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Children on the frontline of Malawi's crisis

WFP's web editor Chris Endean is on a mission to Malawi. This is his fourth and final e-card from a country in the midst of a food crisis, and first appeared on the Guardian Unlimited website.

With an intravenous drip taped to her head and her cries echoing through the paediatric ward of the Nsanje Mission Hospital, Gertrude is clinging to her mother Esme’s breast; and her life.

Esme, who was divorced three months into her pregnancy and pounds maize for a pittance, took an HIV test last week. She is still waiting for the results, but the nurses’ grim faces and, above all, her daughter’s feeble condition make the official slip of paper superfluous; Gertrude shows every sign of being HIV positive.

At 11 months old, this severely malnourished child should be learning to walk. Instead she hardly has the strength to lift her head for her mother’s milk.

Unlikely to ever go home

This is Gertrude’s second visit to the hospital. Two months ago, she was treated for malnutrition after suffering fever and diarrhoea; now, she has contracted malaria and is unlikely to ever go home again.

For district nurse Anna Banda, it is an increasingly common story.

Five other malnourished babies are fighting for their lives under the ward’s green mosquito nets. Their rasping breaths are barely strong enough to break the dark room’s heavy, stale silence.

Malnourished babies

On her daily round, cycling through the villages that surround Nsanje Town, Anna is diagnosing more and more malnourished babies. Often, they are HIV positive.

“The hunger is worse this year,” she tells me, “and that makes it harder and harder for small weak bodies to fight off disease.”

As the full impact of Malawi’s food shortages start to take effect, children are on the frontline.

Rising admission rates

Last month, the rate at which malnourished children were admitted to Nutrition Rehabilitation Units for therapeutic feeding across southern Malawi was 15 percent higher than during September 2004.

Paul Tember, head of the paediatric ward at Blantyre’s Queen Elizabeth hospital, warns that the rate will climb even higher over the coming months.

A series of bar graphs charting admissions at Tember’s surgery wall shows that, even in a normal year, by the time Malawi’s traditional hunger season starts in January, his ward is overflowing with severely malnourished kids.

The first to suffer

Tember explains that, in times of hunger, young children are always the first to suffer; they lack the strength to cope with common diseases and, all too often in Malawi, HIV.

Some 30-40 percent of the mothers queuing up on the hospital verandah to weigh their frail babies have given birth to HIV-positive children.

According to Tember’s estimate, if pregnant mothers took an automatic HIV test after falling pregnant, the number of babies born with the virus would drop by 60 percent, as the women who tested positive could be treated to help avoid transmitting the condition to their children.


Just up the road from the Mission Hospital in the village of Napasha, 62-year-old Lucia Prize is also waiting for the results of her HIV test. Sitting on a bamboo mat outside her hut, Lucia is still in mourning after the death of her husband Benedicto from tuberculosis two weeks ago.

Unlike Esme and a generation of Malawian mothers haunted by HIV/AIDS, Esme can at least remember better times for her village.

“When I was young, a funeral was a rarity,” she tells me. “There would never be more than one per year. Now, even the children know what ‘funeral’ means.”