title: Ready-to-use foods for management of moderate acute malnutrition: considerations for scaling up production and use in programs.
abstract: Ready-to-use foods are one of the available strategies for the treatment of moderate acute malnutrition (MAM), but challenges remain in the use of these products in programs at scale. This paper focuses on two challenges: the need for cheaper formulations using locally available ingredients that are processed in a safe, reliable, and financially sustainable local production facility; and the effective use of these products in large-scale community-based programs. Linear programming tools can be used successfully to design local compositions that are in line with international guidelines, low in cost, and acceptable, and the efficacy of these local formulations in the treatment of MAM was recently demonstrated in Malawi. The production of local formulations for programs at scale relies on the existence of a reliable and efficient local production facility. Technical assistance may be required in the development of sustainable business models at an early stage in the process, taking into account the stringent product quality and safety criteria and the required investments. The use of ready-to-use products, as of any food supplement, in programs at scale will be affected by the practice of household sharing and diversion of these products for other uses. Additional measures can be considered to account for sharing. These products designed for the treatment and prevention of MAM are to be used in community-based programs and should therefore be used in conjunction with other interventions and designed so that they do not replace the intake of other foods and breastmilk. Remaining challenges and implications for the (operations) research agenda are discussed.
authors.forename: Saskia
authors.initials: S
authors.lastname: Osendarp
authors.forename: Beatrice
authors.initials: B
authors.lastname: Rogers
authors.forename: Kelsey
authors.initials: K
authors.lastname: Ryan
authors.forename: Mark
authors.initials: M
authors.lastname: Manary
authors.forename: Peter
authors.initials: P
authors.lastname: Akomo
authors.forename: Paluku
authors.initials: P
authors.lastname: Bahwere
authors.forename: Hilina
authors.initials: H
authors.lastname: Belete
authors.forename: Mamane
authors.initials: M
authors.lastname: Zeilani
authors.forename: Munirul
authors.initials: M
authors.lastname: Islam
authors.forename: Filippo
authors.initials: F
authors.lastname: Dibari
authors.forename: Saskia
authors.initials: S
authors.lastname: De Pee
mesh_terms: D015362:Child Nutrition Disorders / Q000178:diet therapy; D002675:Child, Preschool; D003153:Community Health Services; D003365:Costs and Cost Analysis; D019587:Dietary Supplements; D005502:Food; D005511:Food Handling / Q000379:methods; D005526:Food, Formulated / Q000191:economics; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000178:diet therapy; D007231:Infant, Newborn; D008295:Malawi; D044342:Malnutrition / Q000178:diet therapy* / Q000517:prevention & control; D018673:Nutrition Policy; D011382:Programming, Linear