guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM In-patient: Transition phase 102
Even if the child is going to remain in a facility for recovery-phase, RUTF can be given for transition
phase and subsequently; this relieves the burden on the staff of making up feeds frequently. It also
means that there does not need to be a kitchen for the in-patient facility; this allows decentralisation of
in-patient treatment to day-care (residential or non-residential) facilities at health centre level.
Warning: F100 should never be given to be used at home. F100 is always prepared and distributed in
an in-patient unit by staff trained in its use. F100 should not be kept in liquid form at room temperature
for more than 3 hours before it is consumed, if there is a functioning refrigerator, constant electricity
and a very clean kitchen/ utensils, then it can be kept (cold) for up to 8 hours (i.e. overnight). A whole
day’s amount should never be made up at one time even with adequate refrigeration.
RUTF can be used both in in-patient and out-patient programmes, does not require refrigeration and
can be taken straight from the sachet.
Table 16: Look up table for RUTF in Transition Phase per 24h
Class of Weight Paste Sachets BP100
gram Sachets Bars
3 - 3.4 90 1.00 1.5
3.5 - 3.9 100 1.00 1.5
4 - 4.9 110 1.25 2.0
5 - 5.9 130 1.50 2.5
6 - 6.9 150 1.75 3.0
7 - 7.9 180 2.00 3.5
8 - 8.9 200 2.00 3.5
9 - 9.9 220 2.50 4.0
10 - 11.9 250 3.00 4.5
12 - 14.9 300 3.50 6.0
15 – 24.9 370 4.00 7.0
25 - 39 450 5.00 8.0
40 - 60 500 6.00 10.0
Total
The amounts given in the table are for the full 24h period. The amounts represent an average increase
in energy intake of about one third over the amount given during acute-phase. However, this varies
between an increment of 10% and 50% depending upon the actual weight of the child and the product
used.
There are several products that are currently available:
Kcal
500
550
600
700
800
1000
1100
1200
1350
1600
2000
2500
2700
� RUTF Paste is a manufactured (either locally or imported) anhydrous paste made up of dried
skimmed milk, sugar, oil, vitamin & mineral mix and a flavouring - usually peanut butter. It
contains about 5.4 kcal/g and is normally available in plastic pots of up to 250g or sachets of