Dr Susan Shepherd is a paediatrician and nutrition consultant for MSF’s Access Campaign. She describes how the introduction of ready-to-use food has transformed lives in the projects where she worked in Chad and Niger.
Mothers everywhere know which foods their children need to grow up healthy. In wealthy countries, mothers can rest assured that even if their children live on an unvaried diet, the foods they do eat will be fortified with essential vitamins and minerals - they can rely on a nutritional safety net. Where we struggle in many poorer countries is with how to bring highly nutritious foods into the hands of families that can’t afford them.
On my first assignment in Uganda in a general pediatrics ward, I was facing a very different situation from when I worked in the US. There I was used to helping children easily through bouts of diarrhea, but in Uganda, I struggled to keep them alive. The critical difference was pervasive undernutrition. There was no nutritional safety net.
The revolution in treating malnutrition
I first treated children with therapeutic ready-to-use food (RUF) during a measles epidemic in Chad in 2005. Thanks to this product, we were able to treat over two thousand children suffering from severe acute malnutrition in the aftermath of this epidemic. This was a revolutionary new product that helped us to treat far more children, far more effectively than with previous interventions.
We came to see just how effective this new product was the same year just a few hundred kilometers away in Niger, when MSF was faced with mounting a rapid response to a massive unfolding nutritional crisis. RUF was the key element in enabling MSF to treat 60,000 children over a six month period. 90% of the children recovered as a result of the treatment. It was nothing short of miraculous - but a miracle grounded in sound nutritional science.
Since these events and other similar emergency situations from Somalia to Sudan, Malawi and Ethiopia, RUF, delivered through community-based programmes has become the international standard for treating children with severe acute malnutrition.
From emergency to everyday: catching malnutrition before it gets too severe
Realizing that nutritional emergencies tend to flare up in places where children are already vulnerable to acute malnutrition because of permanent inadequate nutrition, the following year, we expanded the use of RUF to include children with less severe forms of acute malnutrition. This resulted in a marked decrease in the number of children who developed severe acute malnutrition during the months of the ‘hunger gap,’ from August through October, before the harvest comes in.
We estimate that in 2006, we treated almost half of all children between six months and three years of age in our intervention zone near the city of Maradi. This suggested that if half of the children were acutely malnourished, then the other half were likely to have nutritional deficiencies, too. We wondered what would happen if we could supplement the daily diets of these children ,- would it prevent them from slipping into a malnourished state in the first place?
Supplemental programme finds favour with mothers
With this mind, the following year, we undertook a distribution of a supplementary ready-to-use food for all children between six months and three years of age in one district. The daily calorie supplement was only one quarter of what children with acute malnutrition receive, but it contains high quality protein through powdered milk and all the daily recommended intake of those 20 vitamins and minerals needed to promote health.
We are still working on analyzing this intervention, but one thing is clear: mothers believe that this supplemental programme works. Of the 63,000 children receiving the supplement, all but 900 returned to each distribution. Mothers told us that their childrens’ appetites were better, infants were nursing more, and in general, that their childrens’ skins were ‘brighter’.
RUF is one of many possibilities to improve children's nutritional intake
Distribution of a supplementary RUF is but one of myriad possibilities for improving the daily diets of large numbers of children. Already in Niger, a local company has brought to market a lipid-based fortified paste in the capital city at an affordable price. Another possibility is using nutrient sprinkles for home fortification. The bottom line is that children everywhere need essential nutrients to grow and be healthy.
We need to work to ensure all children have a nutritional safety net. Countries are going to need create new programs, but for this to happen there is an urgent need for international financial support.
Food is not Enough
MSF’s malnutrition campaign is advocating for global scale-up of therapeutic ready-to-use food (RUF) for the most at risk children. The campaign is pushing to ensure that more children under three in malnutrition hotspots receive essential nutrients to avoid becoming seriously malnourished. MSF is also highlighting the need for increased research and development into a range of nutritional products adapted to these children’s needs.