Abstract
Severe acute malnutrition (SAM) remains a major concern in sub-Saharan Africa. In the Democratic Republic of the Congo (DRC), health care providers in therapeutic feeding units produce locally formulated food preparations empirically, with unknown macro- and micronutrient compositions. This study compares ingredients and nutritional values of locally formulated food preparation with those of standard ready-to-use therapeutic foods, as per Codex Alimentarius standards. A descriptive, comparative case study design was employed across outpatient therapeutic nutrition units (OTNUs) in four provinces of the DRC. Food samples were collected. Analysis included theoretical nutritional values calculation using NutVal software and laboratory analyses for selected nutrients (phosphorus, iron, calcium, magnesium, energy, lipids, and proteins) via standard protocols. From theoretical nutritional values, we calculate percentages of WHO/Codex Alimentarius requirements covered by the recipes and recipes in deficit by nutrient group. Laboratory analyses of selected nutrients were compared with the cut-off of the corresponding nutrient in the Codex Alimentarius. Analyses were conducted using Stata 18. Locally formulated food preparations were mostly milk- and peanut-free, often exceeding protein and lipid recommendations but deficient in vitamins (A, D, E, K, B12, folate), and critical minerals (calcium, iron, iodine, selenium, zinc). Compliance with Codex standards was very low, confirming macronutrient inadequacy but widespread micronutrient gaps. This study highlights critical gaps in locally formulated preparations in the management of SAM compared with WHO/Codex standards, emphasizing the need for fortification, balanced nutrients, and regulatory oversight. Engaging local industries, optimizing ingredient value chains, and rigorous evaluation are essential to ensure sustainable, effective, and context-appropriate SAM treatment solutions.