In THE latest decision taken by the Women and Child Development (WCD) department to treat severe malnutrition among children, a programme to distribute Ready to Use Therapeutic Food (RUTF) will soon be implemented across the state. The decision comes after a recent Gabha committee meeting with the health department, WCD, and NGOs.
However, some social groups are debating the government’s decision because of the high cost involved in procuring processed food and whether its efficacy is worth the expenditure.
The RUTF is a World Health Organisation (WHO) recommended ready-to-eat paste for severe acute malnourished (SAM) children.
The paste, a mix of peanut with dried skimmed milk, vitamins and minerals, provides high micro-nutrient support to children and can be stored for three to four months.
A project to give SAM children RUTF paste was run on pilot basis in Palghar and Nandurbar in 2015 and 2016.
“We have taken a decision to implement RUTF after seeing the results. Tenders will be called to fix the cost and work out finer details,” said Vinita Singhal, secretary, WCD.
According to WHO statistics, around one-third of child deaths across the world are caused by malnutrition although, it is rarely listed as a direct cause. Maharashtra accounted for 6.93 lakh malnourished children by end of monsoons in 2016, according to the Integrated Child Development System (ICDS) data.
While the WCD has sought answers for severe malnutrition in processed food, rural and tribal social groups claim that hot, cooked meals offer a better solution. A study by the Nandurbar health department showed that RUTF had 49 per cent efficacy in treating severe malnourishment. Of 7,927 SAM children in the district, only 3,886 were cured and discharged following RUTF treatment. The program was monitored by UNICEF and Tata Trust in Nandurbar at a cost of Rs 70 per paste packet.
“There are some definite advantages and quick results of ready-to-consume food. But a major disadvantage is that tribals have different food habits across the state and they cannot be forced to consume uniform food,” said Dr Abhay Bang, director of NGO Search that works on health and nutrition in Gadchiroli.
According to Brian Lobo from Kashtkari Sangathna, rejection of processed food is higher in tribal areas of Palghar. “I do not know about scientific validation of RUTF. But there are also concerns about the quality of processed food,” he said.
In Nandurbar, a study conducted by Janarth Adivasi Vikas Sanstha showed that of 14 SAM children given RUTF in a pilot project, only nine consumed entire packets. The study observed that mothers complained that their children were unable to consume the entire packet and could not eat any other food. Of the 14 SAM children, only two converted to the normal category and four to the moderately acute malnourishment category.
Different studies have shown varied results.
Mumbai-based pediatrician, Dr Alka Jadhav, who treats urban malnourished children at Sion Hospital, found 70 per cent success rate in RUTF. “If a child consumes it regularly for eight weeks, we have noticed that 60-70 per cent recover from severe malnutrition (in those cases),” she said adding that to prevent relapse, parents need to continue the diet once RUTF stops.
However, at a time Maharashtra has cut down its ICDS budget to Rs 2,033 crore this year — a 31 per cent drop from the 2016-17 budget — NGOs are skeptical about the programme as the cost of procuring RUTF would be high.