LIFE

Peanut paste not a solution for severe malnutrition: study

Deaths due to severe acute malnutrition (SAM) in India could be about a tenth of what was earlier believed, which implies that instead of taking emergency measures such as providing Ready To Use Therapeutic Food (RUTF), there needs to be a focus on non-food interventions such as sanitation, health, clean drinking water along with an emphasis on nutrition, suggests a new study published in a peer-reviewed medical journal on Wednesday.

The paper, published in PLOS Medicine , provides new evidence at a time when inter-ministerial discussions are under way on formulating guidelines for nutritional management of SAM children and when policymakers and experts are divided on the issue of providing either RUTF or locally-made energy-dense food.

During the study, the researchers observed 2,704 children in West Singbhum district in Jharkhand and Kendujhar district in Odisha, who were born between October 1, 2013 and February 10, 2015 and alive at six months of age. They were followed up at 9, 12 and 18 months.

Risk of death

The research found that there were total 513 SAM children, of which six died — four within six months of the start of the episode, and two after six months. The fatality for SAM was 0.8% (4/513) within 6 months and 1.2% overall (6/513).

These figures are much lower than the 10%-20% range for SAM fatality estimated by WHO and often cited by policy makers for prescribing remedial methods. Moreover, 99% of all children with SAM at 6 months of age (227/230) were alive 3 months later, 40% (92/230) were still SAM, and 18% (41/230) had recovered.

“There are multiple attempts to show that Severe Acute Malnutrition is an acute emergency situation and that afflicted children will either die or never “recover” unless “magical therapeutic food” (RUTF) is provided. We have busted this myth. Mortality in SAM is very low over six months to one-year period and spontaneous recovery occurs in a substantial proportion. In fact, after 32 weeks of starting RUTF (given for 16 weeks), the recovery rates in our studies without CMAM are broadly comparable to any therapeutic food (augmented home based or RUTF, both of which are equal). Thus, the current Indian evidence indicates scare mongering over SAM is unwarranted. These children are not merely nutrition starved, but are hungry for development,” Professor H.P.S. Sachdev, a paediatric consultant at Sitaram Bhartia Institute for Science and Research, who co-authored the study, told The Hindu .

Preventive measures, apt nutrition counselling, and care for illnesses are vital aspects of SAM management, he added.

According to WHO, RUTF is a thick paste of peanuts, vegetable oil, sugar and milk powder and a complex of vitamins and minerals.

The findings echo results from three other Indian studies, which found fatality rates for SAM to range between 2.7% to 5.2% among children older than 6 months.

Tracking weight

The study also explains that the most vulnerable children probably died before reaching six months, which is before a child begins complementary feeding along and treatment with RUTF becomes relevant. These deaths are due to pre-mature birth or low birth weight — factors that account for 46.1% of all deaths of children under five years in 2017.

According to government data shared before Parliament, there were 93.4 lakh SAM children based on National Family Health Survey-4 conducted in 2015-2016.

Recommended for you