CHILDHOOD: MALNUTRITION

RACHEL'S STORY:
In Malawi, PIH helps malnourished children make rapid and dramatic recoveries.

By Robbie Flick, Health Programs Coordinator, Malawi

Two-year-old Rachel Namazongo only recently began growing her first strands of hair. Her eyes twinkle and her lips curve into a grin as she toddles over and climbs onto the lap of Blessings Banda, the HIV and Nutrition Manager for PIH’s sister organization in Malawi, Abwenzi Pa Za Umoyo (APZU).

Just three months ago, Rachel didn’t have the energy to walk. Listless and with sunken eyes, the toddler was dehydrated and severely malnourished, recalls Banda. The circumference of her upper arm, measured to assess the nutritional status of children, was less than 9 centimeters — about the circumference of a plastic bottle cap. At this acute stage of malnutrition, she was so sick that she didn't want to eat, said Banda. Her frightened mother brought her to a nearby children’s clinic in the rural southwestern corner of Malawi.

Sadly, Rachel’s poor health is not an unusual story. Many Malawian children suffer from malnutrition, which is the single biggest contributor to child death in the country, according to UNICEF. Girls, in particular, carry the heaviest burden of malnutrition worldwide – they are twice as likely as boys to die from malnutrition as boys, according to the Food and Agriculture Organization. But Banda and his team of clinicians from PIH/APZU and the Malawian Ministry of Health were determined that Rachel would not become a statistic—and they had the resources to act.  

Seeing that Rachel needed immediate medical care, Banda’s team quickly transported her to Neno District Hospital for admission into the new Nutritional Rehabilitation Unit (NRU).

A complex battery of health issues most likely contributed to the young girl’s malnutrition. She was treated for parasites and given antibiotics to help fight other possible infections. Doctors also diagnosed her with HIV, and quickly began a course of lifesaving antiretroviral therapy. The medication soon helped spark her appetite, and the NRU staff was well-equipped to provide her with food especially formulated to combat her condition.

	Rachel with her mother, shortly after being admitted to the Nutritional Rehabilitation Unit in Neno, Malawi.
	Rachel one week after being discharged from the Nutritional Rehabilitation Unit, with Blessings Banda, HIV and Nutrition Manager for APZU.

Every day, she ate packets of a special calorie-rich therapeutic food. Thanks to partnerships with UNICEF and Two Degrees Food, APZU has access to a peanut-based therapeutic formula for treating severely malnourished children. The special calorie-rich product quickly helped put weight onto her small frame. After just two weeks of the intensive therapy, which also included drinking a daily concoction of nutrients, Rachel was well enough to return home.

Rachel is one of the dozens children who are now enjoying healthy childhoods thanks to the lifesaving care provided by the NRU since it opened in May 2011. The space — with its walls of colorful, hand-painted cartoon animals and hanging dioramas of repurposed plastic — allows clinicians at PIH to provide a full spectrum of care for acutely malnourished children, from treatment of underlying infections like HIV and malaria to a balanced food regimen that allows rapid recovery. Because of the NRU, a child like Rachel can quickly recover from a critical state and begin living a healthy childhood in just weeks.

Lifesaving care does not end at the NRU's doors, however. As a patient in APZU’s outpatient nutrition program, Rachel receives food packets from our partners and other food supplies to help prevent malnutrition from returning, including Likuni Phala, an enriched corn-soya blend that can easily be cooked in the home. She will also continue to receive antiretroviral therapy for the rest of her life.

Today, Rachel has the contagious energy of a healthy toddler. “Rachel’s progress has been a tremendous improvement,” Banda says, as Rachel grabs his pen and scribbles on his notebook. “I am really thanking the family for making sure Rachel adheres to her medication and nutrition support, as these things go together.”

“However, there is still much more to be done for a child like Rachel,” he adds. Rachel’s mother has no source of income, for example, and because she was in the hospital with Rachel during the planting season, she has no crops to harvest. In addition, like other HIV patients on antiretroviral therapy, Rachel faces heightened nutritional needs that must be met. To address these complex issues, Blessings alerted PIH/APZU’s Program On Social And Economic Rights, who conducted a needs assessment and will support Rachel and her family to help her stay in good health.

Learn more about PIH's work in Malawi.