PATH India, New Delhi, India.
Indian Pediatr. 2010 Aug;47(8):702-6. doi: 10.1007/s13312-010-0096-0.
Limited resources for hospitalized treatment of Indias nearly 8 million children with severe acute malnutrition (SAM) make community management of SAM a priority. Capability to produce sufficient quantities of Ready to Use Therapeutic Food (RUTF) is one component of preparedness for community management of SAM. Production of RUTF is a simple process that consists of grinding, mixing and packaging using widely available equipment. Nitrogen flush packaging increases shelf life to 2 years though it is the most expensive and slowest step of the production process. Being a therapeutic product, quality and safety must be ensured including aflatoxin measurement and estimation of micronutrient and macronutrient content consistently. RUTF can be made in India in several production models (i) Dairy cooperatives and private manufacturers can produce large quantities to meet regional requirements, (ii) small and niche food manufacturers can produce smaller volumes but have a major presence in most parts of India; and (iii) hand made RUTF can be made by village industries for immediate local consumption. All the ingredients and equipment for RUTF are widely available in India RUTF is already being produced in India for export. Concerns from various sections of society will need to be heard before community management of SAM using therapeutic, processed nutritional products can begin. Despite apprehensions about processed RUTFs or the sections of the public health community that press for its use, withholding alternative treatment for one of the largest killers of Indias children must not be the option. It is time public health/ medical communities and civil society come together to make effective community management of SAM an immediate reality.
印度约有 800 万重症急性营养不良(SAM)患儿需要住院治疗,而医疗资源有限,因此社区管理 SAM 成为当务之急。具备生产足够数量的即食治疗食品(RUTF)的能力是 SAM 社区管理准备工作的一个组成部分。RUTF 的生产过程较为简单,包括使用广泛可用的设备进行研磨、混合和包装。氮气冲洗包装可将保质期延长至 2 年,但这是生产过程中最昂贵和最慢的步骤。作为一种治疗性产品,必须确保质量和安全,包括黄曲霉毒素测量和估计微量营养素和宏量营养素的含量。印度可以采用几种生产模式生产 RUTF:(i)奶制品合作社和私营制造商可以生产大量产品,以满足地区需求;(ii)小型和利基食品制造商可以生产较小的数量,但在印度大部分地区都有很大的存在;(iii)乡村工业可以生产手工 RUTF,以满足当地即时消费。RUTF 的所有原料和设备在印度都广泛供应,印度已经在生产 RUTF 用于出口。在开始使用治疗性加工营养产品进行 SAM 社区管理之前,需要听取来自社会各界的意见。尽管有人对 RUTF 或公共卫生界要求使用它的部分持保留意见,但不能将替代治疗重症急性营养不良这种印度儿童最大杀手之一的方法拒之门外。现在是公共卫生/医疗界和民间社会共同努力,将 SAM 的有效社区管理变为现实的时候了。