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Plumpy'Nut bars manufactured at the Edesia Nutrition plant in Rhode Island. Has the "ready-to-use therapeutic food" — credited with an 80 to 90% recovery rate among malnourished children — been caught up in the U.S. aid cuts? Gabrielle Emanuel/NPR hide caption
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Gabrielle Emanuel/NPR
Fatima Jubril lost her husband when the militant group Boko Haram attacked their farm in northeast Nigeria last September. Fleeing her village with her four children, she found shelter in a displaced persons camp – but then came another monumental challenge: Jubril came dangerously close to losing her 2-year-old son, Ibrahim.
Jubril says the food rations in the camp were not enough so she was not producing sufficient breast milk for her young child. Ibrahim started losing weight. She remembers he was crying and irritated all the time. He was diagnosed with acute malnutrition at the local aid clinic.
What saved him from starvation, she believes, are little packets of Plumpy'Nut — a nutrient-dense paste made up of peanut butter, powdered milk, oil and sugar, fortified with vitamins and minerals.
Plumpy'Nut is one of the brand names for a ready-to-use therapeutic food. USAID has been a big supporter of RUTFs – ordering them from factories and helping to distribute them around the world. But now RUTFs have been caught up in the Trump administration's dismantling of USAID and, aid workers in crisis zones say, these lifesaving packets aren't always getting to the kids who need them.
The birth of an RUTF
Plumpy'Nut was developed in France and since 2001 has become the go-to intervention for malnourished children. Each packet is about the size of the bag M&Ms you'd buy at the candy counter and costs roughly 30 cents to produce. A typical regimen is two or three packets a day for six to eight weeks.
The therapeutic food is prescribed if a child's arm measurements or height-to-weight ratio are significantly below average.
With a smooth, slightly grainy consistency, it's definitely ready-to-eat and appealing to kids. "Rip the corner and suck it out," says Dr. Mark Manary of Washington University, a longtime booster of the product. "It's really, really sweet."
Within three weeks of starting his Plumpy'Nut diet, Ibrahim rapidly improved. "After he started taking the packet, I noticed he started gaining weight," Jubril said. "He also stopped crying all the time, and I was really happy."
What studies show
Ibrahim is one of millions to benefit. "Since 2001 we would estimate 40 million children treated," says Dr. Manary, who ran the first Plumpy'Nut trial that year.
Over the years, studies have shown that this product is dramatically effective in areas struggling with child malnutrition. Independent researchers have determined that the survival rate for severely malnourished kids was about 25% in the pre-Plumpy'Nut era — and the use of RUTFs has boosted that number to 80 to 90%.
"RUTF has been a game changer in saving children from being malnourished and subsequently dying," says Nadia Akseer, an associate scientist at the Johns Hopkins Bloomberg School of Public Health who researches maternal and child health and malnutrition in lower income countries. "Children who take RUTF have high recovery rates, end up bouncing back and being able to survive and thrive."
This photo taken on June 14, 2016 shows a woman feeding her child suffering from malnutririon with a pack of "Plumpy Nut" food, which contains vitamins, proteins and all neccesary nutriments, in the pediatrics unit at the Niamey hospital. Plumpy Nut is now manufactured locally, a few kilometers away in the industrial area of Niamey, by the Societe de Transformation Alimentaire (STA, or Food Transformation Company. Niger has been repeatedly plagued by food and humanitarian crises, as more than 300,000 people have been displaced. 240,000 have fled the atrocities of the Nigerian Islamist group Boko Haram in the southeast, while 60,000 have fled to Niger to escape the Islamist groups in Mali. Issouf Sanogo/AFP via Getty Images/AFP hide caption
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Issouf Sanogo/AFP via Getty Images/AFP
In the past few years, the number of kids using RUTFs has increased dramatically — from an average of about 5 million in the early 2020s to 9 million in 2024.
That's due to "the generosity of the American people," says Manary, citing increased USAID support for manufacturing and distributing the products.
The current state of Plumpy'Nut
Has the rapid-fire disruption of cuts and reinstatements at USAID had an impact on the manufacture and global distribution of this product?
A State Department spokesperson emphasized that the strong U.S. commitment to RUTFs has continued in an email to NPR, saying that "USAID has multiple active contracts for ready-to-use therapeutic food (RUTF) products and several shipments pending routine checks with the interagency, including nearly $300 million in active humanitarian assistance related awards in Nigeria at this time. Additionally, USAID has previously purchased RUTFs and is making determinations on where to ship."
The spokesperson emphasized that even as efforts are made to improve "accountability and strategic coordination" that "critical life-saving programs have continued uninterrupted."
Yet a UNICEF report dated March 25 warns that "impacts across 17 high-priority countries due to funding cuts could leave more than 2.4 million children suffering from severe acute malnutrition without access to Ready-to-Use Therapeutic Food for the remainder of 2025." Further it said, up to 2,300 lifesaving clinics for malnourished children with medical complications are at risk of closing or dramatically scaling back services.
Representatives of two RUTF factories in the U.S. also raised concerns with NPR about supply and distribution.
Navyn Salem, who founded Edesia Nutrition in Rhode Island, buys food from producers across the U.S. and makes Plumpy'Nut for five million children in 30 countries in a typical year. But this has not been a typical year.
