# Acceptability and Adherence to Ready-to-Use Therapeutic Foods (RUTFs) Treatment in Cases of Moderate and Severe Acute Malnutrition in Children from Rural and Indigenous Communities in Mexico

## TL;DR

This study evaluates how well children in rural and indigenous Mexican communities accept and adhere to RUTF treatment for malnutrition.

## Contribution

The study provides new insights into RUTF acceptability and adherence in culturally diverse and vulnerable communities in Mexico.

## Key findings

- 85% of participants achieved RUTF consumption-based acceptability.
- 77% of participants rated RUTF as pleasant or very pleasant on a hedonic scale.
- 79.2% of cases showed adequate treatment adherence (≥70%).

## Abstract

Background/Objectives: Infant acute malnutrition increases the risk of morbidity and mortality but also has adverse effects on growth, cognitive development, and quality of life. Ready-to-use therapeutic foods (RUTFs) represent the standard treatment in moderate (MAM) or severe acute malnutrition (SAM) cases, but acceptability and adherence in culturally diverse settings remain poorly understood. To evaluate the acceptability and adherence to RUTF treatment among children with MAM or SAM in rural and indigenous communities of three Mexican states. Methods: We conducted a mixed-methods study in Chihuahua, Guerrero, and Chiapas between February and August 2024. A total of 66 children aged 6–59 months with confirmed MAM or SAM diagnoses were enrolled, with 48 completing the study. Acceptability was assessed by weighing leftovers of the consumption RUTF sachet and using 5-point hedonic scales evaluating taste, texture, appearance, and smell. Adherence was measured by comparing consumed versus prescribed RUTF sachets. Semi-structured interviews with primary caregivers explored perceptions, barriers, and facilitators of RUTF use. Results: Consumption-based acceptability was achieved by 85% of participants. On the 5-point hedonic scale, 77% of participants rated RUTF as pleasant or very pleasant. Overall treatment adherence was adequate (≥70%) in 79.2% of cases. Qualitative information revealed primary caregivers’ perceptions about weight gain and increased appetite as benefits. Conclusions: Since acceptability and adherence were adequate and a high score was obtained on the hedonic scale, which led to an improvement in the nutritional status of MAM or SAM cases, the feasibility and acceptability of RUTFs in highly vulnerable community contexts in Mexico was reaffirmed.