EFFECTIVENESS OF READY-TO-USE THERAPEUTIC FOOD (RUTF) IN THE TREATMENT OF MARASMUS AT DUTSE GENERAL HOSPITAL, JIGAWA STATE

INTRODUCTION

1.1 Background of the Study

            Malnutrition remains a major public health problem, particularly among children under five years of age in developing countries. Marasmus, a severe form of protein-energy malnutrition, is characterized by extreme wasting of fat and muscle tissues resulting from prolonged deficiency of dietary energy. The introduction of Ready-to-Use Therapeutic Food (RUTF) has revolutionized community-based management of acute malnutrition (CMAM). RUTF provides a high-energy, nutrient-dense paste composed mainly of peanut butter, vegetable oil, sugar, milk powder, and a premix of vitamins and minerals. It allows home-based treatment and has been proven effective in restoring normal nutritional status among children with severe acute malnutrition. (Cichon et al., 2020; Collins et al., 2018).

            Malnutrition remains one of the major public health challenges globally, particularly in developing nations where poverty, food insecurity, and infectious diseases are prevalent. According to the World Health Organization (WHO, 2023), an estimated 45 million children under five years of age suffer from wasting, a form of acute malnutrition that significantly contributes to child morbidity and mortality. Among the severe manifestations of acute malnutrition is marasmus, characterized by severe wasting of muscle and fat tissues due to prolonged deficiency in dietary energy and protein intake (UNICEF, 2022).

            Marasmus is caused primarily by insufficient caloric intake relative to the body’s requirements, often compounded by frequent infections and poor feeding practices. Affected children exhibit severe weight loss, muscle wasting, and loss of subcutaneous fat, giving them an emaciated appearance (Black et al., 2020). In Nigeria, particularly in the northern regions, marasmus remains a serious concern, accounting for a significant proportion of admissions in pediatric wards and nutrition rehabilitation centers (National Bureau of Statistics [NBS], 2021).

To address this problem, global and national health agencies have implemented community-based management of acute malnutrition (CMAM) programs that emphasize the use of Ready-to-Use Therapeutic Food (RUTF) as the cornerstone for treatment. RUTF is a high-energy, nutrient-dense paste made from peanut butter, powdered milk, vegetable oil, sugar, and a vitamin-mineral premix (Briend et al., 2019). It is designed to be consumed directly without the need for preparation, thereby minimizing contamination risks and allowing for outpatient management of malnourished children.

            Studies have demonstrated that the introduction of RUTF has revolutionized the management of marasmus and other forms of severe acute malnutrition (SAM) by shifting care from hospitals to communities (Cichon et al., 2020; Collins et al., 2018). The use of RUTF in Nigeria was adopted as part of the national CMAM strategy supported by UNICEF and the Federal Ministry of Health. It has led to significant reductions in hospital admissions and case fatality rates, with recovery rates above 80% reported in several northern states (Adewale et al., 2022).

            However, despite the proven efficacy of RUTF, challenges persist in its implementation. Issues such as supply chain disruptions, caregiver non-compliance, and inadequate follow-up have been observed to influence treatment outcomes (Yusuf & Ahmed, 2021). At Dutse General Hospital in Jigawa State, anecdotal evidence indicates that while RUTF is available, variations in recovery outcomes among children receiving the treatment suggest the need for systematic evaluation. Therefore, this study seeks to assess the effectiveness of RUTF in the treatment of marasmus among children attending Dutse General Hospital.

            Malnutrition continues to be a major public health concern in northern Nigeria, particularly in Jigawa State, where child undernutrition and poverty rates remain high. Among the most severe forms of malnutrition is marasmus, a condition characterized by extreme wasting of fat and muscle tissues resulting from prolonged deficiency in dietary energy and protein intake (UNICEF, 2022).

            In Jigawa State, recurrent food insecurity, poor dietary diversity, low maternal education, and limited access to healthcare services exacerbate the burden of acute malnutrition. The Jigawa State Ministry of Health (2023) estimates that more than 35% of children under five in the state suffer from one form of acute malnutrition or another, with marasmus accounting for a large proportion of hospital admissions in paediatric wards. This situation is most prevalent in rural communities where traditional feeding practices and seasonal food shortages hinder child growth and recovery.

