A history of therapeutic RUF and its use by MSF

Action Contre la Faim, Concern and Valid International have been leading forces behind piloting RUF. Their contributions have been invaluable.
1994: First use of therapeutic milk

Action Contre la Faim (ACF) pioneers the use of the milk formula F100 for the treatment of severe acute malnutrition. The formula is used in therapeutic nutritional centres where children are hospitalised to receive treatment. The milk needs prior preparation as warm clean water has to be added before it can be given to the child.
1997: RUF is invented

Building on ACF field experience, a French medical researcher from the Institut de Recherche pour le Développement, Paris, together with the French company Nutriset, succeed in making a nutrient-dense spread for the treatment of severe acute malnutrition. The spread contains milk powder, vegetable fat, peanuts, and sugar and is enriched with vitamins and minerals. The product has the same specifications as the F100 formula, but comes with crucial advantages: it is ready-to-use, it can be stored even in tropical climates, and no preparation is required.

MSF uses a prototype of this therapeutic RUF on an experimental basis in southern Sudan in emergency programmes, where security conditions prevented teams from operating in-patient feeding centres. In this case outpatient treatment was the only option.
1999: A protocol allowing decentralised care is adopted

The aid organisation Concern creates a protocol that allows for treatment at home using the ready-to-use product for malnourished children that don't present medical complications.
2000-2002: Therapeutic RUF becomes an essential tool to treat children during food crises

In 2000, therapeutic RUF were used by MSF during the major food crises in the Pool region in Congo, and more than 1,700 children were treated in the Ogaden region in Ethiopia. In 2001, MSF treated 3,000 children in the Karuzi province of Burundi, and in 2002, 8,600 children were treated in Caala, Angola. Each time, therapeutic RUF were used as part of the treatment provided in therapeutic feeding centres.

In some of these cases therapeutic RUF were not yet used in the outpatient phase because MSF teams were uncomfortable about setting up in-home monitoring. The most significant problem facing this new approach was the medical teams' concerns that they would not be in control of monitoring the children and thus would not be present in the event of complications that might occur at home. But with experience teams saw results were excellent and their fears were unfounded.
2001-2007: Outpatient treatment with therapeutic RUF

MSF initiated outpatient treatment in Faryab province, in northern Afghanistan in early 2001. Because mothers could not spend the night away from their homes, the teams had no alternative but to try out new options for treating severe malnutrition at home. The programme involved only a few children, but it marked the launch of the new ambulatory strategy within MSF.

By 2004, thousands of children were treated in Darfur, Sudan as well as Maradi, Niger using outpatient strategies with therapeutic RUF.