Treating malnutrition: The RUF revolution

"I prefer to come here once a week rather than staying in a treatment centre, because I have to take care of the fields and my other children - I have three other children at home."

"I have no-one to look after my other kids, my oldest girl is only 10 years old, I have no-one to help me. Without this place I wouldn't have sought help, even if my child was very sick, because I can't leave my other children alone for weeks." Mothers of children receiving therapeutic RUF outpatient care in Magari, Niger

International food aid today relies heavily on fortified blended foods to improve the quality of children's diets. Over 450,000 tons of such food, mostly in the form of a fortified corn-soy blend (CSB), was distributed in 2006.

Fortified blended foods however have serious limitations that make them far less effective than RUF at targeting malnutrition in children under the age of three:
Fortified blended foods are not particularly dense either in calories or in nutrients. Even though the blends are fortified with nutrients, they rarely include all of those needed by a malnourished child, and the levels of fortification are often inadequate or inappropriate. In addition, the cereal and soy components have anti-nutrient factors that reduce the utility of fortification, as they make absorption of nutrients difficult. If any of the 40 essential nutrients are deficient in a young child's diet, it will greatly impact the function of their immune system, and their ability to resist disease.
In contrast, the ingredients of RUF are better suited to children's needs. The nutrient-dense spreads are better able to target as well as safely and effectively deliver the full range of minerals, trace metals, essential amino-acids and lipids and other beneficial nutrient factors required by young fast-growing children. They are tasty, dense in calories, and are ideal for small children with small stomachs.
RUF lasts longer, is safer and is easier to use. The fact that there is no need to prepare a porridge means that with RUF, there is no need to add water, which eliminates the risk of contamination. RUF's packaging also allows it to be stored for significant periods of time without spoiling, even in hot or humid climates. Fortified blended food, on the other hand, requires water and preparation time for cooking, has the risk of under- and over-dosing, has a limited shelf-life and is easily spoiled or infested.
Experience shows that RUF makes it easier to target the child because it comes in individual packages. Distributing amounts of fortified blended food to a family runs the risk that the food is shared by the entire family, and the child not be treated.
Ready-to-use packages are easy to store and transport. RUF is lighter and less voluminous, thus it requires less storage space, and is eases transport from the production site to the child's home.

Results achieved with RUF for moderately malnourished children are far superior to many emergency Supplementary Feeding Programmes (SFPs) implemented with blended flours. A study mainly focusing on children under five reviewing the impact of 82 SFPs, conducted by 16 agencies in 22 countries, showed worrying trends. Only 41% of programmes met accepted standards with regard to impact at the individual level.

Considering the critical advantages and effectiveness of RUF, fortified blended food must be replaced with RUF when targeting the nutritional needs of children under the age of three.