What is a Ready-to-Use Therapeutic Food (RUTF)
A Ready-to-Use Therapeutic Food (RUTF) is a special food , very low in water, with advanced nutritional properties. It comes in the form of a paste that can be squeezed directly into the mouth from the package, or dispensed in containers with a spoon. It is a mix of ingredients that aim to satisfy the nutritional requirements of children aged 6 months to 5 years , affected by Severe Acute Malnutrition (MAS): in fact, it is a set of pathological states connected to an insufficient intake of nutrients taken through food.
In its classic meaning, RUTF is composed of peanuts, skimmed milk powder, palm oil, rapeseed oil, soy lecithin, icing sugar and a mix of mineral salts and vitamins. Unfortunately, the high cost of skimmed milk powder accounts for more than a third of the total price of the finished product. Furthermore, the intolerance that children have towards milk after weaning age and its unavailability on the African and Asian markets make the local production of RUTF very problematic .
Why use a RUTF?
Severe Acute Malnutrition corresponds to a clinical picture that can have various degrees of complication. In its most serious forms, the patient's immune system is compromised to the point of being exposed to countless possibilities of infection , including the very dangerous dysenteries that are among the main causes of death in African and Asian children under five years of age. The RUTF is a precious ally of humanitarian workers working in the field, as it allows the decentralized treatment of the less serious states of MAS, directly in the villages.
This allows for a decongestion of hospitals , which are thus able to treat the most serious cases. Furthermore, RUTF can also be used in hospital follow-up directly at home, that is, in the post-treatment phase of the most serious cases, to prevent relapses in the short term. The data from various trials carried out in recent years demonstrate a considerable recovery of subjects affected by MAS if treated with RUTF, compared to those fed with traditional humanitarian products.
How to use a RUTF
RUTF has the remarkable advantage of being able to be used directly in the theaters of need, since it does not require prior preparation. It can be administered to small patients directly from the package , or, if prepared on site, from the jar in which it was placed. Admission to RUTF therapy occurs by determining the child's brachial perimeter (arm): if it is less than 115 mm and does not present particular clinical complications that require specialized treatment, the small patient can be treated at home with RUTF for 6 to 8 weeks, with quantities equal to 200 kcal/kg body weight/day; if the brachial perimeter, however, is greater than 115 mm, then treatment with RUTF is not necessary.
The use of such an easy-to-measure indicator has represented a clinical turning point in the use of RUTFs, as it allows a rapid diagnosis to the healthcare workers involved, instead of other anthropometric parameters previously adopted that require extremely advanced statistical calculations.
RUTF Treatment Statistics
Classic RUTFs are distributed by UNICEF in developing countries. Although local production through franchising is planned, it has never really taken off due to the high production costs and the license fee to be paid to Nutriset, which owns the manufacturing patent. In fact, more than half of the total volume of RUTFs produced worldwide comes from Europe, the USA and Asia; only less than half is manufactured in Africa. RUTFs have seen a dramatic expansion in their use since their introduction to the market in 2001, the year of their conception.
It went from 2,000 tons in 2001 to over 35,000 tons in 2017. The price per carton (150 bags of 92 g of RUTF) is around 50 dollars for locally produced RUTF and 38 - 40 dollars for RUTF produced in the West. UNICEF, in recent years, has increasingly encouraged local producers to use alternative ingredients, easily available on local markets, provided that the nutritional and hygienic characteristics of the finished products are relevant to the international standards proposed by FAO and UNICEF itself.
The NutriMAS RUTF
NutriMAS aims to solve the problems that have emerged in the use of classic RUTF. First of all, unlike what happens with classic RUTF powdered milk, it aims to use ingredients that are easily available in the markets of developing countries (providing a recipe containing toasted soy, toasted sorghum, sunflower oil, impalpable sugar and lecithin).
Secondly, it aims at an extremely widespread production delocalisation , thanks to the easy adaptability of the process, consisting of roasting, coarse grinding and ball milling.
Thirdly, the adoption as a supplementary ingredient of the dried cyanobacterium Arthrospira maxima (commonly called Spirulina), which can be 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 strategic mineral salts for human metabolism such as Copper, Iron, Zinc and Calcium.
The aim of this fundraiser is to create a pilot experimental machinery in Gulu (Uganda), to directly verify on children the efficacy predicted by preliminary studies.
Drying 1
Drying of Spirulina and roasting of Soybeans and Sorghum.
Drying 2
Drying of Spirulina and roasting of Soybeans and Sorghum.
Grinding
Coarse grinding of Spirulina, Soybeans and Sorghum.
Mixing
Mixing of Spirulina, Soy, Sorghum, Impalpable Sugar, Lecithin and a mix of mineral salts and vitamins with Sunflower Oil.
Ball milling
Refining by ball mill to obtain a compact edible cream.
Administration
Administration to children with severe acute malnutrition
LET'S NOT FEED THEM FROM A DISTANCE
With a small donation you too can contribute to fighting Severe Acute Malnutrition.
Every year Severe Acute Malnutrition causes the death of 4 million children
In the world, according to estimates by the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), there are one billion malnourished people. Of these, 200 million are children under 5 years of age.
The turning point in the treatment of Severe Acute Malnutrition (MAS) came with Ready-to-use Therapeutic Food (RUTF), known commercially as Plumpy'Nut ®, used by the United Nations and by Non-Governmental Organizations (NGOs) and Governmental Organizations (GOs).
It is a creamy paste, very similar to peanut butter, in consistency, color and flavor. Among the ingredients are: peanuts, skimmed milk powder, rapeseed oil, sugar and a mix of mineral salts and vitamins, balanced to optimize the energy and nutritional intake of malnourished children. RUTF allows you to treat cases of malnutrition, which do not present particular clinical complications, directly at home. In this way, hospital beds are freed up.
However, RUTF has very serious problems. For example, peanuts cause allergies, while skimmed milk powder is not easily digested by African and Southeast Asian children. In addition, it is economically unsustainable: the price of milk accounts for almost ⅓ of the overall cost of the ingredients of the finished product. Although franchising is planned, the presence of a patent makes it difficult to develop local production, since the licensing costs are very high.
Aware of these problems, Vincenzo Armini proposed an alternative RUTF in his doctoral thesis at the Department of Agriculture of the University of Naples "Federico II": NutriMAS.
Toasted soy, toasted sorghum, sugar, dried Arthrospira maxima and sunflower oil are its components that have the advantage of being easily available in third countries.
NutriMAS is produced with a simple technology: this will allow it to activate directly in the villages and rural areas of Africa and Asia, especially if soon coupled with the use of renewable energy sources, such as photovoltaics, a challenge that will soon be implemented by NutriAfrica ODV.
