The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries

Bazzano, Alessandra N.; Potts, Kaitlin S.; Bazzano, Lydia A.; Mason, John

doi:10.3390/ijerph14040403

Cited by 29 publications

(24 citation statements)

References 92 publications

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“…Rather than creating whatever evidence-base is currently lacking to address the issue of how to empower communities to take charge of the nutrition of their own children better, it is engaged in promoting a reliance on technical, top-down measures of only marginally greater efficacy in the short term (10,13,16). It has also steadfastly refused to recognize the opportunity costs of pushing for an elusive 'cure' at the constant expense of prevention (17,18) and ignored concerns related to impacts upon health in the long term with products like RUTF (14) that are high in sugar. While we are still trying to build conclusive evidence for such programmes, we expect and wish the stronger players would do more in this regard, or at least show a modicum of interest in programmes which are truly community-based.…”

Section: Resultsmentioning

confidence: 99%

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Foregrounding ‘Community’ in Community Management of Severe Acute Malnutrition

Prasad¹

2017

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The issue of widespread food insecurity amongst children in Africa and Asia has often been narrowed to the discourse on 'severe acute malnutrition (SAM)' in the last decade. Further, conflicting notions exist in relation to the root causes and solutions for SAM; ranging from the dominant view that it is a medical emergency needing medical/technical assistance, to its being perceived as a socio-economic-political phenomenon, to be managed largely by enhancing the agency of the affected families and communities. Much recent experience, and some evidence, has emerged that suggests that SAM in India is a unique phenomenon with distinct differences from its counterpart in Africa. Nonetheless, the technical community has been slow to acknowledge these differences, leave alone alter their recommendations accordingly. These differences in understanding are sharply evident in the interpretation of community management of acute malnutrition (CMAM) in particular. This paper examines these differences; factual and perceptual, and critically interrogates the definition and programmatic interpretation of CMAM that is in current usage, which results in the further marginalization and dependence of the affected community upon external resources. It also highlights the characteristics of alternate programmes for CMAM using a few models for illustration.

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Section: Resultsmentioning

confidence: 99%

“…Though conflict of interest is notoriously difficult to document and evidence, it has been well documented in a recent paper by Bazzano et al (14).…”

Section: The Justificationmentioning

confidence: 99%

Foregrounding ‘Community’ in Community Management of Severe Acute Malnutrition

Prasad¹

2017

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“…Second, using local foods has so many advantages, including that children like to eat them, and more so if they contain more oil and preferred tastes: there is little difficulty in replacing lost weight fast if the supplementary food is delicious. (We showed this in 1974 (Mason, Hay et al 1974) -Lancet Mason et al) Further, many disadvantages for children's health and nutrition can arise from accustoming children to sweetened peanut butter paste -this is addressed in the paper by Bazzano et al (Bazzano, Potts et al 2017). A recent paper from India convincingly highlights many of the problems of RUTFs, and their implications, in Maharasthra (Shukla and Marathe 2017).…”

Section: High Dose Vitamin a Capsules (Hdvac)mentioning

confidence: 97%

“…RUTFs are described in detail in (Bazzano, Potts et al 2017), from this same conference. Some of the key points in this context are in table 1B.…”

Section: Community-based Programmes (As An Alternative)mentioning

confidence: 99%

“…Early in an emergency this may be so, but then should transition to local foods. In non-emergency situations it is very doubtful if imported sweetened peanut butter (the usual formula) is needed; moreover there are many harmful effects, discussed in (Bazzano, Potts et al 2017) and (Shukla and Marathe 2017). Issues of enhancing available family diets are also discussed in the conference paper (Bazzano, Potts et al 2017).…”

Section: High Dose Vitamin a Capsules (Hdvac)mentioning

confidence: 99%

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Magic bullets vs community action: the trade-offs are real

Mason

Margetts

2017

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Abstract Magic bullets refer to single interventions, vertically delivered (i.e. from the centre), expected to have a dramatic effect, and often in practice circumventing or displacing more locally appropriate and sustainable activities. Once policies have defined intended outcomes – here childhood malnutrition is considered – decisions on programme specifics should take full account of trade-offs (including opportunity costs), and these decisions at present are often unduly influenced by vested interests. Magic bullets have times-and-places where they may be effective. These may get superseded, for example with changing disease patterns or other conditions, or because of new technologies. Regular transparent assessments of current applicability, with some estimate of benefits and costs, are essential, but uncommon. Six examples of single purpose interventions are summarized considering times-and-places: protein supplements, infant formula, high dose vitamin A capsules (HDVAC), the vitamin supplement industry, ready-to-use therapeutic foods (RUTFs), and oral rehydration therapy (ORT). HDVAC and RUTFs are compared to community-based nutrition programmes. Protein is rarely the binding constraint in preventing or treating infant and child malnutrition. Infant formula is hardly ever to be preferred to breastfeeding; and in poor countries with inadequate hygiene its use carries much increased mortality risk. HDVACs were shown to have a mortality impact in the 1980’s and early 90’s, leading to global programs now covering a reported 200 million children; however recent studies have shown that this effect is no longer seen, but policies and programmes have yet to change in most countries. The vitamin supplement industry is included as it contributes to misguided views of nutrition and health, which should be mitigated. RUTFs are very useful for the narrowly defined group of children with severe acute malnutrition still with an appetite (most severely malnourished children have a poor or zero appetite, and require liquid diets first). However, the off-label use of these sweetened peanut butter pastes for moderately (or less) malnourished children is becoming widespread: it has many immediate and long-term disadvantages, including on children’s food preferences; local foods, maybe enhanced with micronutrient mixes, are far preferable, including for rehabilitation of severely malnourished children. Oral rehydration provides a further example of where local solutions are preferable – but still seldom applied. Community-based programmes have known effectiveness, are more sustainable than magic bullet approaches, and in all the examples above can contribute to local problem solving. The implications for resource allocations are that shifting resources from magic bullet programmes to local, community- (and facility-) based activities will have many advantages. While cost estimates are hard to find, it seems that some such as HDVAC cost around $1 per child per year, and RUTFs for SAM around $5 per child per year (in the overall population; per SAM case treated the estimated cost is more than $100). Effective community-based programmes cost about $10 per child per year, but address not one but most of the nutrition problems faced by children in those communities. Major donors have allocated 50% or so of their budgets to such supplies, and these funds go to the manufacturers in the rich countries, not to the countries in need. Allocation of resources to the countries themselves, and to local activities, could amount to billions of dollars, leading to improved nutrition, if single purpose interventions like HDVAC and RUTFs were no longer soaking up time, efforts of frontline workers, and funds.

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