Community Therapeutic Care for managing severe acute malnutrition-The effect of RUTF
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Community Therapeutic Community Therapeutic Care for managing severe Care for managing severe acute malnutrition-The acute malnutrition-The effect of RUTF 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
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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 - PowerPoint PPT Presentation
Transcript of Community Therapeutic Care for managing severe acute malnutrition-The effect of RUTF
Community Therapeutic Care for Community Therapeutic Care for managing severe acute malnutrition-managing severe acute malnutrition-
The effect of RUTF 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 overviewPresentation 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: Introduction: Important background issues in AfricaImportant 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: Introduction: Important background issues in Africa Important background issues in Africa (cont)(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
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CTC entry point?CTC entry point?
Livelihoodprogrammes
HIV care
VCT
CTC
Primary study questions & outcomesPrimary study questions & outcomes
1. Can CTC be used as an entry point for providing HIV testing and treatment referral?
Outcome: VCT uptake
2. Are CTC protocols effective in HIV-positive children (or are modifications needed)?
Outcomes: weight gain/d, recovery, mortality, default
CTC protocols for childrenCTC 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
Summary of VCT uptakeSummary of VCT uptake
97.192.2 94.1
64.158.4 60.5
0
20
40
60
80
100
Retrospective Cohort Prospective Cohort Total
Children Adults
Nutritional Recovery in the Nutritional Recovery in the Prospective Cohort: WHM Prospective Cohort: WHM >> 85% 85%
59.1
83.4
0
20
40
60
80
100
HIV+ (n=22) HIV- (n=692)
%
Nutritional Relapse in the Nutritional Relapse in the Retrospective CohortRetrospective Cohort
HIV+(N=28)
HIV-(N=1102)
p-value
% losing WH 38.9 20.2 0.07
% WHM < 80%
% WHM < 70%
14.3
0
2.0
0.4
<0.001
% MUAC < 125
% MUAC < 110
32.1
7.1
7.8
1.2
0.02
0.05
Median timing of follow-up 15.5 months post discharge (SD: 12.8)
~ 86% of HIV+ children had WHM >80%
Adult studyAdult studyEffectiveness of RUTF delivered in the Effectiveness of RUTF delivered in the community through CTC linked with community through CTC linked with
HBC organisationsHBC organisations
InterventionIntervention
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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Activity performanceActivity performance
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Admission (n=60) 0.0 42.4 35.6 22.0
End of programme (n=50) 72.0 22.0 4.0 2.0
Normal activity Activity reducedCare self- unable
to w alk long distance
beddriden
Access to clinicsAccess 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
25 bedriddenCompleted 3 months
22 Resumed
activity
3 Absence of
improvement
Eager to restart some activitiesEager 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
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Eager to restart some activitiesEager 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
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She is going to harvest MaizeShe 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 KgMedian (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
Weight gain closely related to RUTF Weight gain closely related to RUTF intakeintake
210196182168154140126112988470564228140Num ber of pots consum m ed
25.0
20.0
15.0
10.0
5.0
0.0
-5.0
-10.0
We
igh
t g
ain
in
pro
gra
mm
e i
n k
g
Fit line for Total
started ARV while in program m e
on ARV prior to entering the program m e
not on ARVstarted ARV
R Sq Linear = 0.231
F ig u r e 2 b
Mangochi program:Mangochi program:Impact on HIV testingImpact on HIV testing
n% of the
total
Tested prior to recruitment 9 4.1%
Tested while in program 102 46.4%
tested positive 98
tested negative 4
Not yet tested 109 49.5%
Total 220 100.0
Counselling continuing
Mangochi program:Mangochi program:Impact on ART accessImpact on ART access
n % of the total
Not yet on ART 160 72.7%
ART prior to the recruitment 3 1.4%
ART while in program 53 24.1%
Tested negative 4 1.8%
Total 220 100.0
Counselling continuing
Livelihood integration Livelihood integration
SC US Malawi supported
farmers earn 355$ from the
sales of their products Picture removed
Improvement continues after dischargeImprovement 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
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ConclusionsConclusions
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?
Picture removedPicture removed
Thanks to all organisations and Thanks to all organisations and experts who provided supports and experts who provided supports and
advisesadvisesSARA/AEDFANTAConcern WorldwideSave Children USValid InternationalGovernment of MalawiSASO and NASOProfessor Andrew Tomkins