Edesia received stop work orders on January 29 from the U.S. government which were rescinded on February 6. It received contract terminations later in February which were, again, later rescinded. The company is still owed $20 million by the U.S. government
A production line at Edesia Nutrition's Rhode Island factory. Usually it's jam-packed with boxes of Plumpy'Nut but the company has cut back because it's owed $20 million by the U.S. government. Gabrielle Emanuel/NPR hide caption
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Gabrielle Emanuel/NPR
Salem and a representative of MANA Nutrition in Georgia — which also produces RUTFs — disagree with the State Department assessment of orders for their product. In an email to NPR this week they said: "Edesia and MANA have no active RUTF contracts from fiscal year 2025. We look forward to working with a new team at the State Department in order to restart operations."
Representatives of the factories say they have been impacted by all the contract disruptions and late payments, with some production lines and conveyor belts at a standstill.
"What you would normally see is almost like a traffic jam of boxes of Plumpy'Nut," says Salem, walking through her pristine factory in North Kingstown on February 28. "It shouldn't be this quiet. No one in this building has ever seen it look like this."
Concerns in Kenya and Nigeria
What worries her the most is the quiet in places like northern Kenya.
That's where Peter Too works. He's a nutrition officer for the most severely malnourished children at Kakuma refugee camp, not far from the borders of Uganda and South Sudan. When he spoke with NPR on March 19, he was in a ward caring for 20 children laying on narrow beds with IV lines and oxygen to keep them alive. The children were weak from a combination of malnutrition and disease, he said.
Medics from Doctors without Borders in Nigeria stand by stacks of Plumpy'Nut, which is used to treat severely malnourished children. Sally Hayden/SOPA Images/LightRocket via Getty Images)/LightRocket hide caption
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Sally Hayden/SOPA Images/LightRocket via Getty Images)/LightRocket
"Most of these children are too weak to cry. You will see the sign of crying: their mouths moving and their faces aching with exhaustion," Too says. "You see the aspiration to cry out of the pain. But you find that they are weak. There is no sound. You find them dehydrated, so you don't see any tears."
Too, who has worked at Kakuma for seven years, says he's never seen such a desperate situation. Funding from the U.S. helped support this ward – called a stabilization center – but that money was halted as part of the January freeze, prompting the International Rescue Committee to draw from its limited pool of emergency funds to keep the center open. U.S. funding has since resumed, but humanitarian experts at the IRC say many of these programs are at critical risk.
The situation is particularly worrisome, Too says, because the region is in its rainy season, which usually starts in March and lasts through May, bringing a spike in diseases like malaria and diarrhea. In a typical year, the center, which has 35 beds, receives a surge of patients during April, May and June. In recent rainy seasons, there are often months with more than 150 patients admitted to the ward. This requires doubling up patients in beds and having others stay on the floor.
Too is bracing for worse this year. Food rations at Kakuma refugee camp have been significantly cut as a result of the U.S. cutting aid to the World Food Programme. And other malnutrition wards are running out of Plumpy'Nut, with some even shutting down as funds dry up and supply chains collapse.
Jeanette Bailey, director of nutrition research at the IRC, says the rescue organization has received contract terminations from the U.S. government for more than a dozen nutrition programs, though some have subsequently received rescission letters. "Every single day, we are hearing about new disruptions, new closures and new reopenings," she says.
What's more, the supply chain — the local people paid to get it from ports in lower resource countries to warehouses to clinics that distribute it — has been broken because many local charities have had to lay off vital staff in the wake of the U.S. aid cuts.
Those disruptions are being seen in Nigeria, where nearly half of all deaths of children under age 5 are linked to malnutrition.
Muhammed Wakil, an aid worker with the international nonprofit Save the Children, is based in Nigeria's northeast state of Borno. He has been distributing Plumpy'Nut for three years, but he lost his job soon after the cuts kicked in. "All of a sudden, we no longer received shipments of Plumpy'Nut," says Wakil. "Even existing shipments… are now locked in warehouses because there are no staff to distribute them." The shelf life is two years but given the current situation, Wakil worries that "they will now expire or go bad."
Meet 'Tom Brown'
Given all the uncertainty in U.S. aid, Wakil says Nigeria has started looking for local alternatives — notably a therapeutic food known as Tom Brown.
Tom Brown is a powdery blend of local ingredients: millet, groundnut, sorghum, fish spices and dried ginger. Add hot water and it becomes a porridge. Locals call it Tom Brown because the powder turns brown when hot water is added to it. (The word "turns" morphed into "Tom.")
Dr. Adbulrauf Waziri is a nutrition expert in Nigeria's northeast. He says the Nigerian government must now invest in the production of Tom Brown to save malnourished children: "This really requires urgent attention from the Nigerian government to scale up local production of Tom Brown, this really needs to be taken as a matter of urgency."
But Tom Brown has pros and cons.
The use of local ingredients is a plus – and would reduce dependency on global aid, says Nadia Akseer of Hopkins.
But she cautions that such local formulations "may lack the precise energy, fat, protein, and micronutrient content proven to treat severe acute malnutrition." She adds that these alternative products may also require refrigeration and that quality control could be an issue.
As for families who have been displaced, they may find that Tom Brown isn't easy to make. Fatima Jubril, who is now turning to Tom Brown in the absence of Plumpy'Nut for her son, Ibrahim, says ingredients are expensive. And she often lacks the fuel needed to boil water in order to prepare the porridge.
But at least for the time being, she says, her son Ibrahim is doing well.
