Funding for the treatment of malnutrition: a need for greater transparency

The Editors
1
The Lancet
A thirst for action.

highlight the gap between the humanitarian need to treat millions of children suffering from severe acute malnutrition and the amount of funding available. However, I fear that focusing only on supply-side issues misses a major problem in the cost-effective use of funding. One example is the UN’s adherence to the non-evidence-based stipulation that ready-to-use therapeutic foods (RUTFs) must contain at least 50% of their protein from dairy products. This 2007 stipulation corresponded to the only recipe available at the time. Subsequently, highly effective and less expensive herbal RUTFs were developed and found to be clinically effective.

2
  • Bahwere P
  • Akomo P
  • Mwale M
  • et al.
The ready-to-use therapeutic food based on soy, maize and sorghum with amino acids is as effective as the standard formulation based on milk and peanut paste for the treatment of severe acute malnutrition in children : an individually randomized controlled non-inferiority clinical efficacy trial in Malawi.

,

3
  • Akomo P
  • Bahwere P
  • Murakami H
  • et al.
Ready-to-use therapeutic foods made from soybeans, maize and sorghum are more effective in correcting anemia and iron deficiency than standard ready-to-use therapeutic food: randomized controlled trial.

,

4
  • T-band
  • Chawanda K
  • Tsuchida W
  • Kathumba S
Report of a pilot program using a milk-free ready-to-use therapeutic food made from soybeans, maize and sorghum to treat severe acute malnutrition.

Strong data from randomized controlled trials show that a novel plant-based RUTF enriched with amino acids is not inferior to the milk-based recipe for all major treatment outcomes, and is superior in the treatment of anemia and iron deficiency.

It took the WHO 4 years from the publication of the trial data to organize a revision of their dairy stipulation. By their own admission, they did not carry out a cost-effectiveness analysis in accordance with their terms of reference.
5
Despite the pressure, the WHO review maintains the status quo on the treatment of malnutrition.

The WHO relied solely on a meta-study that pooled data from the effective amino acid-enriched recipe with five other very different recipes. Pooling data from five ineffective recipes with the effective recipe naturally served to mask its effectiveness.

By focusing only on increasing funding without addressing the cost-effective and transparent use of resources, it is difficult to see how donors will have sufficient confidence in the system to provide the funding needed.

I am an unpaid director on the boards of the Irish and UK charities Valid Nutrition. Valid Nutrition is a charity that has worked to develop and test a ready-to-use therapeutic plant-based food enriched with amino acids.

References

  1. 1.

    A thirst for action.

    Lancet. 2022; 3991991

  2. 2.
    • Bahwere P
    • Akomo P
    • Mwale M
    • et al.

    The ready-to-use therapeutic food based on soy, maize and sorghum with amino acids is as effective as the standard formulation based on milk and peanut paste for the treatment of severe acute malnutrition in children : an individually randomized controlled non-inferiority clinical efficacy trial in Malawi.

    Am J Clin Nutr. 2017; 106: 1100-1112

  3. 3.
    • Akomo P
    • Bahwere P
    • Murakami H
    • et al.

    Ready-to-use therapeutic foods made from soybeans, maize and sorghum are more effective in correcting anemia and iron deficiency than standard ready-to-use therapeutic food: randomized controlled trial.

    BMC Public Health. 2019; 19: 806

  4. 4.
    • T-band
    • Chawanda K
    • Tsuchida W
    • Kathumba S

    Report of a pilot program using a milk-free ready-to-use therapeutic food made from soybeans, maize and sorghum to treat severe acute malnutrition.

    Food Nutr Bull. 2021; 42: 91-103

  5. 5.

    Despite the pressure, the WHO review maintains the status quo on the treatment of malnutrition.

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