Nutritionists oppose new ready-to-use therapeutic food for malnourished children in Bangladesh

A fresh debate has started in Bangladesh over a new ‘ready-to-use therapeutic food’ for treating children suffering from the worst form of malnutrition.

Bangladesh Breastfeeding Foundation (BBF), which had led the earlier campaign against marketing a French company’s peanut butter ‘Plumpy Nut’ meant for treating acute malnutrition, is back with a fresh campaign.

The government did not allow the marketing of Plumpy Nut in Bangladesh in 2011.

This time, the debate started after the ICDDR,B scientists produced a similar ‘ready-to-use therapeutic food’ (RUTF) but with “local ingredients”.

The same company that marketed Plumpy Nut, Nutriset, helped in the research.

The BBF at a press briefing on Thursday protested against the new product, asking the government not to buy it.

ICDDR,B had said earlier that the effect of their Sharnali-1 and Sharnali-2 diets were similar to those of Plumpy Nut but were based on locally available food.

One is based on rice and lentils, and the other on chickpeas. Both contain milk powder, soyabean oil and micronutrients.

“As they (Nutriset) failed to introduce this (Plumpy Nut) in Bangladesh, they funded the research so that a product based on local food could be marketed,” BBF Chairperson Dr SK Roy said.

“It’s a step to commercialise the whole thing by taking a product-based approach,” Dr Roy, a former ICDDR,B senior scientist, said.

The ICDDR,B had earlier said their solutions would help treat children without admitting them to hospitals.

But the BBF said the challenge was to identify the children with acute malnutrition, not treating them.

“We already have standard protocol to treat them,” he said.

Bangladesh has an estimated 5,000,000 children with acute malnutrition, down from 600,000 estimated four years ago.

Leading paediatrician and BBF advisor Prof MQ-K Talukder was also present at the press briefing.

He pointed to the use of powdered milk in the new RUTF and said “eventually they are going to promote powdered milk”.

“The powdered milk disaster will now be compounded with the beginning of the RUTF disaster,” he said.

“It will be the unfortunate children from poor families who would fall victim to greedy multinationals,” he said.

“With the involvement of private sector, which funds them, the UN agencies, too, have started taking product-based approach across the world.

“We have to be cautious,” he said, adding that India had banned Plumpy Nut in 2008.

The BBF presented their own study showing mothers with proper feeding practices helped improve nutrition status.

It suggested special efforts to identify all children with severely acute malnourishment.

The current practices for feeding the infant and the young, it said, will provide the “appropriate and correct” solution for children with severe malnutrition.

The current practices are six months of exclusive breastfeeding and then home-made food along with breastfeeding for two years.

“The government, development partners and NGOs should all work together on this instead of looking for a ‘quick-fix’ with high-energy content infant food,” the BBF said in a written statement.

Dr Tahmeed Ahmed, Director, the ICDDR,B Nutrition and Food Security department  who led the research, told bdnews24.com  they had developed product based on the government’s guideline.

“The government published the guideline in 2011 on how to treat severe malnourished child and it clearly said that it must be based on food.

“Our research showed that the effects of our local food-based products are the same as the imported products.

 “It’s up to the government to buy or not,” he said.

An assistant director at the government’s nutrition institute, IPHN, Dr Taherul Islam Khan, said they had not taken any decision on the new RUTF yet.

“We have protocols on treating children with severe malnutrition. We cannot go beyond our rules,” he said at the BBF press briefing.

The BBF and IPHN work closely on the implementation of breast milk substitute code (BMS) that bans powdered milk companies to target children below five years of age.