Eleven-month-old Khodeja weighs only 5.6 kilograms.
When her mother brought her to Patuakhali Medical College Hospital after days of fever and weakness, doctors discovered that the illness was only part of the problem.
The child was suffering from severe acute malnutrition (SAM), one of the deadliest forms of undernutrition affecting an estimated one million Bangladeshi children every year.
For decades, children like Khodeja have depended on hospital admission, therapeutic milk, and weeks of treatment to survive.
But nutrition experts increasingly believe a simple invention, known globally as Ready-to-Use Therapeutic Food (RUTF), could fundamentally change that reality and help Bangladesh tackle one of its most persistent public health crises.
The challenge is immense.
According to the Bangladesh Bureau of Statistics (BBS) and Unicef's Multiple Indicator Cluster Survey (MICS) 2025, 12.9% of children under five now suffer from wasting, a key indicator of acute malnutrition.
The figure has risen from 9.8% in 2019 and is now classified by the World Health Organization as a "high" public health concern.
The same survey found that 24% of children under five are stunted due to chronic undernutrition, while 23% are underweight.
Perhaps most alarming, nearly two-thirds of children aged six to 23 months suffer from child food poverty, meaning they do not receive the minimum dietary diversity needed for healthy growth.
The result is visible in pediatric wards across Bangladesh.
Children arrive with pneumonia, measles, diarrhea and severe infections.
Behind many of these illnesses lies malnutrition, which weakens the immune system and leaves children unable to fight disease.
"Many children come to us in critical condition," said Dr Mariam Akter Joly, a pediatrician at Patuakhali Medical College Hospital.
"Treatment requires much more than feeding. These children need specialized nutritional support, infection management and close monitoring."
Yet hospitals can reach only a fraction of those who need care.
Unicef estimates that around one million Bangladeshi children develop severe acute malnutrition each year.
However, only about 21,000 children received inpatient treatment through Unicef-supported facilities in 2025, roughly 2% of the total burden.
Experts say the numbers expose the limits of a hospital-centred system.
"You cannot solve a million-child problem through hospital beds alone," said one senior nutrition official.
That is where RUTF enters the conversation.
Developed to combat severe malnutrition in low-resource settings, RUTF is a ready-to-eat, nutrient-dense therapeutic food typically made from peanuts, milk powder, vegetable oil, sugar, vitamins and minerals.
Unlike therapeutic milk, which requires hospitalization and medical supervision, RUTF can be administered at home.
Children consume small sachets daily while receiving periodic monitoring from health workers.
The approach has transformed malnutrition treatment across Africa and parts of Asia.
International studies show recovery rates exceeding 80% in many community-based programs, dramatically reducing hospital admissions and treatment costs.
Bangladesh has already taken initial steps.
With Unicef support, researchers at icddr,b have developed locally produced therapeutic foods known as Shornali-1 and Shornali-2.
Early clinical results have been encouraging, demonstrating that children can recover successfully without prolonged hospitalization.
Nutrition officer for Barisal and Khulna divisions Dr Shahnaz Begum believes the country is approaching a critical policy moment.
"RUTF is a proven and globally recognized intervention," she said.
"If it is incorporated into the Essential Drug List, it will strengthen procurement, regulation, distribution and accessibility throughout the country."
She said wider use of RUTF would allow thousands of children to receive treatment closer to home instead of travelling long distances to hospitals.
The push for RUTF is closely linked to another long-delayed reform.
Bangladesh adopted Community-Based Management of Acute Malnutrition (CMAM) guidelines in 2017.
The strategy was designed to shift treatment from hospitals into communities, allowing health workers to identify and treat children before they become critically ill.
Nearly eight years later, nationwide implementation remains incomplete.
As a result, many children are diagnosed only after severe complications develop.
Hospital superintendent Dr Dilruba Yasmin Liza said the consequences are visible every day.
"These children often require weeks of treatment. Many families struggle to stay in hospital for that long. Some leave before treatment is complete," she said.
The burden is particularly heavy for poor rural households.
Mariam, whose one-year-old daughter Rumana has spent more than two weeks in hospital, said the prolonged stay has strained the family.
"My husband is a farmer. There are responsibilities at home. But doctors say we cannot leave yet," she said.
Experts argue that community-based treatment could prevent many such cases from ever reaching hospitals.
They also warn that the stakes are rising.
Globally, Unicef, WHO and the World Bank estimate that 42.8 million children suffered from wasting in 2024, including 12.2 million with severe wasting.
Bangladesh has made notable progress in reducing stunting over the past decade, but the recent rise in wasting suggests new threats are emerging -- from food insecurity and poor dietary diversity to disease outbreaks and climate-related shocks.
For many nutrition specialists, the question is no longer whether Bangladesh needs a community-based malnutrition strategy built around RUTF.
The question is how quickly it can be implemented.
Because for children like Khodeja, every month of delay means another child slipping silently from hunger into a medical emergency -- and perhaps missing the chance to recover before it is too late.
