Ready-to-use therapeutic food in the treatment of childhood malnutrition in South India - A randomized controlled trial

PURPOSE OF THE WORK- This study examines the effectiveness of a Ready-to-Use Therapeutic Food (RUTF) in the community-based treatment of childhood malnutrition in South India. RUTF provides the nutrients required for adequate rehabilitation and potentially fosters better compliance; it has been associated with appropriate weight-gain and decreased morbidity during the period of recovery. This study explores the effectiveness of this supplement in decreasing childhood malnutrition and its effect on micronutrient levels. DATA USED– The diet of Indian children is often insufficient in quantity and protective factors. According to the National Family Health Survey 3, 33.2% children are under weight, 21.5% are wasted and 25.1% are stunted. Currently-practised methods for community-based nutritional rehabilitation are often inadequate and have poor compliance. METHOD – The study is a randomised controlled trial in a rural Indian community. The nutritional status of pre-school children aged 18 to 60 months was assessed; Underweight children (-2 SD weight-for-age) were randomised either to the intervention group receiving 250 g of RUTF per week for 12 weeks or the control group, whose mothers were taught how to prepare a fortified milk-based supplement; all mothers received health education. Weight-for-age, height-for-age, weight-for-height, BMI, serum albumin, plasma zinc, iron status and vitamin B-12 were assessed at baseline and at the end of the study; height and weight measurements were repeated each month. RESULTS – Of 334 children screened, 140 were identified as being malnourished. The trial will be completed in May 2008 and a reduction of malnutrition in the intervention arm by 50% as opposed to 25% in the control arm is expected. RECOMMENDATIONS – If the use of an RUTF in treating malnutrition in the community is successful, its programmatic use in primary health care centres should be implemented. The supplement is easy to produce, store and distribute and is made from locally-available foods. Production of the supplement in bulk, and the establishment of Women's Co-operative Groups will decrease costs and make it more easily available to the families that may need it the most. The cost of an RUTF may potentially be offset by decreased spending on medical care for frequent diseases, severe malnutrition and hospitalisation for complications arising from untreated mild-to-moderate malnutrition.