The development of RUTF along with the adoption of Community-based Management of Acute Malnutrition (CMAM) have greatly increased the effectiveness and efficiency of therapeutic care for millions of children with acute malnutrition. UNICEF considers RUTF a strategic commodity and included in its Emergency Supply List (ESL) procuring hundreds of thousands of metric tons of RUTF each year providing this life-saving commodity to millions of children with acute malnutrition. Despite this high procurement volumes, UNICEF still only reaches less than a quarter of the global estimated number of children suffering from SAM.  The major reasons behind this are two: the high cost of milk-peanut RUTF and the lower acceptability of the milk-peanut RUTF in the communities were peanut is not part of the staple diet. This study aims to determine the non-inferiority of alternative chickpea-based RUTF compared to the standard peanut-based RUTF in order to address these challenges.

A two-phase randomized controlled, double-blinded, 2 x 2 crossover non-inferiority trial comparing consumption in children 6-59months old with moderate acute malnutrition (phase 1) and severe acute malnutrition (phase 2) will be conducted. Duration of participation for each participant will be  2 weeks. In both phases, half the children will receive the standard RUTF  first and the other half the new RUTF, switching on day 7. The study setting will be outpatient-based treatment program of selected health centers across Jimma Zone, Southwest Ethiopia.