ABSTRACT
A review was undertaken of locally available energy and nutrient-dense foods used in the management of undernourished children in India. Suitability of the 42 food products identified was examined in terms of nutrient profile, palatability, safety, cost-effectiveness, shelf life and feasibility for scale-up of production. Results showed that there is potential to supplement several existing products with additional foods, multivitamins and mineral mixes to enable their use as therapeutic foods in the management of uncomplicated severe acute malnutrition (SAM) in the community. Based on these findings, an existing locally produced product (Balamrutham) was adapted (Balamrutham+) to provide improved energy, protein and nutrient density to enable its use in SAM treatment. To test Balamrutham+, the product was given to uncomplicated moderate and severe malnutrition cases in children under five years old admitted to a government supplementary feeding programme in a district in Telangana state. Follow-up was only possible for two weeks due to the COVID-19 pandemic. After two weeks of supplementation, 22.3% of children with moderate acute malnutrition (MAM) reached discharge criteria and 17.7% of severe acute malnutrition (SAM) children reached MAM criteria. Production of Balamrutham+ has since been scaled up and is being used in treatment across Telangana state according to pre-existing plans as the food was found acceptable by the children in the community. COVID-19-related adaptations include use of mid-upper arm circumference (MUAC)-only protocols for treatment and a separate strategy for follow-up visits in designated containment zones for COVID.