Community therapeutic care for managing severe acute malnutrition the effect of rutf
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Community Therapeutic Care for managing severe acute malnutrition-The effect of RUTF. By Dr. Paluku Bahwere -Valid International 34 th session of the SCN- WG on nutrition and HIV/AIDS February 28 th 2007. Presentation overview. Introduction Management of HIV infected children in CTC

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Community therapeutic care for managing severe acute malnutrition the effect of rutf

Community Therapeutic Care for managing severe acute malnutrition-The effect of RUTF

By Dr. Paluku Bahwere -Valid International

34th session of the SCN- WG on nutrition and HIV/AIDS

February 28th 2007


Presentation overview
Presentation overview malnutrition-The effect of RUTF

  • Introduction

  • Management of HIV infected children in CTC

  • CTC and the management of HIV malnourished adults in the community

  • Local RUTF production and linkage with livelihood programmes

  • Conclusions


Introduction important background issues in africa
Introduction: malnutrition-The effect of RUTF Important background issues in Africa

  • High HIV prevalence

    • High mortality prior to ART and in ART programmes

    • Affect country and community in many sectors

  • Malnutrition common among HIV infected individuals

    • In Therapeutic feeding programmes

    • Very common first AIDS defining condition

    • Common at ART commencement.

    • Not always related to AIDS stage

    • Malnutrition related to survival time


Introduction important background issues in africa cont

Very low VCT coverage malnutrition-The effect of RUTF

83% adults untested in Malawi (2004MDHS)

Fast progression of HIV

sero-conversion to stage 2 - 25.4 months

sero-conversion to stage 3 - 45.5 months

Progression from AIDS to death < 1 year

Introduction: Important background issues in Africa (cont)

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Ctc entry point
CTC entry point? malnutrition-The effect of RUTF


Primary study questions outcomes
Primary study questions & outcomes malnutrition-The effect of RUTF

  • Can CTC be used as an entry point for providing HIV testing and treatment referral?

    • Outcome: VCT uptake

  • Are CTC protocols effective in HIV-positive children (or are modifications needed)?

    • Outcomes: weight gain/d, recovery, mortality, default


Ctc protocols for children
CTC protocols for children malnutrition-The effect of RUTF

  • CTC provided 200 kcal/kg/d locally produced RUTF for OTP in weekly take home rations

  • Per CTC protocols, children given Vitamin A, de-worming, antibiotics for bacterial infection, anemia treatment as needed, malaria prophylaxis

  • HIV+ children referred to Lighthouse Clinic for further evaluation, and adults referred to Dowa District ART clinic


Summary of vct uptake
Summary of VCT uptake malnutrition-The effect of RUTF


Nutritional recovery in the prospective cohort whm 85
Nutritional Recovery in the Prospective Cohort: WHM malnutrition-The effect of RUTF > 85%


Nutritional relapse in the retrospective cohort
Nutritional Relapse in the Retrospective Cohort malnutrition-The effect of RUTF

Median timing of follow-up 15.5 months post discharge (SD: 12.8)

~ 86% of HIV+ children had WHM >80%


Adult study malnutrition-The effect of RUTF Effectiveness of RUTF delivered in the community through CTC linked with HBC organisations


Intervention

3 months nutritional support malnutrition-The effect of RUTF

500 g /day of RUTF (Chickpea-Sesame recipe)

2600 kcal/day

70g protein/day

Routine cotrimoxazole

Delivered through existing HBC structures

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Intervention


Activity performance
Activity performance malnutrition-The effect of RUTF


Access to clinics
Access to clinics malnutrition-The effect of RUTF

  • 26/60 (43.3%) able to walk to the clinic at admission

  • 22/34 (73.5%) able to walk to the clinic after intervention

  • In total, 47/60 (78.3%) resumed productive activity


Eager to restart some activities

At admission malnutrition-The effect of RUTF

Can just walk out of the house

Only support= HBC volunteer

After 2 weeks

Walk long distance (to the river to bath)

Prepare instrument to restart some activities

After 1 month

Active

Need of social life

Eager to restart some activities

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Eager to restart some activities1

At admission malnutrition-The effect of RUTF

Can just walk out of the house

Only support= HBC volunteer

After 2 weeks

Walk long distance (to the river to bath)

Prepare instrument to restart some activities

After 1 month

Active

Need of social life

Eager to restart some activities

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She is going to harvest maize
She is going to harvest Maize malnutrition-The effect of RUTF

  • Beddriden before admission and staying alone with her baby

  • Admitted in the programme in Oct 06

  • November 06 started farming

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Median iqr weight gain in kg
Median (IQR) weight gain in Kg malnutrition-The effect of RUTF

  • After 1 month : 2.0 (0.0-3.5) kg

  • After 2 months: 2.5 (0.0 -6.0) kg

  • After 3 months: 3.0 (2.0-7.0) kg


Weight gain closely related to rutf intake
Weight gain closely related to RUTF intake malnutrition-The effect of RUTF


Mangochi program impact on hiv testing
Mangochi program: malnutrition-The effect of RUTF Impact on HIV testing

Counselling continuing


Mangochi program impact on art access
Mangochi program: malnutrition-The effect of RUTF Impact on ART access

Counselling continuing


Livelihood integration
Livelihood integration malnutrition-The effect of RUTF

SC US Malawi supported farmers earn 355$ from the sales of their products

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Improvement continues after discharge

04/2005: 41 kg and 17.3 cm at admission malnutrition-The effect of RUTF

07/2005: 47 kg and 20.5 cm after 3 months in programme

12/2006: 55 kg and 24.6

Not yet on ARV

Improvement continues after discharge

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Conclusions

Conclusions malnutrition-The effect of RUTF


  • RUTF facilitated effective nutrition care to malnourished children and chronically sick PLWHA.

    • Nutrition stabilisation

    • Improved physical activity performance

    • Improved quality of life

      Improved physical activity performance

      restoration of hope

      improved access to care including ART

      willingness to undergo HIV testing


Do we need of rutf
Do we need of RUTF? children and chronically sick PLWHA.

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Thanks to all organisations and experts who provided supports and advises
Thanks to all organisations and experts who provided supports and advises

  • SARA/AED

  • FANTA

  • Concern Worldwide

  • Save Children US

  • Valid International

  • Government of Malawi

  • SASO and NASO

  • Professor Andrew Tomkins


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