Background
While
HIV has had a major impact on health care in southern Africa, there are few
data on its impact on acute malnutrition in children in the community. We
report an analysis of outcomes in a large programme of community management of
acute malnutrition in the south of Lusaka.
Programme Activities and Analysis
Over
3 years, 68,707 assessments for undernutrition were conducted house-to-house,
and children with severe acute malnutrition (SAM) or moderate acute
malnutrition (MAM) were enrolled into either Outpatient Therapeutic Programme
(OTP) or Supplementary Feeding Programme (SFP) respectively. Case records were
analysed using tabulation and unconditional logistic regression.
Findings
1,859
children (889 boys, 970 girls; median age 16 months) with MAM (n = 664) or SAM
(n = 1,195) were identified. Of 1,796 children whose parents consented to
testing, 185 (10.3%) were HIV positive. Altogether 1,163 (62.6%) were
discharged as recovered from acute malnutrition. Case fatality while in the
programme was 4.2% in children with SAM and 0.5% in those with MAM,
and higher in children with HIV infection.
In multivariate analysis, HIV, MUAC
<11.5cm and the first year
of the program all increased mortality. Children
with HIV infection who were able to initiate antiretroviral therapy had lower
mortality.
Interpretation
Our programme suggests that a comprehensive community
malnutrition programme, incorporating HIV care, can achieve low mortality even
in a population heavily affected by HIV.
Below: Flow of children with MAM through the program
Full article at: http://goo.gl/N84AKd
By:
Department of Paediatrics, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
Tropical Gastroenterology & Nutrition group, University of Zambia School of
Medicine, Nationalist Road, Lusaka, Zambia
Blizard Institute, Barts & The London School of Medicine, Queen Mary
University of London, 4 Newark Street, London, United Kingdom
More at: https://twitter.com/hiv insight
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