Persistent high rates of child mortality in subSaharan Africa and South Asia will not be reduced if malnutrition is not addressed more aggressively. This is a medical emergency.

MSF teams see the devastating impact of childhood malnutrition every day, having treated more than 150,000 children in 99 programmes in 2006. Malnutrition weakens resistance and increases the risk of dying from pneumonia, diarrhoea, malaria, measles and AIDS, five diseases that are responsible for half of all deaths in children under five. Despite its overwhelming contribution to child mortality and its impact on longterm health, treatment of malnutrition has not been a high enough priority in international and national public health planning and programming.

Deprived of essential nutrients a young child will stop growing. Those that survive are often scarred by longterm consequences that include stunted growth and developmental delays, as well as an increased risk of chronic disease and lower life expectancies as adults.

Severe wasting in early childhood is common in large areas of the Sahel, the Horn of Africa and South Asia, which are the world’s “malnutrition hotspots”. If nutritional deficiencies become intense a child will begin to waste – to consume its own tissues to obtain needed nutrients. The World Health Organization (WHO) estimates that there are 20 million young children with severe acute malnutrition at any given point in time.

A new generation of simple, highly nutritious ready-to-use food (RUF) specifically designed for young children has greatly expanded the potential for effective nutritional interventions. Despite accumulated evidence of therapeutic RUF’s effectiveness - high cure rates, low mortality and low default rates – only about 3% of children with severe acute malnutrition have access to therapeutic RUF.

Inadequate policies increase the risk of childhood deaths

Current national and international policies to address malnutrition have fatal flaws. Many programmes designed to reduce mortality of children under five from malnutrition focus on changing behaviours of mothers, supplying enriched blends of flour and addressing poverty or food security. These strategies are important but do not effectively meet the needs of malnourished children under the age of three. Mothers in the Sahel, the Horn of Africa or South Asia don’t just need advice about how to feed their children. They need access to highly nutritious therapeutic and supplemental foods.

Ready-to-use food to address a medical emergency

In the last five years, the use of therapeutic ready-to-use food has radically changed the approach to the treatment of severe acute malnutrition. It is now possible to treat uncomplicated or stabilised cases of severe malnutrition as outpatients. The vast majority of malnourished children can now take treatment at home, under the supervision of their mother or other caregiver, instead of in hospital. There is accumulated evidence of therapeutic RUF’s effectiveness. When it comes to the treatment of life-threatening forms of malnutrition in malnutrition hotspots, therapeutic RUF should be considered an essential medicine.

Given their effectiveness, the use of RUF should not be limited to children with severe acute malnutrition. It should be expanded to address malnutrition in young children before it progresses to a life-threatening stage.

While effective RUF alternatives exist, donors and UN agencies are still shipping hundreds of thousands of tons of enriched blended flours to be distributed as supplementary foods, even when the effectiveness of this strategy has proven to be limited for children under the age of three