Malawi Country Program

Theresa Banda

VI

Operational Research

Advocacy

Technical support

VN

Production and marketing RUF

Introduction

ResearchResearch

Follow up component- SC USAdata collection, analysis and report completed

Detailed analysis for identification, write up and publication of papers is on going

CSA (Chronically Sick Adults)

PREWAS(Prevention of Wasting)Prevention of Weight Loss in People

Living with HIV/AIDS PLWHAs (PREWAS)Implementers – Valid, MACRO, MoHStudy sites –

MACRO structure- LL, Mzuzu, (2008)Government Rural hospital structure

Mitundu (2009)

OBJECTIVE

Identify a nutrition intervention that would prevent wasting in PLWHAs in WHO stages 1 and 2 with CD4 Count >250

TARGET GROUP

WHO Stage 1 or 2 with CD4 count >250

Well nourished and good health (no diabetes, hypertension, kidney)

Age 18 – 59, not on ARTDischarge criteriaMeets ART initiation criteriaHas developed stage 3 or 4 condition defining

Progress of studySlow progress – 288 out of

required 300 recruited into the study Phased out recruitment in MACRO

sites- follow ups only. Recruitment continues in Mitundu

Monthly follow-ups are a challenge in MACRO sites (urban areas)

ObservationsOnly 50 % of the clients collect CD4 count

results 50% of clients in WHO Stages 1 and 2 have

CD4 count >250 cells/ml CD4 count results are declining regardless

of nutritional status or history of illness Follow-up of clients is challenging-

preventive vs Curative culture, fear to be known, occupation-small business

SUB STUDIESBIO-ELECTRICAL IMPEDANCE ANALYSIS (BIA)

Is detailed assessment of body composition and cell condition using Bodystat® 1500MDD machine

Identifies malnutrition before weight, MUAC and BMI decrease

BIAVariables of interest :

Fat (weight, percentage, mass index),

Fat free (wt, mass index),Phase angle (measure of cell integrity),

Wellness markerBody mass index (BMI)

BIA StatusNormal distribution determination

exercise completed, Offered to everyone regardless of HIV sero-status

Those in study offered BIA onAdmissionEvery 6th month (when due for CD4

count recheck)When there is a disease episodeAfter disease episode

Uptake of PLWHA into Positive Living GroupsTo determine coverage and factors

that influence uptake of PLWHA into Positive living groups

BackgroundHigh prevalence of HIV, High HCT

uptake, Many positive living groups in the district

StatusData collection, entry, cleaning

completedStarted analysis, slow, qualitative

research, little expertise within Valid at country level

Whey Protein RUTF(WPC34)Development, acceptability and effectiveness trial of

milk whey protein based Ready-To-Use Therapeutic Food in treatment of severe acute malnutrition in under-five children

.Collaborators – Valid (VI & VN) MOE, MoH, CF funding from USDEC

Study sites – Lilongwe District (schools and OTP sites

Production of RUTF Kenya and Malawi

Whey Protein RUTF(WPC34)StatusRecipe Development and Production test completedAcceptability trial in progress and Effectiveness

trial planned to start January 2010Overall impression, school age children like the

product- most of them complete 250g within a short time (break times at school)

ObservationChallenges in sourcing Whey Protein

AdvocacyAdvocacy

Advocacy ActivitiesNutrition as Central in Development Importance of good nutrition through

government structure- Nutrition committee, Technical working groups, specific events

Coordination of nutrition in the countryResource mobilization within the government

structure (OPC and MOH)

Advocacy Activities CTCAs member of CAS (CTC Advisory Service)Through TWGs on management of malnutrition,

infant and young child nutrition, Nutrition care and support for PLWHA, Research

Special events- American Embassy health functions, National celebrations

• HIV interventions- VI member of Health sector response to HIV

Technical Technical SupportSupport

Technical SupportHas reduced over time after formulation

of CAS and impressions that VI is expensive

TA provided to organizations :scaling up CTC within districts- MOH

and CHAMNutrition care and support for PLWHA-

Action AID and Private hospitalsOPC, MOH in nutrition research,

monitoring activities

RUFRUFProduction Production

and and MarketingMarketing

RUF Production and MarketingProduction facility- certified by UNICEF for

local supply and awaiting global certification scheduled for January

VI promotes RUF products for the following:CTC, management of adolescent and adults

malnutrition, school feeding, research e.gMajor supplier of RUTF in CTC programsRUSF accepted to be used in school feeding to

start on pilot- awaiting fundingRUSF planned to be used in growth faltering

THANK YOU