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Urgent question for treatment of AM in besieged areas of Syria with NO access to RUTF

This question was posted the Management of wasting/acute malnutrition forum area and has 5 replies.

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Óscar Serrano Oria

Unicef UK. Nutrition and ECD Programmes Specialist

Normal user

20 May 2015, 15:43

Published on behalf of the Nutrition cluster in Syria: "There are some partners starting work in IMAM in the besieged areas of Homs. There is no way that RUTF or F75/100 can be brought in. They want advice on how to make alternatives using local resources. They mentioned wheat and vegetables as being available so I assume wheat flour. I know this is a very difficult thing to do as they currently have no training. Being wheat the only staple available, it is important to know if there is any adverse effect of that grain in the metabolism of the AM children and I believe that it is not an option anyway for children with SAM and medical complications at the SC." Please, only answer if having current expertise in the subject, it is a very urgent question and requires immediate solutions, if there are. Thanks to everyone. Óscar Serrano Oria


Forum Moderator, ENN

Forum moderator

20 May 2015, 22:04

Just to add, Óscar informed us that a comprehensive list of available foods is being generated now so there will be more information coming shortly. Thanks for any advice.

André Briend

Frequent user

22 May 2015, 06:03

Dear Oscar, Using a wheat based diet to treat MAM chidren is quite possible. The only problem you can face is to come across malnutrition related to gluten intolerance, for which a wheat based diet will not work, and even can do harm. But I guess this will not be the most common form of malnutrition in the present situation. Other foods will have to be given in addition to wheat, in particular legumes to balance the proteins. Difficult to tell you which foods to add, not knowing what is locally available. In any case, I suggest you try to combine local foods using a nutrient calculator, such as nutval ( to attempt to approach recommended values for MAM children (see : For SAM, if you have no access to F75, and RUTF, the same process should be followed. Better a balanced wheat based diet based on locally available foods than no food to treat these children. I hope this helps

Anne Walsh

Normal user

24 May 2015, 15:08

Dear Oscar and all, In a current CMAM pilot in Odisha, India children are enrolled in a study comparing treatment with a standard RUTF type recipe, and a modified take home ration using wheat and other locally available foods. The findings are showing that SAM children do make a better recovery on a standard RUTF type recipe (peanuts, milk powder, sugar, oil, CMV) but they also make a good recovery on the modified take home ration that has a base of 62.5% wheat, plus Bengal gram, peanuts and sugar. A wheat based recipe will be effective, but as André says, it will need to be balanced with other ingredients. Depending on the raw materials available efficacy of alternative recipes may be lower but still beneficial. Of course the most important action is to identify acutely malnourished children early and ensure they get supplementary food to prevent deterioration. If more information about the study would be useful please contact: Hope this is helpful

Rita Bhatia

Senior Advisor

Normal user

24 May 2015, 16:33

To complement Anne and Andre's response - for India CMAM take home ration also include ghee ( local fat ) in addition to roasted wheat flour, roasted Bengal gram dal ( split chick pea or lentils), roasted peanut and sugar. This is used for SAM children with no medical complication and eventually may be used for MAM as well. So in conclusions - local ingredients can be used in the absence of RUTF.

Andrew Musyoki

Nutrition Specialist; UNICEF

Normal user

30 May 2015, 10:18

Treatment of children with locally constituted alternative of therapeutic products is possible. In Bangladesh, this has been done successfully in hospital settings. There is of course the risk of gluten intolerance but I guess it would present in very few cases. I am willing to share the recipes that are used in Bangladesh. Please do send me an email at:

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