Acceptability of a reduced dose of therapeutic food in the management of severely acutely malnourished children aged 6–59 months in Mbuji-Mayi, Democratic Republic of Congo

Despite a higher prevalence of Severe Acute Malnutrition (SAM) in children living in Sub Saharan Africa, access to outpatient treatment remains limited. In relation to this, the 2023 WHO guidelines proposed reducing the dose of Ready to Use Therapeutic Food (RUTF) distributed on the basis of recent evidence. One of the positive consequence is that savings made by reducing RUTF prescription per child can then be reinvested to admit more children and hence increase treatment coverage. But this RUTF reduction may not be acceptable in all contexts and more evidence is needed to ascertain this strategy is acceptable by main actors of SAM management. This qualitative study assessed the acceptability of the reduced dose as part of a nutritional intervention programme in Mbuji-Mayi, Democratic Republic of Congo (DRC). The present qualitative study, a sub-study of the EfRAMAS clinical trial, assessed the acceptability of the reduced dose in the context of a nutritional intervention programme run by Action Against Hunger (AAH) in Mbuji-Mayi, DRC. Information was gathered through 54 semi-structured interviews, 10 focus groups and 6 in situ observations. Deductive analysis (from pre-established hypotheses) and inductive analysis (using themes that emerged in the field) were based on a triangulation of different sources of information. The hypothetico-deductive analysis was based on a triangulation of the different sources of information. The acceptability of the reduced dose of RUTF during the treatment of children 06 to 59 months with SAM was confirmed provided that two conditions were met: firstly, that the savings made are used to treat other children suffering from SAM, but who do not have access to treatment, and secondly, that accompanying measures are put in place to address food insecurity, lack of access to drinking water, and gender-based violence. The reduced dose was deemed acceptable by the majority of health workers. Others, on the contrary, feared that it would increase their workload by lengthening the duration of children’s treatment or increasing the number of children treated. Some caregivers showed a high degree of acceptance of the idea of reducing the dose to enable more children with SAM to have access to the treatment. Other caregivers felt that this would affect the children’s health and reduce household income or food sources. Overall, the reduction in RUTF doses seems relatively acceptable to the majority of those interviewed, considering the benefit of more children accessing treatment, in that aligned with recent WHO recommendations. However, the caregivers, health care personnel and local authorities recommend paying attention to their vulnerable situation prone to food insecurity, low access to drinking water, lack of income-generating activities, and gender-based violence in Kasaï Oriental, eastern DRC.