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Local Production of RUTF (Special Supplement 2)

By Dr Peter Fellows

Introduction

The development of RUTF has been an important factor facilitating the development of CTC. However at the moment, most RUTF is made in France, is marketed at a high cost and incurs considerable transport overheads to move it to the point of use. This is a major factor in increasing the cost and decreasing the applicability of CTC. To address this, the CTC programme has included substantial research into the development of locally produced RUTF.

Technologically, RUTF possesses a number of advantages over other foods, making it an excellent product for local production and central to the implementation of CTC. It has a low water activity (Aw), which not only makes it microbiologically safe but also means that simple packaging can be used because it does not require protection against microbial contamination. Unlike some other products, such as highenergy biscuits, the paste does not require protection against crushing or other damage during transport to distribution sites or at the homes of beneficiaries. Even if it is contaminated (e.g. by children's dirty fingers), pathogens cannot grow in it. These are major benefits in the context of local production, where modern processing facilities and the availability of more sophisticated packaging materials may be limited. The product can be stored at ambient temperatures without the need for refrigeration, and the 3-4 month shelf life at tropical temperatures is sufficient to distribute RUTF, hold stocks at distribution points and allow for a few weeks' supply to be given to mothers for home consumption.

RUTF is eaten directly without cooking or the need to be diluted with potentially contaminated water, and each pot has a standard food value, therefore making administration of doses easier for programme staff. Also most children can feed themselves and do not require their mother's help. Provided peanut butter is available, the process is a simple mixing operation that can be easily learned by unskilled operators, and requires a relatively low investment in equipment and facilities. The inherent microbiological safety also means that the level of control needed during processing and distribution is less rigorous than for many other protein-rich foods. Local RUTF production also offers the opportunity to stimulate agricultural production and widen the benefits to farmers in surrounding communities.

Over the last 2 years I have been working with the CTC research programme on the development of local production of RUTF. This article describes our first attempts at developing relatively large-scale local production in Malawi.

Local production in Malawi

The use and production of RUTF is not new in Malawi. The Moyo House unit at the Queen Elizabeth Hospital in Blantyre, working with the St Louis University of the USA has been using RUTF for the home treatment of severely malnourished children in the recovery phase of treatment since 2001. In 2002, the unit developed some small scale local production and conducted a trial demonstrating that the locally produced RUTF was equally effective in treating severe acute malnutrition as the imported Plumpy nut product (27).

First steps - sourcing ingredients and equipment

The ingredients used to make RUTF are peanut butter, sugar, oil, dried milk and a mineral-vitamin complex (CMV) (Figure 6). In all but a few countries, it is necessary to import dried milk and CMV, but local manufacturers of sugar and oil are likely to be found. To make RUTF without a major investment in equipment, it is necessary to identify a local supply of peanut butter. Ideally, this would be an established food manufacturer that has experience of its production, quality assurance and also knowledge of the peanut market to ensure that high quality nuts are used. After investigating various options in Malawi it was concluded that Tambala Food Products Ltd. in Blantyre met these requirements. In Ethiopia, Valid and Concern staff have identified a potential producer that has experience of making medicines and has diversified into food manufacture with experience of the peanut market sector.

In Malawi we put systems in place to import dried milk and CMV, to purchase icing sugar and cooking oil from local suppliers, and to contract Tambala Foods to both produce peanut butter without added salt and produce the RUTF.

Using Tambala as the local supply of peanut butter removed the requirement for a peanut toaster and stone mill, meaning that to start local production the only significant equipment that we had to purchase were four 40-litre capacity planetary mixers. Once they had cleared the Customs and Excise procedures, the mixers were installed at Tambala's factory.

Factory audit, analyses and staff training

Because this was the first time that local production had been attempted, we needed to ensure that all potential problems were anticipated in relation to RUTF safety and composition. Three aspects were considered: an audit of the production facilities, processing methods and skills at Tambala; identification of independent analytical facilities; and training of production staff.

The audit of Tambala's operation included:

• Physical facilities (including the quality of the building used for production).
• Supplies of raw materials.
• Equipment and production facilities.
• Hygiene and sanitation procedures, cleaning routines, washing and toilet facilities etc.
• Production records and product labelling.
• Stock control procedures.
• Management of quality assurance.

I found that the company facilities, procedures and management were mostly suitable for RUTF production and suggested minor improvements to improve the factory buildings. However, a potentially serious problem was discovered in the peanut supply. Although the company's peanut storage facilities were satisfactory, there was no system of traceability to the peanut farmers or distributors. This meant that managers could not ensure correct post-harvest handling and storage of nuts before they were purchased. The risk was that incorrect procedures could result in aflatoxin contamination if moulds had been allowed to grow on incorrectly stored nuts. We therefore decided to implement three actions:

• As the nuts for a year's production had already been harvested and were stored in Tambala's warehouse, we took a representative sample for aflatoxin analysis.
• An additional inspection stage was introduced to the production process to remove discoloured or mouldy nuts
• We requested Tambala to introduce traceability procedures for future nut purchases. The company will introduce improvements in the next buying season and train their buyers to offer guidance to farmers on post-harvest storage.

The company had only basic analytical facilities and it was therefore necessary to identify an independent laboratory that could verify the quality of ingredients and RUTF, and confirm that routine quality assurance procedures were followed. Analytical facilities were identified in universities, research institutes and the Malawi Bureau of Standards. In order to assess the accuracy and reliability of results produced by these institutions, we conducted a study in which the same materials were given to four laboratories; three in Malawi and one in UK, and the results were compared. We also assessed the comparative costs of analysis, and the efficiency of the laboratories in producing timely results. Samples of oil were analysed for free fatty acids, Iodine and Peroxide values, proximate analyses were made on groundnuts, peanut butter and RUTF, and a microbiological analysis of RUTF was made. Groundnuts and RUTF were also tested for aflatoxins and Oxford Brookes University checked the Aw of the RUTF. Chancellor College in Zomba and Malawi Bureau of Standards in Blantyre each produced results in a timely way that were in agreement with the UK laboratory at Oxford Brookes University, and each had similar costs. The results indicated that the ingredients and RUTF had a satisfactory chemical composition and microbiological quality when compared to standards developed for PlumpyNutË by Nutriset .

