per carton (150 sachets of 92 g of RUTF) stands at around $ 50 for RUTF produced locally and $ 38- $ 40 for RUTF produced in the Occident. During last years, UNICEF has been strongly encouraging local producers to use alternative ingredients easily available on local markets, provided that the nutritional and hygienic characteristics of finished products are relevant to the international standards proposed by FAO and UNICEF.
NutriMax aims to solve the problems arised from the use of original RUTF. First of all, unlike what is done for powdered milk from the original RUTF, it points to the use of easily accessible ingredients in the markets of Low Income Countries (by providing a recipe with toasted soybeans, toasted sorghum, sunflower oil, impalpable sugar and lecithin). Secondly, it aims at an extremely capillary and delocalized production, thanks to the easy adaptability of the process, consisting of toasting, coarse grinding and ball milling. Third, adoption, as an additional ingredient, of the dried cyanobacteria Arthrospira maxima (commonly called Spirulina), easily cultivated in warm and tropical climates, is the extra gear, ensuring a complete nutritional intake of Vitamins A, D, E and K, as well as vitamin B12 and mineral salts that are strategic for human metabolism such as Copper, Iron, Zinc and Calcium. The aim of this fundraising is to build a pilot experimental plant in Gulu (Uganda) to test the efficacy of the preliminary studies directly on children under five years old.