By Betty Rigodon and Dr. Jonas Rigodon


Patients picking up food on horseback at Nohana

In August 2007, the staff at PIH's clinic in Nohana confronted an alarming increase in the number of malnourished children arriving from the surrounding mountain villages. Within a single week, more than 100 children were diagnosed as malnourished in Nohana. Most were suffering from moderate malnutrition and several exhibited symptoms of wasting (marasmus) and swelling (kwashiorkor) associated with severe lack of calories and protein. Months before headlines and television reports announced a global food crisis, these children alerted PIH to a spike in the hunger and malnutrition that chronically afflict poor communities in Lesotho and other countries where we work.

Statistics reveal the scale of the persistent "silent tsunami" of hunger that only captured the attention of the media and the world when people took to the streets to protest soaring food prices. More than 800 million people suffer from chronic hunger. Nearly 10 million of the world's children die each year before reaching the age of five. Sadly, two out of three of these children die from easily preventable and treatable diseases such as diarrhea, pneumonia and malaria, and most would survive if they had not been weakened by hunger and malnutrition.

Conditions in Lesotho reflect these global trends. It is estimated that 40 percent of children under five are stunted and 20 percent are underweight, which are respectively signs of chronic and acute undernourishment.

Even before the recent upsurge of hunger in Lesotho and around the world, PIH-Lesotho had teamed up with the World Food Program to provide monthly food rations to all tuberculosis and HIV patients. This program reflects our belief that prevention and treatment of HIV are impossible without adequate nutrition. Numerous studies have confirmed what our experience tells us every day – that HIV patients are more likely to contract severe illnesses due to the weakness of their immune systems if they are not well-nourished.

When cases of severe malnutrition shot up last year, PIH launched a supplementary feeding program to provide nutritional support to all malnourished children in the mountains. Every child enrolled in the program receives a package containing 60 kilograms of maize meal, 9 kilograms of beans, 4 liters of cooking oil, and 6 kilograms of a nutritious corn-soy blend to help them gain weight. In addition, all severely or moderately malnourished children older than six months receive a special high-protein, high-energy peanut butter fortified with vitamins and sugar. This “Ready-to-Use Therapeutic Food” requires no preparation or special supervision and can be delivered to malnourished children at home by their parents or any other untrained adult.

Each child’s file at the clinic includes an intake form that records his or her weight, height, and upper arm circumference—all of which are used to measure nutritional status. Progress is monitored on a follow-up form that requires children to come back to the clinic both for a regular assessment and to pick up their monthly food rations.

The benefits of the program extend far beyond what can be gauged by measuring upper arm circumference. The regular visits also provide opportunities to:

  • vaccinate many children who have never been immunized
  • test a large number of children and their parents for HIV (in a country where nearly a quarter of the adult population is HIV positive)
  • distribute vitamin A to improve eyesight and reduce child mortality exacerbated by the high incidence of vitamin A deficiency
  • supply iron supplements for a population where more than half of all children under five suffer from iron deficiency anemia
 Malipho before treatment Malipho after treatment

Malipho before and after receiving
food and treatment


For a child like Malipho Ramahapa, the Plumpy’nut and food packages are just as essential as the other medicines that spell the difference between life and death. Malipho, a 19-month-old boy, weighed only 5.2 kilograms (11.5 pounds) in October 2007, when he was brought to the clinic at Nohana. According to his mother, little Malipho was suffering from a daunting array of symptoms – a very high fever, oral thrush (a fungal infection in his mouth), chronic diarrhea, vomiting, loss of appetite and weight loss. An examination confirmed the symptoms and a diagnosis of both severe malnutrition (marasmus) and pulmonary tuberculosis. Results of an HIV test revealed that he was also suffering from advanced HIV progressing to AIDS.

Just two months after starting treatment and a diet of Plumpy’nut, Malipho was barely recognizable. Gone was the child so weak and wasted that he could barely sit up, replaced by a robust boy with an engaged look and a ready smile.

Malipho’s mother was so overjoyed by her son’s recovery that she chose to speak out and urge other parents to bring their children to the clinic. Just 20 years old and HIV positive, she had been reluctant to undertake the long trip to the clinic herself. But with her only child on the brink of death, she finally decided to come. “I took the decision to come to this clinic just because my child was so sick,” she recalled. “And also because the village health worker forced me to. I remember that it took me two days to get to the clinic, for a trip that would normally take about eight hours for a health person on horseback.”

Now, she says, “I really appreciate all the help that I got from this clinic, which keeps my child from dying today. It may be difficult for patients to come to the clinic, but all of them should do so in order to save their children’s lives. Saving lives is more important than worrying about the two-day trip.”

[posted June 2008]