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RUTF

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 12 replies. You can also reply via email – be sure to leave the subject unchanged.

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Anonymous 3527

Normal user

23 Feb 2016, 09:39

Are simplistic charts for calculation of RUTF ration required per day based on weight recommended by WHO?

Most of the RUTF sachets are packed in 92 gms can it be done in 100 gms packaging. Are there any challenges.

Valérie Captier

Nutritionist, ICRC Geneva

Normal user

23 Feb 2016, 11:02

Hi Anonymous 3527,

Several NGOs are using in OTP the below cut-off:
- Children below 8 kg --> 2 sachets of RUTF / day (1000 kcal)
- Children above or = 8 kg --> 3 sachets of RUTF / day (1500 Kcal)

The sachets of RUTF are 92 gr and they bring 500 kcal per sachet.
it is very easy to calculate the dietary treatment / prevention.

There are some initiatives to change the packaging to 100 gr for logitic constrains. On my point of view the primary objective is to ease the treament and not the logistic.
Best

Paul

Technical expert

23 Feb 2016, 17:07

2 packets of RUTF for an8 Kg child is 125 kcal / kg / day and is less than the usual recommendation of 175-200 kcal / kg / day.

There are simple RUTF tables which are more than likely provided by the relevant national guideline. I would recommend you follow those.

There are places where RUTF is produced in 100g sachets, Ethiopia I think is one and there are likely others too. These producers do export RUTF but when calculating the new knee of packets per day according the weight of the child it does not really make the calculations / tables any simpler.

Paul

Technical expert

23 Feb 2016, 17:08

Sorry about the typos! Auto spell errors!

I meant "when calculating the number of packets per day"

sandra

Director of Nutrition Projects/chifundo Org.

Normal user

23 Feb 2016, 17:23

Hi Paul,

This is very useful, I am currently dealing with malnourished children admitted at the Nutrition Rehabilitation Unit, please I need more information on the calculations of RTU as compared to age. And I had a question, are people still using the milk formula... F75 and F100?

Paul

Technical expert

24 Feb 2016, 07:38

Hi Sandra
In which country are you working?

Ekuwam

Nutritionist

Normal user

24 Feb 2016, 08:17

In Kenya we are still using Both F75 and F100
Our calculation here
F75
Assume child weight X is multiplied by 130 then divided by 8 hours
(Xx130)/8h =
(130X/8)/18Ml you get the number of spoons scoop

F100
Assume child weight X is multiplied by 150 then divided by 8 hours
(Xx150)/8h=
(150X/8)/20Ml you get the number of spoons scoop
Any one else share your formula please

Paul

Technical expert

24 Feb 2016, 09:51

The calculations noted above are dependent on context and it is important to follow any national guidelines relevant to the country in which you are working.

The situation is not as simple as indicated in the formulae mentioned above. There are different protocols for children aged less than 6 months and full strength F100 should not be used in these children. Generally, the re-establishment of breastfeeding is a primary aim of treatment.

For children aged over 6 months the use of F75 and F100 are commonplace. The type of feed used and the amount depends on the structure of the protocols. If there is a Phase 1 (stabilisation phase), Transition Phase and Phase 2 (rehabilitation Phase), the calculation of the amount to use is indicated below. If there is a CMAM programme present the method of transition from F75 / F100 to RUTF may also vary.

As a general rule of thumb:

F75 Phase 1 = 100 kcal / kg / day = 130 ml F75 / kg / day
F100 Transition Phase = 130 kcal / kg / day = 130 ml F100 / kg / day
F100 Phase 2 = 200 kcal / kg / day = 200 ml / kg / day

Note that the calculation is based on weight rather than age.

If the NRU provides only stabilisation care the unit may use only F75 for stabilisation or may use diluted F100 for children aged less than 6 months. It is recommended that national guidelines are consulted rather than adopting the sometimes inconsistent protocols used by different NGO organisations.

Shafiqullah Bashari

Sr. Nutrition Adviser - SCI in Afghanistan

Normal user

25 Feb 2016, 09:33

Hi,
The National guidelines in Afghanistan recommend:
RUTF is required in 200 Kcal/kg/day, and the matter of 92 gr is probably due the fact to make 500 Kcal/sachet. Below is the table for easy reference where you don’t need to calculate it for each child.
TABLE 14 PRESCRIPTION OF RUTF FOR CHILDREN AGED 6 TO 59 MONTHS WITH SAM
Weight of the child, kg - Packets per week - Packets per day
3.5-3.9 11 1.5
4.0-4.9 14 2
5.0-6.9 18 2.5
7.0-8.4 21 3
8.5-9.4 25 3.5
9.5-10.4 28 4
10.5-11.9 32 4.5
Greater than 12kg 35 5


Children’s treatment as inpatient should be done in three phases:
Stabilization phase:
• Treatment should be done with F-75 which produce 75 Kcal/100 ml
• The energy requirement in this phase 100 Kcal/kg/day
• For 100 Kcal 130 ml milk is required
• The preferred feeding time is every 3 hours means 8 feeds/ day
• If a child is, for example, 7 kg the simple calculation would be as follow:
7*130 = 910 ml/day, then 910/8 = 113.75 ml/feed

Transition phase:
• Treatment should be done with F-100 which produce 100 Kcal/100 ml
• The energy requirement in this phase 130 Kcal/kg/day
• For 130 Kcal 130 ml milk is required
• The preferred feeding time is every 3 hours means 8 feeds/ day
• If a child is, for example, 8 kg the simple calculation would be as follow:
8*130 = 1040 ml/day, then 1040/8 = 130 ml/feed

Rehabilitation phase:
• Treatment should be done with F-100 which produce 100 Kcal/100 ml
• The energy requirement in this phase 200 Kcal/kg/day
• For 200 Kcal 200 ml milk is required
• The preferred feeding time is every 4 hours means 6 feeds/ day
• If a child is, for example, 8 kg the simple calculation would be as follow:
8*200 = 1600 ml/day, then 1600/6 = 266.66 ml/feed

Anonymous 3540

Community Health Officer

Normal user

27 Feb 2016, 06:53

Shafiqullah Bashari, I think children less than 4kg shouldn't be given RUFT, instead they should be managed in SC

Shafiqullah Bashari

Sr. Nutrition Adviser - SCI in Afghanistan

Normal user

28 Feb 2016, 16:13

Definitely if weight is less then 4 kg and age is more then 59 months during the admission should be dealt with as a Special Case and will be treated as inpatient by milk (F75/100).

Paul

Technical expert

29 Feb 2016, 09:59

Hi Dr. Bashari,
The protocol in use may vary according to country.

A generic guideline for West Africa by Mike Golden and Yvonne Grellety:

http://www.cmamforum.org/Pool/Resources/Example-of-IMAM-protocol-West-Africa-Golden-Grellety-2012-eng.pdf

suggests a protocol for recovering infants of "less than 6 months or less than 3 kg with no prospect of being breastfed" with therapeutic milk (see Annex 20). For cases with a possibility of being breastfed, the re-establishment of effective breastfeeding should be a primary goal of treatment.

Anonymous 2824

Nutrition Coordinator

Normal user

6 May 2016, 08:45

Here is the formula for calculating RUTF Ration per Day

Assume Child weight X, multiple by 200 (200 /Kg/day) divide by 500 (One Sachet of RUTF provide 500 Kcal)

5 x 200
------------ = 2 Sachets/Day
500

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