Dear Rogers, Difficult to answer your question without knowing more about the formula you are talking about, in particular about its nutritional composition. In any case, to be considered as an infant formula, it should be consistent with the relevant Codex standard Codex Stan 72 available at: http://www.codexalimentarius.net/web/standard_list.do?lang=en . See in particular nutritional composition in section 3. If this formula is not consistent with this standard, or if you don't know, don't use it.

Thanks Andre I have not seen the RTUIF and do not know its Nutrition composition . I learnt about the product while reading an article on Haiti Earthquake Response , which indicated that RTUIF was procured and carefully used during the response. I wanted to know more about RTUIF and In what situations/contexts RTUIF is appropriate without breaching the codes. Thanks

Dear Roger, Your question is a very relevant one, that has been discussed in a lot of circles during and after the Haiti response. The ready to use infant formula, as you say, does not require reconstitution with water and so removes that particular risk associated with preparing powered infant formula. However there remain many many risks associated with its use - once open it is a rich medium for bacterial growth, caregivers will require access to water and fuel for sterilising feeding equipment, will require supplies for as long as the infant needs it, and criticially, its use requires targeting to those infants that are not breastfed and have no other safer option for feeding, eg maternal breastfeeding or breastmilk, wet nurse. It is not a safe option by any standard, just may be a less risky one for infants who need artificial feeding, as in the Haiti context. Other considerations are it is bulky, logistically a challenge and costly. Informed by experiences in the Philippines and then Haiti, an amendment was made to the Operational Guidance on IFE to reflect considerations around artificial feeding in emergencies and made specific reference to RUIF. See it at [url]http://www.ennonline.net/pool/files/ife/insert-operational-guidance-6-3-2-addendum-2010-final.pdf[/url] In terms of the International Code and the Operational Guidance on IFE, the same requirements and provisions regarding breastmilk substitute use apply to ready to use infant formula. At at recent strategy meeting by the IFE Core Group (an interagency collaboration concerned with policy and practice on IFE), we identifed lesson learning and experience gathering on the artificial feeding intervention from Haiti as a priority in the sector. This concern is also shared by members of the Global Nutrition Cluster and the GNC Coordinator, and we are looking to work together to make this happen. Once we have any experiences and details of 'how to do', I'll share them on this forum. Best regards Marie www.ennonline.net/ife

There are RTUIFs available that meet Codex standards. In considering whether it might be an appropriate product to use in an individual circumstance the follow should be understood. 1) Regardless of RTUIF being a sterile product it still damages the gut of infants and retards the development of the immune system and thus still facilitates infection. It is still a dangerous product that should only be used if breastmilk cannot be made available. All of the cautions and support required for the use of PIF are also required for the use of RTUIF. 2) Use of RTUIF still requires the a considerable amount of clean water and fuel for cleaning feeding implements. In fact the greatest amount of water and fuel required when using powdered infant formula is for cleaning. 3) Education of caregivers is still vital- especially in the issue of discarding unused infant formula immediately- RTUIF must be provided in "single serve" portions which of course may not be used at a single feed. Discarding of food is difficult and this challenge should not be underestimated. 4) Introduction of RTUIF to a context where it has not been previously available raises the possibility of opening a new market for the product with associated long term negative outcomes for mothers and infants. It appears that this may be happening in Haiti and that the earthquake response has created a new market for manufacturers.

Thanks Marie and Karleen for the response Thanks for the link to the "Addendum to Operational Guidance on IFE (v2.1, 2007) 2010 '. Rogers