Nutrition supplements are medicines
Treating children for malnutrition
Esnat Chimatiro's 18-month-old daughter, Hanifa, smiles while taking a peanut butter supplement to treat severe wasting in children under five.
The baby was born to a malnourished mother in January 2022 and has been taking ready-to-use therapeutic food (RUTF) since she was six months old.
Her mother receives 14 packets of the paste—known locally as chiponde—every Friday at Kawinga village clinic near her home in Traditional Authority Chowe, Mangochi District.
"This is medicine. My secondborn receives two RUTF packets per day. She takes one in the morning and another in the evening," she says, cuddling the baby on her lap.
Hanifa does not eat more or less RUTF than prescribed by Torea Simenti, the health surveillance assistant (HSA) who built and runs the village clinic.
UNICEF, with funding from the UK's Foreign, Commonwealth, and Development Office (FCDO), is supporting the Ministry of Health to decentralize the treatment of severe wasting to hard-to-reach areas in Mangochi, Dedza, and Mzimba districts. This includes training health workers to manage severe wasting without medical complications and to provide essential supplies such as RUTF, therapeutic milk, and nutrition screening tool kits.
Kawinga village clinic has cut long walks to Mase health centre, where patients pay for services outside its service-level agreement with the Government of Malawi. A return motorcycle trip to the Christian Health Association of Malawi (CHAM) facility costs about K3 000.
"The frequent trips to Mesi would have left me poor since Hanifa started receiving RUTF. The HSA found the baby severely wasted after measuring her weight and upper arm," she explains.
A year on, Hanifa, who weighed two kilograms when she was born prematurely at Mangochi District Hospital, looks healthier.
"I feared losing my daughter as her weight dropped to 3kg nine months after birth. Thanks to the RUTF, she can afford a smile and sits down to eat and play with her sister. Before, she was weak and sickly," Esnat explains.
This personifies the power of the two-sachets-per-day dose in restoring malnourished children’s health.
Previously, some children were receiving over 80 packets a month, depending on body weight.
"The standard dose has made malnutrition treatment easy like any other dosage. As advised by our HSA, I give Hanifa two sachets a day even if she cries for more," says the mother of two.
She swiftly consults the community health worker, who single-handedly constructed the village clinic, when she detects a change in Hanifa’s health.
HSA Torea Simenti wanted to become a nurse but found joy in delivering primary health care. In her sky-blue uniform, Clad has been taking life-saving messages and supplies, such as nutrition supplements, vaccines, modern family planning methods, and water treatment chemicals, from village to village since 2007.
"I built the village clinic because women in my area were shunning health services, including malnutrition treatment, due to long walks to Mesi. Now they see me any time, even at night," she states.
Simenti says the standard dosage has reduced stock-outs and misuse of RUTF.
"Most children defaulted when RUTF was dispensed at the distant CHAM facility. It wasn't easy to trace them and assess their health as I do when giving RUTF every week," she recalls.
The HSA opened the village clinic in 2019. After being trained not to store or dispense medicines and vaccines in the open and at home, she approached village heads to construct a shelter for an under-five clinic then held in the open come rain or sunshine. A lukewarm community response moved her up to make 5 000 bricks, sheaf grass, buy plastic sheeting, and recruit local bricklayers to build the clinic on a piece of land she inherited from her parents.
"Before, many children were dying from treatable diseases like malnutrition because their parents couldn't afford hospital trips. Some didn't know that the CHAM facility was dispensing RUFT free of charge while others were afraid of making off-pocket payments for treatment of opportunistic conditions," Simenti narrates.
Now she sees no less than five children a day and refers critical cases to Mase health centre.
"The village clinic has dramatically improved follow-ups. When we give them RUTF, we also assess if the child is taking and assess any change," she explains.
After waving goodbye to long and costly medical trips to Mase, parents have embraced the weekly distribution of 14 RUTF sachets per child.
"The standard take-home has eliminated off-pocket payments, and malnourished children now get constant feedback," Simenti states.
Fieldworker Rita Kaunda coordinates nutrition activities in communities surrounding Mase, Malukula, Malombe, St Martin's, Malombe and Chikole health centres.
"In all six health facilities, we have observed little or no difference in how children receiving more RUTF respond to the standard distribution. Some used to sell the packets because they felt it was too much. With the standard dose, they appreciate that it is medicine to be taken as prescribed," she says.
And deaths from malnutrition are falling with weekly RUTF replenishments and nutrition checkups, says Kaunda.
"The standard distribution and village clinics have simplified follow-ups and communication with the HSAs. No child in my zone has died from malnutrition since November 2022," she states.