RUTF

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RUTF CTC
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Content

• Relationship between CTC RUTF
• Difference emergency Vs development
• Access
• Quality
• Innovation

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Symbiotic relationship between CTC RUTF

• RUTF facilitates CTC
• CTC provides markets for RUTF
• Cost accessibility of quality RUTF a central
  determinant for success of CTC in development
• Economics of local RUTF production vital to
  sustain CTC in development programmes
• Economic benefits to community
• Revenue generation that subsidises welfare
  element of CTC

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Parallel development of CTC RUTF

• Development of cheap local production of RUTF
  central to the development of CTC

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CTC
RUTF

• Emergency CTC
• Extended emergency CTC
• Transition
• CTC integrated into PHC
• Integration with local economy

• International Plumpynut
• Centralised national-level production
• District level production
• Alternative formulations agriculture
  Integration
• Develop viable small production businesses

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Development - CTC RUTF CTC
RUTF
20012

• International Plumpynut

• Initial emergency CTC implemented through NGOs

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Development - CTC RUTF CTC
RUTF
2002-3

• Centralised local production - plumpynut
  formulation

• Longer term emergency programmes

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Centralised national level production
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Production support at Tambala

• Audit of Tambala factory management procedures
• Comparative trial of laboratories
• identify one having accurate results, reliable
  affordable
• Provision of equipment
• Preparation of production manual
• Training of Tambala workers guidance for
  production QA managers
• Written contract
• Ongoing support
• Testing
• Advice on improving procedures when problems
  identified

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Tambala production multiple mixers 500Kg /
day
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Laboratory selection

• Analytical results from 3 laboratories compared
  to those from Oxford Brookes University (UK)
• Malawi Bureau of Standards selected for accuracy
  of results, rapid professional response
  reasonable cost

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Tambala performance

• RUTF supply was satisfactory after initial
  settling down period
• Routine QA detected increase in aflatoxin levels
  on one occasion
• Steps taken to prevent recurrence
• Problems with marketing and business aspects of
  production

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Development - CTC RUTF CTC
RUTF
2003

• Local level production - plumpynut formulation
• Cost of ingredients
• Quality control issue

• Transition - CTC implemented through local infra
  structure

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Production support at Nambuma

• Design production facility
• Provision of all equipment
• Preparation of facility specific production
  manual
• Training
• Guidance for QA procedures
• Ongoing support
• Logistic support for raw materials product
  delivery
• Support for product sampling testing
• Business

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• Equipment provided

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Equipment modification
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• Transport of equipment

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Measuring equipment
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• Production by Nambuma staff

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• First batch of RUTF produced at Nambuma

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Packing RUTF into 260g pots.
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Capacity 110Kg / day
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• Stock control at Nambuma

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Nambuma

• Production started within an hour of equipment
  being delivered
• Ongoing support much more challenging
• QC
• Logistics
• Business support

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Development - CTC RUTF CTC
RUTF

• Alternative formulations
• Reduce cost
• Improve safety

• Developmental CTC integrated into primary health
  care system
• CTC become standard element of PH intervention

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History of RUTF

• Long history of energy dense pastes
• Preservation technique for centuries
• Tahini, Peanut butter
• Enriched peanut recipes
• Simple concept
• Profound implication

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The Food Square concept to develop RUTF
Professor Jeya Henry Oxford Brookes
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A total of over 15 trial formulations were
developed
Examples of trial formulations
All cereals and legumes were roasted.
Appropriate proportion of sugar, oil and vitamins
and minerals were added
Professor Jeya Henry Oxford Brookes
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Protein digestibility-corrected amino acid score
Professor Jeya Henry Oxford Brookes
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Various RUTF formulations showing textural and
colour differences
Professor Jeya Henry Oxford Brookes
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Example of RUTF gross composition compared to
Plumpynut
Professor Jeya Henry Oxford Brookes
Values from Nutriset
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Protein digestibility-corrected amino acid score

• Protein digestibility-corrected amino acid score
  of a food is calculated as follows
• Lowest amino acid ratio x true protein
• digestibility

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Water activity (aw)

• The term water activity (aw) refers to unbound
  water in food
• The water activity (aw) represents the ratio of
  the water vapour pressure of the food to the
  water vapour pressure of pure water under the
  same conditions and is expressed as a fraction
• Water activity (aw) has its most useful
  application in predicting the growth of bacteria,
  yeasts and moulds

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Water activity (aw) in RUTF samples and
Plumpynut
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Alternative recipe RUTFs

• Low cost, RUTF without use of peanuts milk
  powder are feasible
• Reduce cost
• Greater opportunities to integrate with local
  agriculture
• Minimise mycotoxin contamination
• Decrease problems with allergy
• Gross composition texture comparable to
  Plumpynut
• Protein quantity quality
• Energy density
• Micronutrient
• Low water activity
• Good shelf stability
• Good acceptability

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Adapting recipes for HIV/AIDS

• Tailoring nutrients to requirement of HIV AIDS
  sufferers
• Add in pre probiotics
• Safe
• Dramatically reduce infection in
  immuno-compromised
• Promote growth in HIV infected
• Can be easily safely added to RUTF

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Development - CTC RUTF CTC
RUTF

• Local purchase of crops
• Agricultural extension to promote quality and
  efficiency

• Integration of CTC with local economy to create
  quasi-sustainable model

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Nambuma district integration with agriculture

• Maize, sesame chickpea formulation
• Concern agriculture extension programme
• Sesame chickpea introduction support
• Support for processing storing
• Marketing crops to Nambuma mission RUTF
  production unit

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CTC
RUTF

• Business support for local CTC institutions
• QC systems
• Standards
• Access to wider markets (HIV, military, sports)
• RD

• Business support for local CTC institutions
• QC systems
• Standards
• Access to wider markets (HIV, military, sports)
• RD

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Business support

• Establish evidence based of local formulations
• Field trials
• Ensure QC
• Systems
• Verification
• Develop quality brand
• Market development
• Malnutrition
• HIV
• RUSF
• Complimentary foods etc
• Sports, hospital rations etc

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OTP SC costs Malawi 2002 N 1571 cost /
severe case treated 288
89
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Emergency development differences

• Emergency
• Timeliness
• Quality
• Quantity
• Price secondary

• Development
• Price
• Quality
• Economically viable and self sustaining systems

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Threats

• Poor quality or inappropriately formulated RUTF
  undermining quality local production
• Inappropriate use of donated food undermining
  economic viability of local RUTF producers
• Monopolistic control of RUTF market keeping price
  high

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Future issues

• Formulations for RUTF
• Cost/benefits of production at village-based
  production units
• Need for supervision of RUTF production
• How local should local be?
• Can RUTF production stimulate local agriculture
  or be income generating to help increase food
  security?

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OTP SC costs Malawi 2002 N 1571 cost /
severe case treated 288
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