To combat this, the state government in collaboration with UNICEF and the Federal Ministry of Health has implemented the Community-Based Management of Acute Malnutrition (CMAM) program in various health facilities, including Dutse General Hospital. The CMAM approach emphasizes the use of Ready-to-Use Therapeutic Food (RUTF) for the home-based treatment of severe acute malnutrition, especially marasmus. RUTF is a high-energy, micronutrient-enriched paste made from peanut butter, sugar, milk powder, vegetable oil, and a vitamin-mineral mix (Briend et al., 2019). It can be administered at home without the need for water or refrigeration, making it ideal for rural communities.

In Dutse General Hospital, RUTF is routinely used in the treatment of children with marasmus under the CMAM program. Previous reports have shown encouraging results, with recovery rates ranging between 80% and 90%, but variations still exist due to challenges such as irregular supply, caregiver non-compliance, and poor follow-up (Yusuf & Ahmed, 2021). These variations suggest the need for an empirical evaluation of RUTF’s effectiveness in improving nutritional recovery among children treated for marasmus in this specific hospital setting.

Hence, this study aims to assess the effectiveness of Ready-to-Use Therapeutic Food (RUTF) in the treatment of marasmus among children attending Dutse General Hospital, Jigawa State, to provide evidence-based data that could strengthen local malnutrition management efforts.

1.2 Statement of the Problem

            Despite the availability of RUTF through the CMAM program in Jigawa State, marasmus remains a persistent health problem, particularly in Dutse and surrounding communities. Health records from Dutse General Hospital (2023) show recurring cases of severe malnutrition despite continuous distribution of RUTF. While some children recover within six weeks of treatment, others experience slow or incomplete recovery.

            Factors such as irregular supply of RUTF sachets, sharing of therapeutic food within households, poor feeding practices, and inadequate caregiver education contribute to poor treatment outcomes. Moreover, logistical constraints such as delays in the distribution chain and limited staff capacity further hinder effective program implementation (Adewale et al., 2022).

            Therefore, there is a pressing need to examine the extent to which RUTF is effective in the real-life hospital setting of Dutse, where both social and environmental factors may influence treatment success. Understanding this will provide insights into local barriers, improve program efficiency, and enhance the survival chances of malnourished children in Jigawa State.

1.3  Aims of the research

The general objective of this study is to assess the effectiveness of RUTF in the treatment of marasmus among children at Dutse General Hospital, Jigawa State.

1.4 Objectives of the study

1.      To determine the effectiveness of RUTF in the treatment of marasmus.

2.      To determine the recovery rate of marasmic children treated with RUTF.

3.      To identify challenges affecting RUTF utilization among caregivers and health workers.

4.      To compare outcomes of RUTF treatment with conventional feeding methods.

1.5 Research Questions

1.      Does RUTF have positive effect in the treatment of marasmus?

2.      What is the recovery rate among marasmic children treated with RUTF?

3.      What factors affect the use of RUTF in marasmus management?

4.      How does RUTF compare with conventional feeding practices in treating marasmus?

1.6 Significance of the Study

            This study provides empirical evidence on the clinical effectiveness of RUTF in treating marasmus, guiding nutritionists, policymakers, and healthcare practitioners in improving treatment strategies. It also contributes to academic literature and helps strengthen CMAM programs in Nigeria.

1.7 Scope of the Study

The study was conducted at Dutse General Hospital, Jigawa State, focusing on children aged 6–59 months diagnosed with marasmus and enrolled in RUTF therapy. It covered assessment of weight, height, recovery outcomes, and caregiver compliance.

1.8 Operational Definition of Terms

Marasmus – Severe wasting due to prolonged energy deficiency.

RUTF – Ready-to-Use Therapeutic Food, a nutrient-dense paste used in managing severe acute malnutrition.

Effectiveness – The extent to which RUTF improves nutritional recovery and weight gain among marasmic children

Community-Based Management of Acute Malnutrition (CMAM): A health program that enables the management of malnutrition at the community level using RUTF

 Recovery Rate: The percentage of marasmic children who achieve nutritional recovery after RUTF therapy.