Design and optimisation of a tailored nutrient-dense functional recipe to modulate severe acute malnutrition in children aged 6–59 months in Waliso, Ethiopia

Introduction : Severe acute malnutrition (SAM) remains a critical public health crisis in Ethiopia, affecting 1.2 million children in 2023 alone. This study aimed to conceptualise a nutrient-dense, tailored-functional recipe (TFR) to modulate SAM in children 6 to 59 months in Waliso, Ethiopia. Methods: The study was conducted in two phases: a literature review and fieldwork for data collection and recipe development. A scoping review, based on the Campbell systematic review protocol, identified current approaches to SAM intervention. A market survey was conducted to assess local food security, including availability, pricing and seasonality of ingredients. Results: The literature review highlighted best practices in SAM treatment, including nutrient requirements, recovery indicators, and relapse prevention, such as maternal support and access to health services. Guided by this evidence, a nutrient-dense recipe prototype, iTEFF, was developed. Ingredient selection was based on nutritional value, availability, and affordability. The final recipe included mangoes (50 g), avocados (100 g), kale (40 g), red kidney beans (60 g), and teff (50 g), with a total of 300 g per serving, costing £0.53 per serving. Conclusion: The study identified key gaps in current SAM interventions, particularly the need for sustainable, locally sourced solutions to reduce dependence on foreign aid. The iTEFF recipe provides at least 50% of the recommended nutrient intakes (RNIs) for essential nutrients needed for recovery in children under five. It represents a culturally appropriate, cost-effective, and scalable option for SAM management. Future research should focus on testing iTEFF in community settings to evaluate efficacy and expanding the market surveys to support broader implementation.