A previous discussion, [url=http://www.en-net.org.uk/question/225.aspx]here[/url] discussed some of the challenges of local production of RUTF/RUSF and described some ongoing work in that area.

it is difficult to identify this kind of local food is equal or had same amount of the plumpy nut how ever local food is differ from region to other even in the same town or villages just i say impossible to say local food will be globally look for target community and compare with food diversity list then choose the best or approximately 70% of plumpy nut Thanks

This response from Sachin Jain has just been posted on another link, but I think it should have joined this discussion: I believe Plumynut is a brand of RUTF and I just want to alarm everyone in the discussion not to equate it as RUTF. I appreciate the question raised here regarding local options for RUTF...as it is also being presented as magic bullet in India also. Plumynut was brought in Madhya Pradesh by an UN organisation even without consulting Government of Indian and State Government. There has been significant efforts for commercialisation of Pumpynut and Other RUTF brands. Most of the international organisations are not interested in getting into the discussion of Local options. We have examples (Jan Swasthya Sahyog, Bilaspur, Chattisgarh State of India), where Different kinds of Cereals, Jaggary, Pulses, edible oil and Eggs are being used in Creche program for children; definitely it took 6 to 8 months and more in some cases, but it worked. This organisation did make some arrangements for micro-nutrient supplementation as medicine separately. JSS has also proved that strong availability of primary health services and secondary health services are most essential for addressing chronic malnutrition and SAM. Is it necessary to follow golden formula of RUTF work by word, point by point......./ If you are looking for a local option, you will have to take a different line from Plumpynut!! Sachin Jain India sachin.vikassamvad@gmail.com

I think this confuses the issue a little. It is possible to produce RUTF locally in small food-processing facilities. Plumpy'Nut is little more than peanut (groundnut paste), sugar, DSM, and CMV mixed in appropriate proportions. This recipe can be made locally. Alternatives recipes have been tried (e.g. alternative legumes). You need to take care during production to ensure quality control (i.e. you are getting F100 equivalent) and hygienic practices (the product is usually safe but there have been cases of Salmonella associated with peanut butter in the US and Australia). I have no objection to alternative recipes provided they are evidence-based (i.e. meet the F100 standard). I am a little worried by nationalistic and ideological objections to F100 RUTF when they might lead to the use of products that may be substandard or risk "wet-feeding" which risks iatrogenic outbreaks of (e.g.) diarrhoea. India has a strong pharmaceutical sector and should be able to produce an F100 RUTF easily (Pakistan already does so). There is a patent issue but that can be resolved in negotiation with the patent holders. BTW ... F100 RUTF is (to my knowledge) produced in Malawi, Kenya, Ethiopia, Niger, South Africa, and Pakistan. I suppose I may be misunderstanding the term "local".

I think you are right. We should be able to negotiate the patent issues. Personally, I find the patenting of RUTF to be distasteful. You mentioned Mike Golden in an earlier post. As far as I am aware, he "gifted" his research. I find this commendable. I also think that "local production" is a confusing term. What we have is a franchise system with limited suppliers. The risk is that we find ourselves at the mercy of a cartel in which a large proportion of income from production is "repatriated" to European companies. I disagree about "standards". F75 and F100 are examples of evidence-based medicine developed over many years. The standard is a standard because it works. I do not think it impossibly hard or prohibitively expensive to meet the F100 standard and I think, for SAM at least, we should stick with that standard (until we have something that is both practicable and better). I think that Mark Manary's work in Malawi shows that local production of F100 RUTF is feasible. WRT fortification. I think there may be problems with GAIN's approach of "large-scale" fortification as opposed to "mass" fortification. I am also concerned that selection of vehicles for fortification be driven by mass-production rather than by consumption so you may have (e.g.) wheat flour fortified because there are 2 or 3 mills producing it but rice is not fortified because production / distribution is decentralised when rice is the main staple. This is a species of "large-scale" vs. "mass" issue. GAIN are currently engaged in extensive M&E of their programs. If we set aside the issues of "large-scale" vs. "mass" issue ... There is little doubt that universal fortification works. This is the predominant mode of intervention in many Western countries. For example, in the UK, non-dairy spreading fats (margarines) are fortified (this tends to target poorer households), table salt is iodised, bread / wheat flour is fortified, water is fluoridised (prevents dental caries). In many countries that I work in (Africa and Asia) mass distribution of vitamin A to children and mothers post-partum is the rule as is iron / folate supplements given free to pregnant women. Mass distribution of anti-helminthics is also common. This is a far more cost-effective approach than "supplement upon diagnosis" as diagnosis is only possible late in the deficiency, expensive, and may have limited coverage. With fortification of staples you exploit existing distribution structures and so simplify logistics. I have no idea why this is "sensitive" since it is standard practice. Some degree of population-level targeting may be desirable in a large country such as India or Sudan. Then you would survey and fortify at regional levels. Even then it might be cheaper to fortify at the national level.