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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 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

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  1. 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

  2. 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

  3. 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

  4. 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) Pictureremoved

  5. CTC entry point?

  6. 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

  7. 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

  8. Summary of VCT uptake

  9. Nutritional Recovery in the Prospective Cohort: WHM > 85%

  10. 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%

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

  12. 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 Picture removed Intervention

  13. Activity performance

  14. 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

  15. 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

  16. 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

  17. 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 Picture removed

  18. 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

  19. Weight gain closely related to RUTF intake

  20. Mangochi program:Impact on HIV testing Counselling continuing

  21. Mangochi program:Impact on ART access Counselling continuing

  22. Livelihood integration SC US Malawi supported farmers earn 355$ from the sales of their products Picture removed

  23. 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 Picture removed Picture removed

  24. Conclusions

  25. 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

  26. Do we need of RUTF? Picture removed Picture removed

  27. 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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