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Simplified protocol - RUSF SAM treatment

This question was posted the Simplified Approaches for the Management of Acute Malnutrition forum area and has 5 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?


Forum Moderator, ENN

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.

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,


N.B. This post has been edited to remove reference to a UNICEF project, as requested by UNICEF.


Freelance Nutritionist

Normal user

8 Dec 2019, 11:28

Your question is very important, SAM and MAM are the life threatening conditions, in my country this situation is very alarming, as a developing country we are facing so many problems, RUTF is not available and RUSF is available, but RUTF is used to treat SAM and RUSF is used to deal MAM, so the government requested WFP to conduct the research on the modified formula of RUSF, I am sharing the link of this detailed article, I hope it would give the important information.


As a nutritional professional I know, SAM is a serious condition, it requires the urgent treatment, but I think the RUTF is more suitable than RUSF for SAM, because it is prepared according to the standard defined by WHO. Modified formula of RUSF requires the comprehensive research.

As well the kwashiorkor is the severe protein malnutrition; the child should be stabilized first by giving RUTF diet treatment. We can’t take any risk at this critical stage.



Normal user

9 Dec 2019, 13:33

When I Iook at the composition comparison table, the specifications of Acha mum are pretty much the same as those of the UNICEF RUTF with a few differences.  Would it then not be more clear to say that the reserach is aimed at looking how effective the localy prodouced RUTF (that is currently being used as RUSF) is in treating SAM instead of calling it RUSF?


Freelance Nutritionist

Normal user

10 Dec 2019, 09:29

 I want to share these paragraphs of this article.

(Children with SAM (MUAC <11.5 cm and/or with bilateral pitting oedema [+, ++]) with appetite and without medical complications will receive either Acha Mum or RUTF through trained healthcare workers at the basic health units)

(WFP will be responsible for procurement, labelling and distribution of RUTF and Acha Mum during the study. WFP will distribute the RUTF and Acha Mum to the AKU field office in Umerkot district, from where it will be distributed to the clinics on a weekly basis)

I mean to say “Acha Mum” is the specific modified form of RUSF. It could be given to children with SAM who are in a stable condition (without any medical complication), But Acha Mum is allowed to give under the supervision of trained health worker in this region of Pakistan (Umerkot district).

Marie McGrath


Frequent user

11 Dec 2019, 22:11

Dear Martha and Umbreen,

For those who want to see the details, Figure 1 in the Field Exchange article that Martha shares describing the planned research with adapted Acha Mum in Pakistan, compares its nutrient profile with that of RUTF.   As you will see they are comparable, with the 'RUSF' aligning very closely to a RUTF profile. 

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