Yacine Lo's twins were clearly not well.
Diarra and Khadim, her girl and boy, should have been busily toddling around like almost-2-year-olds they were. Instead "they were very, very weak," she says. "It's very sad to see your kids that way. When my kids aren't well, I can't be well, I can't even eat."
Lo lives outside of Keur Mbar, a small rural community in western Senegal with high levels of poverty. As a result, malnutrition is common here, she says, and she knew the signs. She also knew where to go for help.
So she wrapped Diarra and Khadim on her back, and set off on foot to a clinic over 3 miles away. The route is flat but harsh. The vast, dusty landscape is only broken by the occasional acacia tree or the looming contortions of a baobab, which looks as though it grows by moonlight.
"It takes long," she says. "It's really very painful with your babies on your back under the hot sun."
Initially, the journey was worth it.
At the clinic, community health workers confirmed her suspicion and gave her a week's supply of a near-miracle food — Plumpy'Nut, the brand name of what's called a ready-to-use therapeutic food, or RUTF. It's a nutrient-dense paste made up of peanut butter, powdered milk, oil and sugar, fortified with vitamins and minerals.
Typically, in Senegal and other countries, a parent from a remote area would have had to travel even further to find a hospital or doctor who could provide this life-saving food. But for the past few years, Senegal, with the help of U.S. funding and nonprofit organizations, has been trying to bring care closer to kids like Diarra and Khadim.
Once a week, she'd make the journey back to the clinic for more Plumpy'Nut. Over time, the twins started improving, and her mood lifted.
"When you see that your kids are in good health, you are happy and feel good, because this is something natural, this is something human," she says. "But whenever your child is suffering, you suffer with them."
That suffering has increased over the past year and a half, she says, in the aftermath of the Trump administration's massive cuts to foreign aid. While Lo's son has recovered, Diarra still suffers from malnutrition and needs treatment. But these days, when she comes to the clinic, there's often no Plumpy'Nut.
"It's so frustrating," says Lo. When that happens, she trudges home empty-handed, hoping the key to her child's recovery will be there next time. "It's a big problem."
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A safety net frays
Such shortages are happening across Senegal, according to health officials.
The small rural clinic Lo relies on is one of over 500 across Senegal serving as a net that catches kids with malnutrition and offers this superfood.
U.S. foreign aid, through a variety of programs, supported those clinics and the food they delivered. The sudden cuts have sent a shockwave through the whole system, leading to staff and food shortages.
In a statement, the State Department did not address NPR's questions about the shortages. They did say that the State Department is currently programming $23 million in maternal, child health and nutrition resources in Senegal. But the shortages were evident during an April reporting trip by NPR, and the State Department did not respond to multiple requests for additional details on what that $23 million is funding.
"It's having a heavy impact," says Latsouk Faye, regional supervisor for food, nutrition and child survival in Diourbel. "Many people just abandon, they no longer come to the clinics. Malnutrition is coming back."
An innovative partnership
Roughly 1 in 10 children in Senegal are acutely malnourished, a condition that can lead to long-term health and cognitive deficits. If it becomes severe, it can be fatal.
"About half of the mortality of children under 5 is related to malnutrition," says Ndèye Astou Badiane, country director in Senegal for Helen Keller Intl, a nonprofit that addresses this issue. Identifying cases early and offering treatment is crucial to saving lives, she says. But historically, this kind of treatment was only available at hospitals or doctors' offices, which are often out of reach where malnutrition is highest.
So in 2022, Helen Keller and some other nonprofits partnered with the Senegal Ministry of Health to try something different — training and equipping community health workers to treat severe acute malnutrition.
Fatma Diouf is one such community health worker in Keur Mbar, where Lo's twins got treatment.
Walking around the village, Diouf seems to know everyone. She flashes a wide smile at kids playing soccer in the street and greets them by name. "I'm part of this community," she says, and got into this work to help it.
Her clinic is a squat, tan building with turquoise-painted doors and windows. Families with young kids come to her for screening, advice and treatment. She first brings them to the courtyard, where a large scale hangs from a small tree.
"We start by weighing the child, seeing whether he has a normal weight or not," she says. Then they run through a checklist of other signs of malnutrition. Swollen hands or feet can indicate severe protein deficiency. Lumpy skin, very thin arms and fever can be signs too.
If a child meets the criteria, and doesn't require more intensive care at the hospital, Diouf hands them packets of Plumpy'Nut. Three of these a day over the course of several weeks can bring a child back from the brink. Week after week as families come back, she watches as little ones regain their strength and become active, little kids again.
