title: Acceptability of locally produced ready-to-use therapeutic foods in Ethiopia, Ghana, Pakistan and India.
abstract: Successful treatment of severe acute malnutrition has been achieved with ready-to-use therapeutic food (RUTF), but only 15% of children with severe acute malnutrition receive RUTF. The objective of this study was to determine whether new formulations of RUTF produced using locally available ingredients were acceptable to young children in Ethiopia, Ghana, Pakistan and India. The local RUTFs were formulated using a linear programming tool that allows for inclusion of only local ingredients and minimizes cost. The study consisted of 4 two-arm, crossover, site-randomized food acceptability trials to test the acceptability of an alternative RUTF formula compared with the standard peanut-based RUTF containing powdered milk. Fifty children with moderate wasting in each country were enrolled in the 2-week study. Acceptability was measured by overall consumption, likeability and adverse effects reported by caregivers. Two of the four RUTFs did not include peanut, and all four used alternative dairy proteins rather than milk. The ingredient cost of all of the RUTFs was about 60% of standard RUTF. In Ethiopia, Ghana and India, the local RUTF was tolerated well without increased reports of rash, diarrhoea or vomiting. Children consumed similar amounts of local RUTF and standard RUTF and preferred them similarly as well. In Pakistan, local RUTF was consumed in similar quantities, but mothers perceived that children did not enjoy it as much as standard RUTF. Our results support the further investigation of these local RUTFs in Ethiopia, Ghana and India in equivalency trials and suggest that local RUTFs may be of lower cost.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Jacklyn M
authors.initials: JM
authors.lastname: Weber
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Kelsey N
authors.initials: KN
authors.lastname: Ryan
authors.affiliation: Action Contre La Faim, Baran, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Tandon
authors.affiliation: Action Contre La Faim, Baran, India.
authors.forename: Meeta
authors.initials: M
authors.lastname: Mathur
authors.affiliation: College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Tsinuel
authors.initials: T
authors.lastname: Girma
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Legon, Ghana.
authors.forename: Matilda
authors.initials: M
authors.lastname: Steiner-Asiedu
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Legon, Ghana.
authors.forename: Firibu
authors.initials: F
authors.lastname: Saalia
authors.affiliation: Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Shujaat
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Department of Pediatric and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Sajid
authors.initials: S
authors.lastname: Soofi
authors.affiliation: Agricultural and Biological Engineering Department, Purdue University, West Lafayette, Indiana, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Okos
authors.affiliation: Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.|Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D002675:Child, Preschool; D003258:Consumer Behavior; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005002:Ethiopia; D057140:Fast Foods; D005240:Feasibility Studies; D005260:Female; D005504:Food Analysis; D005526:Food, Formulated; D005869:Ghana; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000178:diet therapy*; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D010154:Pakistan
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D004044:Dietary Proteins
keywords: child feeding; community-based; developed countries; food consumption; malnutrition; pre-school children