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The majority of children affected by severe acute malnutrition live in south Asia and sub-Saharan Africa. The problem occurs mainly in families suffering from the impact of grinding chronic poverty. Many of these families have limited access to nutritious food and education. Unfortunately, this description characterizes the living conditions of many African citizens, and few African nations have specific policies aimed at addressing SAM comprehensively.


Children of any age (and even adults) can be malnourished, but most children who suffer from severe acute malnutrition are between 6 months and 5 years of age. This is a vulnerable period in a child’s life because in about the sixth month, breast milk no longer adequately provides all the needed nutrition for a child. The mother therefore strives to add other food to the diet. At the same time, the child has a very small stomach and cannot eat large quantities of what is likely already energy deficient food.


Countries that experience high rates of malnutrition frequently also have high birth rates. This often compounds the problem of malnutrition, as an older child may be weaned earlier than recommended when a younger sibling is born.

In times of decreased food in the home, a very young child does not yet have the ability to compete with older and equally hungry family members for what food is available.

The young child's need for supervision may also prevent the child from taking part in village foraging like that of older children. (School-age children often find food at other homes or in the area around their villages, picking berries or raiding gardens.)

By age five, a child typically has the dexterity, independence and shrewdness to seek out food, and his/her immune system has had exposure to disease and time to mature. At this point, the child is less likely to experience severe acute malnutrition.


Children are defined as healthy, moderately acutely malnourished, or severely acutely malnourished according to international standards and guidelines.

Severely malnourished children sometimes look wasted (extremely skinny), a condition known as marasmus. Other severely malnourished children experience a painful swelling/buildup of fluid under the skin known as edema.


Learn more:

Acute malnutrition: an everyday emergency (2014)

Community-based management of severe acute malnutrition WHO guidelines (2007)

WHO Child Growth Standards (2009)


From 2000-2004, Dr. Manary and colleague Dr. André Briend experimented with various ingredients until they created a formula that provides the specific, high quality nutrition that severely malnourished children need to recover. The food became known as Ready-to-Use Therapeutic Food (RUTF). RUTF is an energy-dense, peanut butter like paste, but it is more than just peanut butter. It consists of roasted ground peanuts (peanut paste), powdered milk, vegetable oil, sugar, and vitamins/minerals. Peanuts contain mono-unsaturated fats, which are easy to digest, and they are rich in protein and zinc, which is good for the immune system. RUTF’s intended use is for severely malnourished children ages 6 mo- to 5 yrs.




Feeding children with RUTF in the home setting was a revolutionary therapy for several reasons. The standard therapy for treating malnourished children prior to RUTF necessitated that mothers brought their sick kids to crowded hospitals/clinics, where they received milk-based formula. Recovery rates were only 25-40%, whereas they are 75-95% for home-based treatment with RUTF.










Local Production




One of the most unique aspects of Project Peanut Butter’s work is that we produce RUTF locally, in the countries where the product is needed, and we use as many local ingredients as possible.


Our projects support local economies and build stronger communities by providing jobs for farmers, factory workers, administrators, nurses, health aides, drivers, and others. In addition, we lower our carbon footprint by sourcing many of our raw materials locally.

Choosing local production also ensures that consistent supplies of RUTF will be available to healthcare systems in vulnerable communities. Importing RUTF can often pose challenges, such as delays in shipping and materials being held in port for high customs fees.

 "It's all run purely by Malawians. It makes us happy   and proud that we are able to produce this   product, which is serving our own Malawian child." 

 - Liyaka Nchilamwela

former Factory Manager,  PPB  Malawi  

Small Scale


Project Peanut Butter has considerable RUTF production knowledge and expertise stemming from our long history of local production in developing nations and our founder’s extensive malnutrition research background. We endeavor to share this knowledge with other organizations whenever possible in order to reach more children in need of treatment. As a result, we have supported various small-scale production projects across Africa and beyond, in addition to maintaining our own ongoing projects.


In 2010, PPB assisted partners from the Payatas Orione Foundation, Inc. (PAOFI) and the Little Missionary Sisters of Charity in establishing a program to produce RUTF on a small scale. The team originally produced supplements for adults suffering from tuberculosis. In 2012, based on the success of the earlier partnership with PAOFI, PPB extended the success of the existing RUTF program in Payatas to help even more malnourished children who were in need of treatment. We continue to send support staff from the USA to provide input on this project, although it is largely self-sustained.

Women's Program




In March 2017, PPB Sierra Leone launched a new maternal health study for malnourished mothers. The study enrolls malnourished, pregnant women up to 35 weeks into a program distributing a ready to use supplementary food (RUSF) called Mama Dutasi. Mama Dutasi provides basic nutrition, supplements, vitamins and nutrients needed for a healthy pregnancy, including iron and folic acid. The women are also dewormed, screened for infections, given strategies to prevent malaria and tested for genital urinary infections. The women visit a PPB clinic every two weeks up until the birth of the baby. PPB researchers hope to conclude that reliable pregnancy care will result in healthier, less stunted babies sustained even after birth. 

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