The production process for RUTF is a straightforward mixing operation, but operators must ensure that exactly the same amounts of ingredients are added to each batch to ensure a standard nutritional value. Production supervisors also need to understand proper process control, cleaning schedules for the production unit, stock rotation and record keeping. To assist in training production staff and managers who were not familiar with the product a manual was produced. None of this is particularly arduous for a food technologist or for managers at Tambala who were familiar with these aspects of food production, but we also wanted to produce RUTF in a village unit where food technology skills and knowledge would be far more basic. If rural staff are unaccustomed to these procedures the lack of knowledge could cause quality problems, and I therefore included basic management aspects in the production manual. Before starting production, four Tambala staff were trained with assistance from staff at the Community Health Dept., College of Medicine, Queen Elizabeth Central Hospital, Blantyre and the St Louis Project, where RUTF had been produced on a small scale for a number of months. As part of the training, staff constructed calibrated containers to measure ingredients. This is not only faster than weighing, but enables production without the need for accurate and expensive scales.

When the equipment, ingredients, analytical checks and staff training were in place, a contract was drawn up between Concern Worldwide and Tambala for 6 months' production. The contract covered amounts to be produced, delivery times, payments, raw material supplies and quality assurance. Tambala started production in February 2003. Our intention was to increase production each month from 6 tonnes to 20 tonnes, but a reduction in demand meant that the contract was revised downwards. There were some initial teething problems, but Tambala largely met the terms of the contract and supplied Concern Worldwide with RUTF of the correct quality and volumes. In April a routine analysis picked up high levels of aflatoxin in a sample. This is likely to have arisen from a small number of heavily contaminated peanuts that escaped the routine inspection stage. In response Tambala reinforced their inspection procedures to visually examine all nuts, which has cured the problem to date. Other contracts were made with the St. Louis Project and later with other agencies including MSF.

Village scale production

Producing RUTF at the village level has many potential advantages. It is likely to reduce costs and improve cost efficiency as the funds from donors can be used directly in the target district without incurring European or capital city production and transportation overheads. Local production should also help to link CTC more effectively to agriculture and food security interventions. This is particularly true for new recipe RUTFs which aim to make RUTF from local crops without the need for imported milk powder. Local production is likely to be more responsive to local needs and will hopefully engender a greater feeling of local ownership over CTC programmes. Given the wide range of applications for RUTF, local production also has the potential to generate income for small local manufacturers such as district hospitals.

Given all these potential advantages we decided to see whether the process followed at Tambala could be replicated in a village production unit, and selected the Nambuma Mission Hospital as the first site. Mission staff prepared a small production room and three staff were trained by Tambala production staff in Blantyre. In January 2003 an audit was conducted of the production site that identified some minor improvements required to upgrade the facility. In February 2003 we moved one of the mixers to the mission from Tambala and production started within one hour of its arrival. As part of this exercise, three studies were undertaken:

• To determine whether absence of pre-mixing dry ingredients by hand had any effect on the uniformity of RUTF. We wanted to check this as the pre-mixing could be a problem in village production, because the operator leans over a mixing bin and hair or other contaminants could be introduced. It would also simplify the process if this stage were omitted.
• To determine whether the mixing time and speeds were adequate to produce a uniform product using the mixers chosen for local production.
• To determine whether contamination of RUTF by children's dirty fingers affected the microbial composition.

We found that pre-mixing is required to achieve uniform mixture, and that the chosen mixers adequately mixed the ingredients using the selected speeds and mixing times. Microbiological analyses revealed no pathogens in the samples exposed to contamination.

The unit is producing 100-160 kg per day, which meets the mission needs and supplies all the nearby CTC distribution centres in Dowa. All ingredients and packaging are transported to the mission because the quality of oil available in the village is inadequate and other ingredients are not locally available.

Future directions

The developments to date have shown that a village-scale production unit can produce high quality RUTF in the required amounts for one or more NRUs and a moderately sized OTP programme. Already some of the benefits of local production have been realised including lower costs compared to the imported product, greater control over supplies, the creation of local employment and a new income stream for the Nambuma mission. Concern is now working to develop the extent and quality of local peanut farming to support this production and this should provide substantial benefits to local farmers.

We now plan to study the economics, logistics and relative cost/benefits of supplying all materials to village-based production units compared to supplying packaged RUTF from Tambala. If village-scale production is selected as a preferred option, there are a number of ways in which future developments could take place, including:

• Units that are operated by an NGO, which provides staff and supplies ingredients and other process inputs.
• Units that are semi-commercial, supplying RUTF on contract to NGOs, the Ministry of Health or other agencies, but with support from an NGO.
• Units that are fully commercial, with all inputs paid for by sales of RUTF on the open market.

At present the second approach appears to be the most feasible as it retains NGO control over RUTF supplies and quality. However, future developments that may result in RUTF becoming available nationally in Malawi via the Ministry of Health may have a significant bearing on the development of village-scale production.

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Dr Peter Fellows (). Local Production of RUTF (Special Supplement 2). Supplement 2: Community-based Therapeutic Care (CTC), November 2004. p33. www.ennonline.net/fex/102/4-3-1

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