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Simplified protocol - RUSF SAM treatment

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 1 replies.

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Anonymous 24408

Normal user

6 Mar 2019, 06:14

As per the MAM Decision Tool, there is a recommendation to use expanded admissions criteria to admit children 6-59 months classified with MAM into the OTP (MUAC <125mm), or SAM into SFP (<125mm without lower limit), as a temporary
measure in emergency situations when either SFP or OTP are not available. The aim is to avert deaths in SAM children by giving RUSF (when RUTF is not available); and treat MAM cases in OTP with RUTF (when RUSF is not available) so that malnutrition does not become lifethreatening. The dosage of RUTF/RUSF recommended is: MUAC <115mm 2 RUTF or RUSF/day; MUAC between 115mm - <125mm- 1 RUTF or RUSF/day.

Pilots studies/ operational experience has been documented using optimised dose of RUTF for SAM and MAM.

What are thoughts on conducting pilot studies using RUSF as the single product for SAM and MAM treatment?

- Aiming to 'Do No Harm' is there any potential risk that recovery, weight gain, linear growth... could be compromised in SAM children (MUAC<115mm) receiving RUSF compared to those who would have received RUTF?
- What are thoughts also in using RUSF vs RUTF for kwashiorkor +/++ children?
- How about RUSF vs RUTF in SAM children who are also stunted?

Or given that the nutrient content of RUTF is very similar to RUSF could it be considered that treatment outcomes in SAM children (MUAC<115mm or kwashiorkor +/++) will likely be the same regardless of whether they receive 2 sachets of RUSF or 2 sachets of RUTF?

Tamsin Walters

en-net moderator

Forum moderator

24 Jul 2019, 09:39

Dear Anonymous,

Apologies for the delay in response to your question. As you are aware, there is a group focused on developing evidence around simplified approaches and we have been seeking a response from them to your question.

Sophie Woodhead from UNICEF has shared that this approach is currently being tested in Chad, and children’s progression closely monitored, to ensure a Do No Harm approach. 

There is a new community of practice around simplified approaches here: 

en-net has also just launched a new forum area to specifically discuss simplified approaches and I will re-post your question there for further input. 

Best wishes,


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