The Pre-RUTF Era: Limitations of Hospital-Based Care
Before RUTF, treating severe acute malnutrition (SAM) typically occurred in hospitals using therapeutic milk formulas (F-75 and F-100). This approach, while helpful, faced significant limitations in areas with limited resources. Challenges included the need for families to travel long distances, the difficulty of preparing milk formulas with clean water, increased infection risk in crowded centers, and the overall scarcity and cost of these facilities.
The Invention and Rise of Plumpy'Nut
Inspired by Nutella, pediatric nutritionist André Briend and food processing engineer Michel Lescanne co-developed the first RUTF, named Plumpy'Nut, in 1996. This peanut-based paste, made by Nutriset, was enriched with essential nutrients and designed to be shelf-stable. Its low water content prevented bacterial growth and gave it a long shelf life, making it suitable for distribution and use outside of clinical settings.
Early Trials and Adoption
Early trials in Chad and Southern Sudan in 1997-1998 tested the product. Pilot programs in the early 2000s showed high success rates, and a large-scale deployment by Doctors Without Borders (MSF) during the 2005 Niger famine demonstrated RUTF's effectiveness in treating large numbers of children.
The Community-Based Management Revolution (CMAM)
The success of RUTF facilitated the development of Community-based Management of Acute Malnutrition (CMAM). This approach allows for screening and treatment in communities by local health workers, significantly increasing access to care. In 2007, the WHO, UNICEF, and WFP officially endorsed the CMAM approach with RUTF for uncomplicated SAM cases, solidifying its role in global health.
The Impact of CMAM
CMAM has expanded treatment access to millions in remote areas, reduced mortality rates from malnutrition to below 5% in CMAM programs, and is considered a cost-effective treatment method.
The Growth of RUTF Production
Initially, Nutriset held the patent for Plumpy'Nut, leading to discussions about cost and access. To address this, Nutriset established the PlumpyField network in 2005 to license production in developing countries and made the patent available online in 2010 for use by independent producers in developing countries. This expanded production and promoted local economies, though challenges in sourcing and cost remain.
Comparison: RUTF vs. Traditional Therapeutic Milk
| Feature | Ready-to-Use Therapeutic Food (RUTF) | Traditional Therapeutic Milk (F-75/F-100) |
|---|---|---|
| Administration Setting | Primarily home-based, community-level care | Centralized in Therapeutic Feeding Centres (TFCs) |
| Preparation | No preparation needed; eaten directly from packet | Requires clean water and careful mixing |
| Microbial Contamination | Low risk due to low water activity and sealed packaging | High risk if water is not sterile or hygiene is poor |
| Shelf Life | Long shelf life (up to 2 years) | Short shelf life once prepared; requires refrigeration |
| Accessibility | Highly accessible, distributed at community level | Limited by the location and availability of TFCs |
| Medical Supervision | Minimal supervision needed for uncomplicated cases | Requires constant supervision by medical staff |
Conclusion
The history of RUTF highlights an innovation that transformed how severe acute malnutrition is treated globally. Inspired by a common spread, André Briend's invention of RUTF, particularly Plumpy'Nut, and the subsequent implementation of the CMAM model, decentralized care from hospitals to communities. This shift dramatically improved access to treatment, increased recovery rates, and significantly reduced child mortality. Despite ongoing production and distribution challenges, RUTF is a vital tool in combating malnutrition, demonstrating the powerful impact of targeted nutritional products on global health. For more detailed information on CMAM, consult the guidelines published by the WHO and UNICEF.
