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Treatment of severe acute malnutrition

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 2 replies. You can also reply via email – be sure to leave the subject unchanged.

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Issack

Normal user

15 Jan 2015, 17:19

What are the likely scenario to follow if you face supply rupture in the SC more so F75 and the few boxes you have had just expired. Is it advisable to use the expired milk for a while for instance if there is no any other SC to transfer the patients and supply will take time to come.
Can the milk which is expiring in January be used in the first quarter of February or beyond?

Jan Komrska

UNICEF Supply Division

Normal user

16 Jan 2015, 14:27

Nutrition products for management of severe and moderate acute malnutrition (RUTF, RUSF and therapeutic milk) are defined as foods, consequently they are labeled with best before date. However they also contain active pharmaceutical ingredients (vitamins and minerals). Therefore, it is important to test the content of vitamins and minerals should they need to be consumed after the best before date.

Best before date (for foods) and expiry date (for medicines) depends on storage conditions. If foods and medicines are stored as per instructions on the product label their quality will be maintained during the period defined by best before date and expiry date respectively.

Step 1: Visual inspection
Conduct visual inspection of the product. Check if the integrity of the primary packaging is not compromised, look for leakages or spills. Should the primary packaging be intact proceed to the next step, otherwise proceed to Step 4.

Step 2: Taste testing
Open the primary package, inspect visually product, look for signs of degradation (change in colour, presence of lumps, presence of insects,..) and taste the product (in case of foods requiring preparation before consumption, follow the instructions and taste food once prepared). Check specifically for consistency (homogeneity in case of ready-to-use spreads), followed by odour and taste (e.g.: rancidity). Should the colour, homogeneity, odour and taste remain acceptable continue to use the product; in case of products used in therapeutic feeding programmes, proceed to the next step, otherwise proceed to Step 4.

Step 3: Take samples and send for testing (relevant for products used in therapeutic feeding programmes)
Take samples; send samples to Lab for testing to determine levels of vitamins (e.g.: vitamin A and B which are most sensitive) remain within specifications (testing for microorganism growth may be requested at the same time too). Should test results confirm vitamin levels are still within specifications continue to use product. Should vitamin levels are out of specifications offer product to other target groups (e.g.: children with MAM, adults), if not appropriate due to context, proceed to next step.

Step 4: Disposal of product
There are several options for disposal of food products. They include following options:
1, Composting (require removing primary packaging)
2, Animal feed (require removing primary packaging)
3, Deposit into or onto land (e.g.: landfill)
4, Incineration

Stien Gijsel

Normal user

20 Jan 2015, 10:38

If the supply is not of the required quality anymore, you can also always use alternate recipes for F75/F100 using combined mineral and vitamin complex. The recipes are most of the time included in national guidelines and protocols but can also found as Annex 14 in the FANTA generic guidelines (http://www.fantaproject.org/focus-areas/nutrition-emergencies-mam/generic-cmam-materials). This might be a better solution then transfering patients.

I would be careful with giving expired milk, especially if the storage requirements were not always maintained as you are providing foods to severly malnourished children, and in the past have always send food to be tested. Maybe in the future, you might consider implementing a tracking system where you are informed when food is to expire in the coming months. This would allow you to contact UNICEF or partner organizations so the food can be used within the given time period. Of course, having said this, it has happened to all of us.

Regards,
Stien

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