Ready to Use Foods – Challenges for improved infant feeding M.B. Krawinkel & I. Jordan, Institute of Nutritional Sciences, JLU Gießen, Germany Classification of acute childhood malnutrition Steve Collins, Lancet, 2003 Severe complicated malnutrition Severe uncomplicated malnutrition Moderate uncomplicated malnutrition <70% W/H (<-3 SD Score) or bilateral pitting oedema or MUAC <110 mm and one of the following: - Anorexia - Lower respiratory tract infection - high fever - severe dehydration - severe anemia - not alert <70& W/H (<-3 SD Score) or Bilateral pitting oedema or MUAC <110 mm and: - Appetite - clinically well - alert 70-80% W/H (<-3 to <-2 SD Score) and no oedema or MUAC 110-125 mm and: - Appetite - Clinically well - alert 2 Inpatient Outpatient Outpatient stabilisation care therapeutic care supplementary feeding RUF = Ready to use foods breast milk banana apple etc. baby food (industry-made) But also RUTF: ready to use therapeutic food RUSF: ready to use supplementary food 3 ICTP2014 - Michael Krawinkel - RUF Examples of Complementary porridges 4 ICTP2014 - Michael Krawinkel - RUF RUTF Ready to use therapeutic food (RUTF) z.B. Plumpy‘nut ® von Nutriset SA 92 g sachet, 500 kcal ingredients: groundnuts/ peanuts, milk powder, vegetable oil, sugar, vitamines and mineral mix Treatment of severe malnutrition No water needed 5 RUSF/ LNS Ready to use supplemental food (RUSF) Lipid Based Nutrient Supplement (LNS) For treatment/ prevention of moderate acute malnutrition: [WAZ ≤3SD until -2SD ] 6 ICTP2014 - Michael Krawinkel - RUF 7 8 UNICEF Supply Division – Prices for RUTF 9 http://www.unicef.org/supply/files/RUTF_Pricing_Data.pdf WHO Recommendations on IYCF ≤ 6 mos Exclusive Breastfeeding up to two years breastfeeding at 6 mos 2-3 CF meals per day (2-3 tablespoons = 1 meal) 6-8 mos 2-3 CF meals per day + 1 snack (½ a “cup” = 1 meal) 9-11 mos 3-4 meals per day + 1 or 2 snacks ≥12 mos: (½ to ¾ “cup” = 1 meal) 3-4 meals per day + 1 or 2 snacks (¾ to 1 ¼ “cup” = 1 meal) (1 cup = 250ml) 10 ICTP2014 - Michael Krawinkel - RUF Expenditure for food security and nutrition eduction / beneficiary ? Nutrition education: Community based growth promotion with supple-mentary feeding: 2,50 USD/person (1985)* 11,00 – 18,00 USD/person (2001 – 2003)* Breastfeeding promotion: 0.30-0.40 USD/person (1996)* Trials of Improved Practices: (about 50 persons) = 8,000 – 30,000USD (1997)* RUTF: about 60 USD/ person (2 mo‘s treatment / child) * source: World Bank 2006. Repositioning Nutrition as Central to D evelopment 11 ICTP2014 - Michael Krawinkel - RUF Challenges in handling RUTF Patent law Quality insurance Aflatoxine (case Haiti) Codex Alimentarius 60 USD for 2 mo‘s treat-ment Breast feeding and RUTF – per child/360 USD/yr) nutrition education ? Code for marketing of RUTFs ? Taste of peanuts ./. anorexia of severely malnoutrished RUTF doesn‘t contain water – children safe drinking water is needed Locally produced „RUTFs“ are displaced from the market No guidlines for usage and implementation of RUTF Costs (6 US-Cents/sachet = RUTFs for children below 6 months only as an exception 12 ICTP2014 - Michael Krawinkel - RUF Conclusion RUF/RUTF/RUSF are usefull innovations to support community-based management of malnutrition and humanitarian aid in emergencies Points of consideration: 1. 2. 3. 4. 5. Costs and logistics Replacement of natural foods Replacement of breastmilk Taste / Sugar content Lack of acknowledged general guidelines for use and marketing RUF/RUTF/RUSF are no magic bullett for the fight against malnutrition. 13 ICTP2014 - Michael Krawinkel - RUF Thank you for listening No dependency nor interest to be presented.
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