The efficacy of CMAM is “assumed to reduce deaths due to SAM by 55% compared with facility–based management of malnutrition” as reviewed by the Lancet (Bhutta et al, 2008). Of the 21 studies which had appropriate experimental designs and outcomes reviewed by the Lancet on the management of SAM, a summary risk ratio of 0·45 (95% CI 0·32–0·62; random effects) was determined when compared with the conventional treatment (Collins 2006; Nu Shwe T 2003). There are currently no randomized trials in the literature that had investigated the effect of RUTF on mortality. However, observational data from field programmes suggest that CMAM with pre-prepared balanced food can achieve high coverage and low case fatality (Bhutta et al 2008).

Among 23,511 unselected severely malnourished children treated in 21 programmes of community-based therapeutic care in Malawi, Ethiopia, and Sudan, between 2001 and 2005, the overall case-fatality rate was 4·1%, with a recovery rate of 79·4% and default of 11·0% (Ashworth, 2006; Ciliberto, 2005). This compares favourably with case-fatality rates that are typically achieved with facility-based management. However, this comparison must be interpreted cautiously since the severity of cases in the facility-based trials and the community-based observational studies might differ. In view of the association of SAM with HIV infection, infected children must also be given antiretroviral therapy. These preventive strategies for SAM ought to be formally assessed in representative groups. Observational studies show that use of pre-prepared balanced foods such as spreads and ready-to-use supplementary foods is feasible in community settings.