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REPLENISH: When life-saving food becomes a threat

Malnourished child's hair turns grey. PHOTO/HERBERT KAMOGA

What you need to know:

  • Malnutrition remains a silent crisis in the Karamoja sub-region. For years, Ready-to-Use Therapeutic Food (RUTF) has been a lifeline for severely malnourished children. However, a recent health scare has turned this solution into a concern, leaving communities and health workers searching for safe alternatives. District leaders in Amudat are questioning why the government failed to test the product  thoroughly before distribution. Herbert Kamoga brings us closer to the unfolding crisis in Amudat district.

Margaret Meri, a resident of Kaperu village in Moroto district, brought her baby to Amudat Hospital after severe malnutrition left the child weak and vulnerable.

“We often go days without food. Even now, after three weeks in the hospital, I worry about what will happen when we return home. Without daily access to food, the condition could return,” she says.
 
Similarly, Maxmilla Sanya, from Naput village on the Uganda-Kenya border in Moroto district, recounts how her child’s immunity weakened due to malnutrition, making him susceptible to Kala-azar, a parasitic disease rampant in the region. 

“Some days, we survive on milk or meat from animals that have died in the kraal. At times, we pierce our animals to feed on their blood,” she reveals. 

In the food-insecure Karamoja sub-region, malnutrition has entrenched itself as a persistent health crisis, affecting a staggering 12.2 percent of children under the age of five. This alarming statistic underscores a dire reality where food scarcity, high population mobility, and endemic diseases converge with poor sanitation and a high illiteracy rate, creating the perfect storm for nutritional deficiencies.
 
According to Dr Sam Ondoga, the principal nutritionist at Moroto Regional Referral Hospital and the Karamoja regional nutritionist, over 400,000 people in the sub-region, roughly 30 percent of the population, are food insecure. Vulnerable groups, particularly children under five, bear the brunt of the crisis.

To combat this catastrophe, Ready-to-Use Therapeutic Food (RUTF) has been a lifeline for malnourished children. Health facilities provide RUTF, a high-energy paste, to treat severe acute malnutrition and combat its effects on mothers and their malnourished children. For years, brands like Rebound, supported by the United Nations Children’s Fund (UNICEF), have proven effective.

A solution turns toxic

However, a recent setback has rocked the region. REPLENISH, a RUTF brand supplied by the National Medical Stores (NMS), has been linked to severe adverse reactions. Dr Patrick Sagaki, the outgoing Amudat district health officer, health workers in the region began noticing symptoms among its consumers in November, last year. 

“The parents of malnourished children reported cases of diarrhea and vomiting, with some having blood in their stool. We realised we had a problem and reported to the country’s health authorities. The first case was reported in Karita Health Centre IV, where the children who were given the treatment presented with side effects of vomiting and diarrhea,” he says.

Dr Sagaki notes that 41 cases have been documented across health facilities like Karita Health Centre IV, Amudat Hospital, Alakas Health Centre III, and Cheptapoyo Health Centre II.

These reports prompted an immediate suspension of REPLENISH by the Ministry of Health (MoH), pending a thorough investigation. In a letter to all chief administrative officers, seen by this publication, Dr Diana Atwine, the permanent secretary stated, “In light of these developments, the MoH in collaboration with the National Drug Authority (NDA), and NMS, has initiated investigations to determine the cause of these adverse effects.”

To address the issue, the MoH confirmed that it is working closely with both entities to uncover the root cause of these adverse effects. “While these investigations are ongoing, and as a precautionary measure to safeguard the health and well-being of the affected population…other available brands of RUTF can be used to ensure uninterrupted treatment of malnourished children.” 

Alfred Chemutai, Amudat district’s nutrition focal point, reported that this development marks a critical juncture in the fight against malnutrition. Authorities are working to restore trust in essential therapeutic food supplies while addressing the immediate health risks faced by affected children.

“For many years, we have relied on RUTF, in particular,  a component known as Rebound, which has consistently proven effective and safe. For the communities, specifically in Amudat district, this development is a double-edged sword. While the suspension aims to protect vulnerable children, it also disrupts the treatment of malnutrition in an area where alternative solutions are scarce,” he says. 
 
The unfolding situation has brought to light the urgent need for sustainable solutions in one of Uganda's most marginalised regions. Malnutrition affects 17.3 percent of children under five in Amudat District alone. The harsh, arid climate renders farming nearly impossible, forcing families to rely heavily on livestock for sustenance. 