Since 2022, the program has grown to five regions across Senegal, screening hundreds of thousands of children. The Ministry of Health was behind the initiative, too.
"The impact has been very positive," says Mamadou Dieng, regional health director in Diourbel. "Many children who normally wouldn't be screened have been screened, and there has been a reduction in the mortality rate."
The Ministry of Health had plans to expand this model throughout the country. Aid cuts have thrown those plans into question.
USAID directly supported the program in its early days and helped fund nutrition program staff more generally across Senegal until 2025. The U.S. was also the biggest supporter of UNICEF, which buys and distributes the vast majority of RUTF in the country, contributing over $1 billion in 2024.
"So many activities that were supported by the American government have stopped all of a sudden," says Badiane, of Helen Keller. "It was really a severe shock."
"They think we are deceiving them"
It's been a shock at Fatma Diouf's clinic, too.
"We get way less than we used to," she says. That means she's turning many families home empty-handed. Often, those families blame Diouf. "They think we are deceiving them," she says. "That I choose who to give the Plumpy'Nut [to] and just leave them aside."
The situation has been hard on Diouf. She recalls one child who came to the clinic during a shortage and began searching where Diouf keeps the product. After finding nothing, "[the child] just screams and refuses to go home," she says. "It really hurts."
Some of the Plumpy'Nut that ends up at Diouf's clinic is typically stored in a warehouse over an hour away, in the town of Diourbel. The heavy metal doors creak as Faye, the regional health official, opens them.
"This place used to be full," he says, able to store about 4,000 boxes — enough to feed over 4,000 kids for several weeks of treatment. "But since USAID left, since the start of the problem with Trump, UNICEF has become weaker," he says, gesturing at the empty space.
Overall, his district is getting about half of the RUTF it used to, he says. There's also fewer staff to shuttle the life-saving product from central storage facilities to smaller clinics, like Diouf's. Faced with prolonged shortages, he says many families have just stopped making the trip to the clinics.
That point is echoed by Dr. Arame Ndiaye, a pediatrician in Bambey, Senegal. "If families can no longer get RUTF, they are prone to abandoning" and not coming to clinics for care, she says.
Or even for screenings. From October thru December of 2024, more than 180,000 kids were screened for malnutrition in the area, according to data from the National Nutrition Development Council and Helen Keller. After the cuts, from July through September, fewer than 87,000 kids were screened. That represents just 30% of the region's population of children, far from the program's goal of reaching about 80% of kids.
The impact is evident. Tening Ngom is the primary caregiver for her baby nephew, Aliou, who has been getting Plumpy'Nut at Diouf's clinic.
"When he started getting the treatment, he recovered very well," she says outside her home, over the occasional bleating of her goats. But with this shortage, she says he often misses treatment.
"If they don't have [the product], he starts crying and he doesn't stop crying. He never stops crying," she says. In recent weeks, she says Aliou's health has deteriorated, and he's very weak again.
Health officials in Senegal interviewed for this story worry that this kind of relapse is happening more broadly.
Still, there are some glimmers of hope. Through a variety of sources, including philanthropic funds and some foreign aid dollars, the flow of RUTF is improving. But the supply is still unstable. And that net of community health workers who serve as links between families and this lifesaving treatment is fraying.
"Since the aid cuts, many [community health workers] are no longer getting paid," says Diouf. "For some areas, the number of workers have halved, but for others, there's no one."
Despite these challenges, Diouf keeps trying to reach out to families. Instead of offering RUTF, she and her colleagues make a home-grown substitute with local ingredients, like millet, maize and ground nuts. It's not as effective as the real deal, she says, but it's something.
Helen Keller is scrambling to fill the gaps too, says Senegal country director Badiane. They've had some success with the help of the Eleanor Crook Foundation, an American nonprofit. But she says neither the nonprofit nor the Senegalese government has the resources to easily sustain what's been lost.
"Senegal is a poor country," she says, and the government has many competing priorities for spending.
In March, Senegal signed a new, five-year, $90 million health aid deal with the U.S. government. In 2024 alone, the U.S. sent more than $230 million in foreign assistance to Senegal. While the details of the new deal are still being worked out, Badiane says that money for nutrition programs was left out. In a statement, the State Department said that the deal reflects Senegal's own strategic objectives.
In the face of these challenges, Badiane says her team is pushing hard to keep this community-based model of malnutrition care going. "It's an approach that's working," she says, for kids like Diarra, Khadim and Aliou and thousands of others. "We need to treat these children, and they cannot wait. They need RUTF."
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