RUTF: Hope in a sachet; Fighting malnutrition in South Sudan

Malnutrition, for mothers such as Vivian in South Sudan, is not merely a health issue but a potentially fatal condition if not addressed promptly. Vivian Stephen, 21, is a widow and mother of two. 

She lost her husband, Sebit, in November last year after he was robbed and killed while transporting a passenger from Mangaten to Jongoli village. Since his death, Vivian has been raising her children alone. Her nine-month-old daughter, Shushu, began falling ill in September. 

“At first, she refused to eat. I thought it was because of the hot weather,” Vivian recalled. “She had a high fever and lost her appetite, but when it continued, I became worried.” 

At the clinic, Shushu tested positive for malaria. She received treatment, but her condition did not improve. “After a week, her arms and legs became thinner. She was losing weight,” Vivian said.

A concerned neighbor advised her to visit the nutrition center. Though hesitant at first, Vivian eventually went. “We were received warmly. The staff were kind and taught us about hygiene, keeping our compounds clean, and understanding malnutrition. They gave me Ready-to-Use Therapeutic Food (RUTF) for Shushu.”

 When Shushu was admitted to the Outpatient Therapeutic Program (OTP), her mid-upper arm circumference measured just 9.6 cm, and she weighed 6.2kg — clear signs of severe acute malnutrition. Based on her weight, she received 18 sachets of RUTF per week as part of her treatment.

“I feel encouraged to feed Shushu on time with the RUTF and the food I cook at home,” Vivian said. “I know her weight can improve.”

A Crisis Beyond One Family

Vivian’s struggle reflects a much wider emergency. According to the Humanitarian Needs and Response Plan:

4.3 million children under five, adolescent girls, and pregnant and lactating women require life-saving nutrition treatment and preventive care.

·       650,000 children under five are at risk of severe acute malnutrition.

·       1.4 million children face moderate acute malnutrition.

·       1.1 million mothers urgently need treatment.

In 2025, eight in ten children under five are projected to be at risk of acute malnutrition. 7.7 million people, including 1.5 million young children, face severe food insecurity. In Juba County alone, 4,084 children across 27 health facilities were treated for severe acute malnutrition in the last three months.

Grief, Displacement, and Survival

After her husband’s death, Vivian’s life changed dramatically. “His family does not support me. I was sad and didn’t know what to do,” she said. Her cousin sister, Galual, took her and the children into her home.

Vivian’s own family was separated during the 2013 civil war. Her mother now lives in Bentiu with her younger siblings, and her father’s whereabouts remain unknown. “I didn’t want to add to my mother’s worries,” she said.

Galual runs a small tea shop that supports the entire household. With limited income, she struggles to provide food and basic needs for everyone.

“I cannot afford fish, meat, or even milk to supplement my breast milk,” Vivian explained. “But I will continue using the RUTF as recommended. With consistency, I know her condition will change.”

Hope, but fear of relapse

Vivian is grateful for the support she receives but worries about the future . “I believe Shushu will recover,” she said. “But I fear she may relapse because of our difficult living conditions. I wish the nutrition site could also provide other supplementary foods. Given the economic crisis, I may be on the programme for a long time.” 

 For mothers like Vivian, RUTF is more than a therapeutic product,  it is hope in a sachet. And for Shushu, it may be the lifeline that gives her a second chance at life. 

Story by Jemima Tumalu and photos by Alan Roba/World Vision