Columnists Features

Treatment of severe acute malnutrition


GLOBALLY, and in Zambia in particular, the face of malnutrition is vast. Accounting for more deaths than HIV, malaria and TB combined, malnutrition underlies 52 percent of all under-five deaths in Zambia. Stunting, wasting and underweight is what is most often seen and heard, with stunting, low height-for-age, affecting 40 percent of children under the age of five. Wasting (weight-for-height) and underweight (weight-for-age) have rates of six and 15 percent, respectively.
Although all shocking and unacceptable, one aspect of malnutrition is quite often overlooked. This is severe acute malnutrition (SAM). It is a major global public health problem responsible for over one million young child deaths each year. SAM is characterized by extreme wasting where a child’s body shuts down due to starvation.
In Zambia alone, nearly 43,000 children die every year of severe acute malnutrition (very low weight-for-height), with 4,000 being in Lusaka alone. According to the 2013-2014 Zambia Demographic and Household Survey (ZDHS), the percentage of wasting has increased from 5 to 6 percent, a reality which is threatening the survival of children if left unchecked.
A visit to the child malnutrition ward at the University Teaching Hospital (UTH) reveals a 59-bed ward filled to capacity with a bed-to-child ratio of 1 to 3. The Ministry of Health states that more than 108,000 children under the age of five suffer from severe malnutrition every year.
I appreciate the fact that malnutrition programs in Zambia are more focused on stunting. However, we also need to do more to prevent the death of children with severe malnutrition. If the government, healthcare professionals, nutritionists and advocates don’t pay attention, Zambia will continue to see children fall victim to the worst form of malnutrition – SAM. Fortunately, there is hope as ready-to-use therapeutic Food (RUTF) has been proven to treat SAM. RUTF is a high energy, fortified, ready-to-eat food suitable for home-based treatment of children suffering from SAM.
It is a specialized peanut butter-based product designed with the exact combination of vitamins and nutrients needed for a severely malnourished child to recover. RUTF is more than just food; it has become a therapeutic treatment that is widely used and accepted all over the world.
RUTF has many qualities that offer several advantages, first being the convenience and safety component of it. RUTF comes in a ready-to-use paste that does not need to be mixed with water, thereby avoiding the risk of bacterial proliferation in case of accidental contamination. Additionally, RUTF comes ready-to-eat.
RUTF can be consumed directly by the child and provides sufficient nutrient intake for complete recovery. Lastly, RUTF has a long and stable shelf-life. It can be stored for three to four months without refrigeration in harsh environments, such as tropical temperatures, thus ensuring the chance of treatment to the most rural and hard-to-treat areas. With a 90 percent success rate, RUTF’s are a leading treatment option for children with SAM.
In terms of funding and resources, little attention has been given to it. For instance, only 8,000 children were being treated with RUTF last year in all of Zambia, due to inadequate funds available to purchase this treatment.
Moving forward, it will be encouraging to see Government prioritize RUTF considering its benefits and potential impact. Saving the lives of children with severe acute malnutrition should be a national priority.
The Zambian government needs to work with civil society to ensure funding and programs are in place to get RUTF to the children in most need. Moreover, there is a need to bring key stakeholders into the fold such as the private sector, who can benefit from producing RUTF locally or supplying RUTF more efficiently as a sustainable solution that empowers local communities and boosts the local economy. RUTF has revolutionized the treatment of severe acute malnutrition. The government prioritizing RUTF would imply an opportunity for children with severe acute malnutrition to be afforded the life they deserve.
The author is a civil society advocate for good nutrition and country coordinator for Zambia Civil Society Scaling Up Nutrition Alliance (CSO-SUN).

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