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Cheaper recipe for treating hungry children

[Malawi] A child recovering from Kwashikor in a Nutritional Rehabilitation Unit in the Nsanje district. [Date picture taken: 2005/10/06] IRIN
Several million children suffer from vitamin and mineral deficiencies worldwide
The peanutty paste rushes out of the steel pipes into the plastic bottles placed in position by a worker at the Project Peanut Butter factory in Blantyre, Malawi's commercial capital. The red label on the bottle reads Plumpy'nut Chiponde, the Malawian name for the ready-to-use therapeutic food (RUTF) that has revolutionized the treatment of chronically malnourished children.

Chiponde is like crunchy peanut butter, but is thicker and contains sugar, peanut paste, oil, minerals and vitamins; milk powder, a critical ingredient providing animal protein, makes up 25 percent, accounts for more than 50 percent of the cost, and adds a strong milky flavour. Incidentally, RUTF was developed in Malawi

Project Peanut Butter, a non-profit therapeutic feeding programme in Malawi, has begun clinical trials to test the efficacy of substitute ingredients to help bring production costs down.

The programme was founded by Mark Manary, a professor of paediatric medicine at Washington University School of Medicine and a paediatrician at St Louis Children's Hospital in Missouri, US, who was the first to prove that RUTF was effective.

The food and fuel price crisis in 2008 pushed the costs of ingredients up, adding impetus to the study. "Two years ago milk was much more expensive than other ingredients," said Manary.

"Then, in 2008, all food prices rose, so oil and peanuts increased their fraction of the cost. I do not really expect food prices to go down, so the price of RUTF will be what it is - about US$4 to $5 per kilogram. Of course, if costs to produce RUTF fall, RUTF is more accessible."

''Making up some of the proteins with soya instead of milk will reduce the price of the ready-to-use therapeutic food so that we can feed more children''
The average child stays on the RUTF programme for six weeks and consumes about 11kg of RUTF. The project's studies have shown that 95 percent of malnourished children on this formula recover in six to eight weeks.

According to Manary, children maintain this recovery at a rate of 98 percent during the six months after treatment, and 96 percent maintain recovery over the course of a year. This is critical in Malawi, where 111 children out of every 1,000 die between birth and the age of five, one of the highest under-five mortality rates in the world.

Manary's studies have shown that RUTF is a vast improvement over milk-based formulas, which offered recovery rates of between 25 percent and 40 percent and required hospitalisation, subjecting children to infectious agents when their malnourished bodies were less able to withstand this additional burden. RUTF has made it possible to treat a child at home, without refrigeration, even when hygiene conditions are poor.

The trials

The programme is conducting trials with two formulations: the normal recipe and one with reduced milk powder. "This is a randomized controlled double-blind study comparing two formulations of ready-to-use therapeutic food with equivalent micronutrient and macronutrient content, but different protein sources," said Heidi Sandige, a paediatrician working with the programme.

"One formulation has 25 percent milk powder, and the other 10 percent milk powder, with the remainder of the proteins made up in soya. We have enrolled 2,100 severely malnourished children between six [months] and 59 months, between May 2008 and February 2009," she said.

"Making up some of the proteins with soya instead of milk will reduce the price of the ready-to-use therapeutic food so that we can feed more children," Sandige noted. Manary said he expected results from the reduced milk recipe study in four to six months.

Donations help

Milk powder donated by the Austrian government, via the UN World Food Programme, has helped project peanut to pass on a 30 percent cut in price to the charities it supplies. "A donation of cooking oil could make a similar impact," said Manary.

According to factory manager Liyaka Nchilamwela, the plant produces five to six tonnes of RUTF every day, but the small staff of about 12 has kept costs down.

Workers at the Project Peanut Butter factory label containers of Plumpy'nut Chiponde 2009022411
Photo: Jaspreet Kindra/IRIN
The Project Peanut Butter factory produces enough to feed two-thirds of Malawi's severely malnourished toddlers
The factory, which produces enough to feed two-thirds of Malawi's severely malnourished toddlers, is being upgraded so as to increase output and package the RUTF in sachets. This would not only bring down transport costs but also extend shelf-life to two years, he said.

The project has received enquiries about supplies from several programmes based outside Malawi. "Our priority is to be able to fulfil the demand in Malawi first and then we can look at other countries," Nchilamwela said. The project has also begun production at a factory in Sierra Leone.

The Malawian government has endorsed the rollout of community-based therapeutic care (CTC) for treating malnutrition. Besides Project Peanut, which supplies RUTF to government programmes and NGOs, a company called Valid also produces a peanut-based therapeutic paste.

According to a report by an NGO, Concern Worldwide, on the case for scaling up, at least 70,000 children in Malawi need RUTF every year, and their combined scaling-up of production by Project Peanut and Valid could help take care of the country's needs.

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