I have a related question. Would anybody be able to explain the process for local companies getting certified that their ready-to-use food is safe and acceptable for use in treating SAM and/or MAM?

Dear Dianne There are a couple of separate issues here. Maybe i can just say something for RUTF products as this is something we are currently working on. For RUTF we have a technical specification to which all RUTF products should adhere, agreed by WHO,UNICEF,UNHCR, and WFP and published in the joint statement on community-based management of severe acute malnutrition. Also we have a quality assurance protocol that UNICEF, MSF and Clinton foundation have developed. This is not an 'international standard' rather something developed by the main purchasers of the product for the purposes of assessing in particular new local producers of the 'plumpynut' formula RUTF. On top of this we are currently in the situation of having various new producers of RUTF mushrooming and it has become clear that there is a need for increased guidance on for example stability and acceptability testing of products and on particular issues not covered in the technical specification such as phytate content. As a first step to looking at these issues and in order to make sure we are safeguarding the quality and safety of the product we are convening a small group of technical experts to advise us at UNICEF on these additional areas of guidance/standards. This will then be shared with other purchasers and could potentially lead to approaching WHO for ammendment/strengthening of the existing technical specification. Tanya

Thank you for this response!

Dear Caroline I am pretty sure that there are a great deal of unpublished data on efficacy of these new products. At the recent WHO meeting on nutritional requirements for the moderately malnourished there were a number of presentations of data on efficacy of different products for treatment of moderate malnutrition by different research groups. It is likely that if you contact Valid, Oxford Brookes,, Lipids Based Supplement Research Group (Prof Dewey) and possibly Mark Mamary that they can point you in the direction of some of these data. One of the issues that came up at the WHO meeting was that there is no agreed protocol for testing efficacy of new products- although Carlos Navarro did present a potential protocol. A related issue is that any protocol will have to overcome a number of methodological difficulties, e.g. making assumptions about spontaneous recovery (will not be so relelevant for SAM compared to MAM), different implemenation standards between agencies or in different programme sites, different contexts for different populations, etc. Again, reference to experiences of SFP and treatment of moderate malnutrition is relevant here. In the SC UK/ENN retrospective study on emergency SFPs conducted between 2004-6, recovery rates using similar formulations of CSB varied between 40% and 100%. Hope this helps Jeremy

Caroline, I passed this question to Valid International for a technical input and received the following response: As yet no efficacy/effectiveness studies have been carried out in children with these products. We have data for adults using Chickpea Sesame RUTF but not for children. Children did not tolerate the Chickpea Sesame formulation. Acceptability trials of Sorghum Maize Soya RUTF have been conducted in children and the results are encouraging.