Nutrition Supplement for People With HIV
Summary of unpublished research1
The BHC supervisor talks with a mother, who receives a HBCN kit
Compact Norway has developed a new product called AFYA to be used as a nutrition supplement for households affected by HIV/AIDS and TB in resource poor settings, within the context of Home Based Care (HBC) programmes. Table 1 outlines the nutritional profile of AFYA. The acceptability of AFYA included in two types of HBC kits was tested in a study carried out in Lilongwe, Malawi. The HBC kits used in this study were the Community Volunteer (CV) kit for use by a trained health worker and the Home Based Care and Nutrition (HBCN) kit for use by care takers at home (see table 2).
The main objectives of the study were:
- to determine whether AYFA can be used over a long period as a supplement to other foods without creating adverse effects
- to investigate acceptability in terms of taste/smell, packaging and practicality of use
- to gain feedback on the value of the kit itself and the items in it.
The study was conducted at two sites in Lilongwe, Likuni and Alinafe, where HBC is supported by CHAM (Christian Hospital Association of Malawi). A total of 75 home based care patients were enrolled into the study. These 75 study subjects were divided into two groups based on the type of the Medeco HBC kit they received. A total of 11 subjects used the Community Volunteer (CV) kit while the remainder (64 patients) used the Home Based Care Nutrition (HBCN) kit. Three packets of AFYA (180 g), containing 840 kcal and approximately one recommended daily allowance (RDA) of vitamins and micro-minerals, were provided to each patient per day.
through the use of a patient diary which was completed daily and an AFYA qualitative questionnaire completed every 10 days. Mid- Upper-Arm-Circumference (MUAC) was measured in order to monitor any increase or decrease in weight during the study period. Trained supervisors at Alinafe and Likuni hospitals supported the HBC volunteers through regular quality control visits.
|Table 1 Nutritional profile of AFYA|
|Energy profile||Nutrient content/100g|
Energy: 1950 kJ/468 kcal/100g
Total fat: 20g
?-3/ ?-6 ratio: 0.14
Ash: < 4g
Humidity: < 4g
|Shelf life 18 months at moderate temperature and humidity, with a minor decrease in some vitamins.|
|Pack size 60g (2x30g tablets)|
|Table 2 Contents of CV and HBCN kits|
|Community Volunteer Kit (CV Kit)||Home Based Care and Nutrition Kit (HBCN Kit)|
|Oral rehydration salt
Gentian Violet crystals
Kits produced by Medeco
|Table 3 Profile of AFYA study subjects|
|Type of illness||HIV-related||27||37.0|
|Other, e.g. malaria, diabetes||8||10.9|
Table 3 indicates the age and illness profile of the patients who took part in this study2. Atotal of 93.2% of the patients managed to consume the recommended daily ration of three packets of AFYA, providing a total of 840 kcal per day. Sixty-two of the patients (86.1%) reported an overall improvement in their health, while 79.7% of the patients said AFYA tasted good and was appetizing. Overall, 70.8% of the patients said that what they liked most about AFYA was its flavour.
At the beginning of the study, only three of the adults were found to be severely malnourished (MUAC <16 cm), 9.3% were moderately malnourished (MUAC >16 and <18.5 cm) while the rest had a normal arm circumference measurement (MUAC >18.5 cm)3. Of the three severely malnourished adults, two died just before the end of the study, while the third patient showed improvements in MUAC by the end of the study. Overall, 82% of the patients registered an increase in weight based on MUAC readings.
These findings suggest that AFYA could be used to restore nutritional status among HIV/AIDS and TB patients within the context of Home Based Care. However, it should be noted that this study did not verify whether the observed weight gain was due to both lean and adipose tissue. Lean tissue is the functional tissue that includes major components of the immune system. Sharing of AFYA among family members was limited, suggesting that AFYA may be perceived as a specialised supplement for targeting HBC patients.
The contribution of Medeco CV and HBCN kits to the health and hygiene of the study subjects is very important. As health directly impacts nutrition, the kits will have contributed to the nutritional effect separately from the AFYA. Due to its compact nature, AFYA can easily be incorporated into a Home Based Care medical kit for HIV programmes in resource poor settings. However, most of the respondents raised concerns about their inability to replenish the Medeco CV and HBCN kits due to lack of money. It is unlikely that families could sustain provision of HBC kits and nutrition supplements without external support.
One of the HBCN kits containing Afya
The composition of AFYA should be flexible and based on latest research findings. The most recent study carried out in Tanzania has shown that some selected vitamins taken in stipulated doses are important determinants for slowing down HIV disease progression and mortality4 . These types of study should inform future product development.
