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Field ArticleThis article describes some of the preliminary findingsof a recent study that introduced locally producedReady to Use Therapeutic Food (RUTF) 1 intoa hospital setting in Uganda, comparing its use toF100 during the rehabilitation phase. This articlefocuses particularly on the experiences producinglocal RUTF in a hospital setting, including costcomparisons with the routinely used F100.Kumi Hospital (formerly KumiLeprosy Centre) is located in Kumidistrict, about 8 km east of KumiTown in Eastern Uganda. Establishedas a general hospital in1997, most of the servicesand programmes of Kumi Hospital are donorfunded. In 1996/97, a poor regional harvest ledthe Medical Superintendent of Kumi Hospitalto request a nutritionist from the GermanMedical Missionary Team (GMMT) to help withthe construction of a Nutrition Unit (NU). TheNU was subsequently established inSeptember/October 1998.Development of the Nutrition Unit (NU)Initially the NU treated severely malnourishedchildren in the rehabilitation phase, with stabilisationand initial care offered in the paediatricward of the hospital. The NU also providedfood (NU diet, see box 1) for malnourished childrenwho were admitted to other wards orcould stay near the hospital. At this stage, otherward staff provided medical care to the children.To improve the care and monitoring of thechildren, especially at night, and to avoidabsence of the mothers/patients on some days,a 16-bed extension to the NU was opened inMarch 2001, where the children could beaccommodated with their caretaker. In May2004, the NU became a ward with its ownemployed nursing staff and a dedicated doctorfor daily supervision. Severe clinical cases (e.g.those who required naso-gastric feeding) continuedto be first admitted to the paediatricward, with transfer to the NU once stabilised.Malnourished children without obvious medicalcomplications were directly admitted to theNU ward.All children admitted to the NU are treatedaccording to WHO’s 10-step-guidelines (1999).F75 (during the initial phase) and F100 (for therehabilitation phase) are produced from freshcow’s milk, oil, sugar, and vitamin-mineralBox 1complex (CMV therapeutic). The majority ofchildren are weighed daily and weightgain/kg/day was calculated.As well as treating severe malnutrition, the NUis also actively involved in:• Identification of malnourished children inthe area through home visits or immunisationoutreach work.• Teaching caretakers about basics of nutrition,hygiene and primary health care.Caretakers also worked in the garden of theNU growing some of the food for the programmelike groundnuts, vegetables andfruits.• Counselling of the caretakers in the NU andduring home visits, by a trained socialworker.• On the job training and supervision of NUstaff.Since the NU began in 1998, almost 1000 patientshave been admitted. Additionally the NU hastaken care of outpatients enrolled in the feedingprogramme but not admitted to the NU.Study objectivesThe main objectives of the study were:• To compare weight gain, duration of stayand other parameters of two groups of children,one group receiving locally producedF-100 and the other locally produced RUTF,during the rehabilitation phase.• To develop a suitable procedure for smallscale local production of RUTF.• To develop recommendations for use in theNU on how to produce and administer RUTF.• To assess and compare prices of F-100 andRUTF (both locally produced)The study was carried out in the NU betweenSeptember and December 2005.Study outline and preliminary findingsDuring the first weeks of the study, childrenentering the rehabilitation phase (after theirappetite returned) were randomly divided intotwo groups, one group receiving F-100 and theother local RUTF. However, some children didnot like the taste or could not manage 2 RUTFduring this early stage of rehabilitation and sorandom allocation was abandoned. Instead,children whose appetite had improved andwho liked the taste of the RUTF were managedusing RUTF with small amounts of the NU-diet 3 . These children (n=10) were compared tothose who had selected to receive either F-100exclusively for several days first or immediatelya combination of F-100 with small amountsof the NU diet (n=5). All three children whowere suffering from oedematous forms of malnutritionon admission received F-75 during theinitial phase. At the beginning of the rehabilitationphase, two kwashiorkor cases chose the F-100 group and one opted into the RUTF group.Thus self-selection determined the majority ofassignments to the F100 or RUTF group, basedon the appetite and food preference of the malnourishedchild.Weight gainWeight gain averaged 9.7g/kg/d in the F-100group and 7.3 g/kg/d in the RUTF group. Themean duration of stay was 32.6 days in the F-100 group and 28.5 days in the RUTF group. Onadmission, all children in the F-100 group wereseverely wasted (W/H z-score