Development and acceptability of a fish-based local ready-to-use-therapeutic food (RUTF): an intervention in pre-school children in Cambodia

Start date: 7 January, 2014 End date: 14 May, 2014 Project type: Master's Thesis (prior to 2018) Project code: A26735 Countries: Cambodia Institutions: University of Copenhagen (UCPH), Denmark Grant recipient: Remco Peters Total grant: 20,000 DKK


Background and objectives
In South-East Asia, Cambodia has the highest child mortality rate due to severe acute malnutrition (SAM). Treatment of SAM has been improved by the development and implementation of ready-to-use-therapeutic-food (RUTF). RUTF is a high energy dense paste or bar which is rich in macro- and micronutrients. Cambodia is in need for a cost-effective and locally produced RUTF made from local ingredients due to the high cost and low acceptability of imported RUTF. Fish might serve as a high cost-effective ingredient which contributes to the required protein content and quality of the RUTF for stimulating growth. In order for the RUTF to be effective, children still have to accept and consume it. The present study developed a pilot fish-based local RUTF plus tested it for acceptability in Cambodian preschool children. Secondary, changes in anthropometry were observed in order to predict the RUTF’s efficacy on nutritional status.

Important determinants for selecting the ingredients of the local RUTF (referred to as LC-RUTF) were nutritional qualities, local availability plus related costs and cultural preferences. The pilot study used a non-randomized cross-over design in order to test the LC-RUTF against the currently distributed RUTF BP-100™ for acceptance. Two classes with healthy and light/moderately malnourished children between 2 and 7 years old of a pre-school day care center in Phnom Penh were included. RUTF intake, scoring on organoleptic qualities and observed eating pattern were tools for measuring and exploring acceptability. Values for weight, height, MUAC and anthropometric indices (z-scores) were recorded for measuring impact on nutritional status.

The pilot fish-based LC-RUTF fulfilled theoretically to the required nutritional composition for recovery as set by the UNICEF/WFP. However, the LC-RUTF (and BP-100™) was not well and long term accepted (>50% for more than 75% of the consecutive days). For the LC-RUTF, class 1 had an overall higher mean intake of 222.78 g against 70.66 g for class 2, respectively. Inconsistent RUTF intake was observed along the study for both RUTF varying from 0% to 58% of the total daily offered RUTF. LC-RUTF received mixed scorings for organoleptic qualities. It received a mean final product score of 4.20 (‘good’) by class 1 and 2.30 (‘bad’) by class 2, respectively. No side-effects of LC-RUTF intake for morbidity were observed apart from nausea in class 2 due to the fish smell.
Apart from height (p< 0.001), the nutritional status of children who consumed the two RUTF over a 4 week period and finished at baseline (n=27) did not improve significantly.  

Conclusions and perspectives
Several steps in further development have to be taken in order to deliver a wide socially accepted local fish-based RUTF. However, the present study suggests that fish can be a highly potential ingredient for local RUTF production in Cambodia and it builds on other research by showing that local RUTF production, and staffing is possible in a resource-limited setting.
A large-sample efficacy study including children with SAM is needed to test the final local RUTF’s effectiveness on recovery in nutritional status.