Integration of nutrition in the antiretroviral therapy scale up plan for Malawi
Added by Sophie Beauvais on 30 Oct 2008
Download: 2008vol20issue3bisika.pdf (293.1 KB)
Summary: Conducted in 2005 in varied health facilities - 2 in the northern region; 3 in the central region; and 3 in the southern region of Malawi - the purpose of this study was to identify a nutrition intervention that would complement the ARV scale up and draw a consensus on enrollment and discharge criteria among stakeholders.
The method used was descriptive and called for both qualitative and quantitative approaches.
Although few facilities are already providing nutritional support, there is consensus among the different stakeholders about the need for good nutrition for HIV patients on ARV drugs. Most providers have reported that patients complain about lack of food and failure to take daily pills due to food unavailability.
It is also important to note that visited health facilities are willing to provide food rations to patients as long as food is given to them.
The following nutritional support programme for patients on ARV drugs was proposed for implementation:
- Programme should include therapeutic and supplementary feeding as well as food ration for affected households.
- Preferred delivery method is at the clinic or health facilities. Stakeholders also believe that using this method would also help increase treatment compliance.
Note: the major problem raised with food support delivery in the community is stigma.
- The recruitment criteria proposed for supplementary feeding were BMI less than 18.5 for adults, MUAC less than 22cm for pregnant and lactating mothers and weight for height less than 80% or MUAC less than 12cm for children.
- The suggested recruitment criteria for therapeutic feeding were BMI less than 16.0 for adults, pregnant and lactating mothers with Mid-Upper arm circumference (MUAC) less than 20 cm and children whose weight-for-height is less 70% and MUAC less than 11 cm.
- Attainment of these thresholds was recommended as discharge criteria.
Issues raised in providing food support:
- Nutrition education and counseling for HIV patients.
- Irregular food supplies and inadequate storage space.
- Need for patient identification that would maintain confidentiality: to make sure that rations go to the intended patients.
- Transportation: already limited capacity for follow-ups and monitoring visits. Providing bicycles were cited as one option.
- Human resources: 1) Clinicians and nurses interviewed are already overstretched and feel this would be an additional load; 2) Community volunteers currently provide VCT and other services linked to ART in the community. They note that they already forgo their own work in order to do so, which raises the question of sustainability.
Keywords: Food & Nutrition, malawi
Author(s): Thomas Bisika, George Mandere
Source: Malawi Medical Journal
Publication Date: September 20, 2008
Language: English