1. Introduction
wasting, IRD, weight gain, SAM, malnutrition
WASTED, WASTING, COMPLICATIONS, MALNUTRITION
To strengthen community-based treatment of severe acute malnutrition (SAM) in Indonesia, locally produced ready-to-use therapeutic foods (RUTFs) are needed, but data on their acceptability and effectiveness are lacking. We conducted an individually randomized controlled trial in 302 children (6–59 months old) with uncomplicated SAM receiving 8 weeks of a standard RUTF (CON) or one of four alternative RUTFs produced with locally available ingredients: soybean (SOY), mungbean (MUN1, MUN2) or peanuts (PEA). The main outcomes were weight gain and product acceptability. Children consumed on average 2.2 kg of standard RUTF, but up to 4.5 kg of the local products (MUN2, Indonesia has an estimated overall caseload of over 6 million children under 5 years of age with wasting, of whom more than 2 million are severely wasted, based on national basic health research data [The Government of Indonesia has shown great commitment to fighting wasting through a rapid expansion of integrated management of acute malnutrition (IMAM) services to prevent and treat wasting in Indonesia, including strengthening inpatient- and community-based treatments. Inpatient treatment of severe wasting has been a standard component of health services in Indonesia for many years. However, in the >85% of cases that have no complications, SAM can also be treated at home using high-energy-dense ready-to-use therapeutic foods (RUTFs). Indeed, research has shown that home treatment through IMAM is at least as effective as in-patient treatment for uncomplicated SAM [RUTF is defined as a high-energy, fortified, ready-to-eat, soft or crushable, non-water-based food suitable for the treatment of children with SAM from the age of six months onward [To support the efforts of the Government of Indonesia in scaling up IMAM to the national level, UNICEF, Savica and the French National Research Institute for Sustainable Development (IRD) conducted a combined acceptability and efficacy study on different types of RUTFs produced using local ingredients that are readily available in Indonesia. Here we report the main outcomes of the study, including acceptability and changes in weights and MUACs of children treated for SAM using standard RUTF or one of four local RUTFs.