For further information, contact Stanley Chitekwe, Nutritionist, UNICEF, email: email@example.com (Stanley Chitekwe was not working with UNICEF at the time of the AFYA project), or Reidar Retzius, Compact AS, Smoget 29, N-5212 Soefteland/Bergen-Norway. Tel: +47 56 30 35 00, fax: +47 56 30 35 40, e-mail: firstname.lastname@example.org, website: http://www.compact.no
1Possibility of using AFYA, as a nutrition supplement contained in a Home Based Care kit for HIV/AIDS and TB patients - an acceptability study carried out in Lilongwe, Malawi. COMPACT. Available online at http://www.compact.no/nyhet.cfm?id=51968
2Serial MUAC measurement is not a standard method for assessing change in weight (eds).
3 Mid-Upper Arm Circumference (MUAC) theoretical and practical problems, http://www.unsystem.org/scn/archives/adults/ch06.htm
4Fawzi WW, Msamanga GI, Spiegelman D, et al. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med 2004; 351: 23-32.
More like this
By Mieke Moens, MSF Mieke Moens is a paediatric nurse, and is responsible for the PMTCT and nutrition programme for MSF Thyolo, Malawi The author would like to acknowledge...
Summary of published research1 WFP warehouse in Malawi The Bangwe project is a joint home based care (HBC) project run by the Salvation Army and the Department of Community...
By Daphyne Williams Daphyne Williams is currently Technical Advisor HIV and AIDS with Catholic Relief Services where she has worked for the past 2 years. The author wishes to...
Summary of unpublished research Nursing health professional doing clinical investigation at Livningstone Hospital By Liana Steenkamp, Dr Jill von der Marwitz, and Charlene...
By Hisham Khogali Hisham Khogali is currently the Senior Food Security Officer of the International Federation of the Red Cross and Red Crescent. Prior to this, Hisham worked...
By Peter Paul Igu, Reach Out and Mary Corbett, ENN Peter Paul Igu has been a full-time volunteer with the organisation, Reach Out, since Jan 2002, and is the food programme...
By Andrew Mellen, Emmanuel International Andrew Mellen has been the relief programme manager with EI Malawi since 2003. With a background in agriculture, he previously worked...
Glossary ACF Action Contre la Faim CHA Community Health Assistant CHAM Christian Health Association of Malawi CNW Community Nutrition Worker CTC Community Therapeutic...
By Kate A. Greenaway, Elizabeth C. Jere, Milika E. Zimba, Cassim Masi and Beatrice Mazinza Kawana Kate Greenaway is Senior Technical Advisor, HIV Unit, Catholic Relief...
By Mary Corbett Mary Corbett is a food security and nutrition consultant who visited the region on behalf of ENN in early 2005. This article is based on interviews with a...
Child eating BP100 in Freetown TFC. By Carlos Navarro-Colorado and Stéphanie Laquière Carlos Navarro-Colorado is a medical doctor, with a MSc Epidemiology. He has ten years...
By Antonia Torreblanca and Eileen Kim This report outlines the weight progress of clients attending the Reach Out clinic of Mbuya parish clinic in 2002, who were receiving WFP...
By Evelyn Depoortere, Epicentre Evelyn Depoortere is currently a medical epidemiologist for Epicentre. Previously she worked on several MSF missions, including Southern Sudan...
FEX: Issue 22 Editorial
The more cynical amongst us in the emergency nutrition sector may sometimes be heard complaining that there is nothing new in this profession and that we just keep re-inventing...
Summary of meeting abstract1 A man enrolled in the RUTF acceptability programme Those who were sicker found it more difficult to eat RUTF and tended to mix it with other...
Milton Tectonidis By Isabelle Defourny, Emmanuel Drouhin, Mego Terzian, Mercedes Tatay, Johanne Sekkenes and Milton Tectonidis Emmanuel Drouhin is the Niger Desk Officer,...
By Mr Sylvester Kathumba Mr Sylvester Kathumba is Principal Nutritionist with the Ministry of Health, Malawi. This article was authored by Mr Sylvester Kathumba with policy...
FEX: Effects of nutritional supplementation for HIV patients starting antiretroviral treatment in Ethiopia
Summary of research1 Location: Ethiopia What we know: Poor nutritional status at initiation of ART is associated with impaired treatment outcomes among African patients with...
By Paluku Bahwere, Saul Guerrero, Kate Sadler & Steve Collins (Valid International) The district health officer of Dowa, Malawi, briefs clinic and community workers about the...
By Maureen Gallagher and Armelle Sacher Maureen Gallagher is the Senior Nutrition & Health Advisor ACF USA based in New York. She has worked for the last 10 years in nutrition...
Reference this page
Nutrition Supplement for People With HIV. Field Exchange 26, November 2005. p15. www.ennonline.net/fex/26/nutrition