Towards a holistic framework to address infant acute malnutrition in sub-Saharan Africa and beyond

Acute malnutrition remains a leading cause of child mortality in sub-Saharan Africa (SSA), yet treatment coverage with Ready-to-Use Therapeutic Food (RUTF) remains critically low. Recent cuts to international aid funding have further exposed the fragility of nutrition programmes that depend on externally produced RUTF, underscoring the urgent need for sustainable and locally-driven solutions. The 2022 Codex Guideline CXG 95-2022, which permits non-dairy RUTF formulations, together with simplified treatment protocols – i.e. a single product for both severe and moderate acute malnutrition, has created an unprecedented opportunity to develop effective RUTF from locally available ingredients in SSA. We propose here a holistic, multidisciplinary framework for accelerating the development and adoption of local RUTF. The framework encompasses five interconnected pillars: (i) establishing an independent RUTF knowledge platform to coordinate global research expertise; (ii) improving the quality and coverage of food composition data, including bioavailability, protein quality, and bioactive compound characterisation, to support robust formulation design through linear programming; (iii) co-creating culturally appropriate formulations and traceable ingredient supply chains with local researchers, communities, and food industries; (iv) deploying preclinical screening models that integrate multi-omics approaches (e.g. metagenomics, metabolomics, and transcriptomics) to evaluate health outcomes beyond weight and length gain, including gut microbiome restoration, inflammatory status, metabolic state and bone health, thereby reducing reliance on costly clinical trials; and (v) translating research findings into national nutrition policies and engaging the local private sector through public–private partnerships, capacity building, and sustainable supply chain development. Collectively, this approach offers a scalable, evidence-based roadmap for producing lower-cost, more efficacious RUTF using local agricultural resources, with the potential to save additional hundreds of thousands of children’s lives and strengthen local food system resilience.