Boteti children pay price of malnutrition
Nnasaretha Kgamanyane | Wednesday April 29, 2026 06:00
Health officials have recently painted a stark picture of how stockouts and alcohol abuse are driving a child nutrition crisis across one of Botswana’s hardest-hit districts.
Boteti’s underweight rate for children under five stands at 5.12 percent, nearly double the 2.9 percent national target. District dietician Mabedi Mokoto said the district ranks amongst the top five nationally for malnutrition, with hotspot areas like Khwee, Medie, and Buuhe exceeding 10% before recent interventions.
The absence of food rations has been devastating.
“Our caregivers have a tendency to only bring the under-five to the facility when they know they’ll be getting something,” Mokoto said.
Attendance at Child Welfare Clinics has fallen from 10,000 to 7,000 children since supplies of tsabana, malutu, beans, and cooking oil ran out.
“That is at least 3,000 children not being brought to CWC. And we do not know what is happening where they are because nobody is monitoring their growth.”
At Tawana Clinic, nurse Oagaletse Gwabeni sees the gap firsthand. The clinic serves over 1,500 children monthly, but numbers have declined.
“We do not know how many kids we have lost. In March, we saw 150 kids. We do not know how many we have lost,” she said.
A recent screening of 25 children found 10 with moderate acute malnutrition and four with severe cases.
Transport shortages compound the problem. Severe cases need weekly monitoring and Ready-to-use Therapeutic Food (RUTF) treatment, but staff cannot reach mobile stops at farms and ranches.
“Currently, because of the transport issues, I cannot reach out to those kids,” Gwabeni said.
Then there is alcohol. Mokoto listed high alcohol consumption among caregivers as a key driver of malnutrition.
“High alcohol consumption makes caregivers not be able to take care of their children well, or they don’t have time to take care of their children, to cook for them.”
Dr Dick Mpitika echoed this, citing “high alcohol consumption” alongside poor feeding practices, childhood illnesses, and sharing or selling of food rations as core challenges.
Boteti covers 21 CWC facilities and 258 mobile outreach points across a vast area from Mokubilo to Makalamabedi. The estimated under-five population is 9,951. Letlhakane Clinic and Tawana Clinic see the highest volumes.
Data from July to September 2025 showed the district missing critical targets. Ration coverage was 64% against an 85% target before stocks ran out completely. Stunting sat at 1.69 percent against a 0.9 percent district target. Khwee and Letlhakane were previously above the 10% underweight prevalence threshold, though interventions have since moved them out of the high-concern category.
Those interventions include nutrition education, home visits, and direct feeding programmes in Khwee and Buuhe. But direct feeding depends on donations and the same food rations that are now gone.
“In Khwee, they are currently not cooking anything for their children,” Mokoto said.
Amid the crisis, a community-based programme led by UNICEF, the Botswana Red Cross Society, and the Embassy of Japan has drawn praise for curbing acute malnutrition. The SEMAM project, which focuses on integrated management of acute malnutrition, screens and manages children using RUTF in collaboration with district health teams.
“This is one of the interventions that we give in terms of IMAM (Integrated Management of Acute Malnutrition) and OTP (Outpatient Therapeutic Programme), which is a treatment for the acutely malnourished children,” officials noted.
Health authorities applauded the partners for stepping in when resources were scarce, noting that the project, which started in December, has helped mitigate the situation.
Officials want more action. Their recommendations: a nutrition rehabilitation centre to train caregivers, reformulation and enforcement of alcohol licensing and operating hours, expansion of direct feeding to Letlhakane Clinic, and transport dedicated to nutrition programs.
“We have many multiple interrelated challenges that are affecting our child nutrition outcomes,” Mokoto said. Dr Mpitika added that the district saw underweight rates rise in mid-2025 and developed a mitigation plan, but lacked resources until partner support arrived in December.
For now, the equation in Boteti is simple. No rations, fewer clinic visits. More alcohol, less feeding. And children are slipping through the cracks.
“We keep on educating caregivers with good practices of feeding their children,” Dr Mpitika said. “But we need help.”