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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
  • 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: 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

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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primary study questions outcomes
Primary study questions & outcomes
  • 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
  • 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
nutritional relapse in the retrospective cohort
Nutritional Relapse in the Retrospective Cohort

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

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

slide11

Adult studyEffectiveness of RUTF delivered in the community through CTC linked with HBC organisations

intervention
3 months nutritional support

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
access to clinics
Access to clinics
  • 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

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

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

Picture removed

she is going to harvest maize
She is going to harvest Maize
  • 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
  • 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
livelihood integration
Livelihood integration

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

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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slide25
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?

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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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