However, pastoralist communities’ frequent migrations in search of water and pasture often separate children from crucial animal products like milk.

“This place is food insecure. Most of the areas are dry, making it difficult to grow food. The population is highly mobile, and diseases like malaria and Kala-azar exacerbate malnutrition. Additionally, sanitation levels are extremely low, further contributing to these alarming rates,” Dr Sagaki says.
 
There are few health facilities in the region and some people live very far from them. Due to cultural beliefs, some foodstuffs, such as fish and silverfish, are not easily acceptable to the communities, yet they are highly nutritious. 
 
Accusations 
Joseph Lobooti Nangole, Amudat district’s LCV chairperson, strongly condemns the situation, saying the RUTF that is causing problems is not the original type the district has been receiving.

“The World Food Programme (WFP) has been providing effective therapeutic food, but the shift to REPLENISH seems to be driven by business interests rather than public health. It is unacceptable that Karamoja was used as a testing ground for unverified products. This is not a place where someone will wake up one day and say, ‘We need to push this to Karamoja.’ Fortunately, we did not lose any life.” he says.
 
Pharmacovigilance efforts are ongoing, with authorities examining the composition of REPLENISH and understanding its adverse effects. The suspension has brought into focus the fragility of Karamoja’s healthcare and nutritional systems. 

“Beyond food insecurity, access to health services, economic challenges, and poor sanitation play significant roles. Addressing these issues requires a holistic approach,” Dr Sagaki says, emphasising the interconnected causes of malnutrition.
 
Efforts are underway to integrate nutritional support with livelihood programs. For example, the distribution of Gala goats, known for their high milk production, has provided some families with a sustainable source of nutrition.
 
“After treatment, we encourage households with malnourished children to link up with livelihood support projects, such as the Parish Development Model (PDM), which targets struggling households. We also promote the establishment of kitchen gardens and backyard gardening to boost food security. However, the biggest challenge remains access to water, especially during the dry season,” Chemutai explains.
 
The suspension of REPLENISH has undoubtedly disrupted the treatment of malnourished children in Karamoja. However, it also presents an opportunity to re-evaluate the region’s approach to tackling malnutrition. By combining immediate nutritional interventions with long-term livelihood support, stakeholders can build a more resilient system.
 
As investigations into REPLENISH continue, the focus must remain on protecting vulnerable children. The voices of mothers like Meri and Sanya underscore the urgency of addressing malnutrition not just as a medical issue but as a reflection of deeper societal challenges. The road to recovery may be long, but with coordinated efforts, it is a journey worth undertaking.

What is RUTF?
Ready-to-use therapeutic food (RUTF) is a life-saving essential supply item that treats severe wasting in children under five. Wasting is defined as low weight-for-height and happens when someone has not had enough food or food of adequate quality. If not appropriately treated, wasting in children is associated with a higher risk of death.

RUTF paste was invented 25 years ago by André Briend, a pediatric nutritionist, and Michel Lescanne, a food processing engineer. It became commercially available in the early 2000s. It is made from powdered milk, peanuts, butter, vegetable oil, sugar, and a mix of vitamins and minerals. Each packet of RUTF contains approximately 500 calories, vitamins, and minerals. The paste is ready to eat, directly from the packet without prior cooking, mixing, or dilution. 

For the last four years, UNICEF has been procuring an estimated 75 to 80 percent of the world’s RUTF – equivalent to 49,000 metric tonnes.

Malnutrition is a violation of children’s right to nutrition. RUTF’s irrefutable success in saving millions of children from dying has had the power to shock donors and partners to do whatever it takes to ensure RUTF is adequately pre-positioned wherever children are vulnerable to hunger crises.

Integrating nutrition supply chains into national supply systems to improve care for vulnerable children and support for the cost-effective and sustainable production of RUTF is a significant contribution of the supply function towards saving lives. 

Source: UNICEF 


Produced by Nation Media Group in partnership with the Bill & Melinda Gates Foundation

General Manager Editorial, Daniel Kalinaki

Acting Managing Editor,  Allan Chekwech
 

Editor, Sustainability Hub, Gillian Nantume

Features Editor Caesar Karuhanga Abangirah

Contributor, Herbert Kamoga