Food supplements for malnourished AIDS sufferers in Malawi do not work

Many people in Africa suffer from the triple threat of food shortages, high rates of HIV and ineffective government. The World Food Programme launched an appeal in 2004 to raise more than 300 million euros in order to feed 1.5 million people living under these conditions in five southern African countries, including Malawi.

The University of Malawi, based in the city of Blantyre, looked at the effect that food supplements are having on families living with HIV and AIDS in Malawi. The study included around 360 people living in Bangwe, a township of 40,000 people next to Blantyre. They were adults who needed to be cared for at home and had been ill for more than a month. Most of the patients were in an advanced stage of AIDS. Less than five percent had other conditions, such as paralysis.

Basic monthly food packages, which included 50 kilograms of maize, were given to the patients and their families. Half of the families were also given oil. Information about survival rates and the nutritional status of the patients and their families was collected on four occasions over an 18 month period: six months before the food programme began and every six months from then on. New patients were recruited throughout the course of the study. The study found that:

• At the beginning of the food programme half of the patients were malnourished while one quarter were severely malnourished.
• A third of patients died within four months of first being seen. Half of the patients survived 14 months.
• Food supplements did not improve survival rates of patients but they did gain a small amount of weight.
• The patients who received oil had higher survival rates but they did not gain more weight than other patients.

The study suggests that food supplements are not effective. This could be because they were given too late to affect the course of the disease. The poor results of the food programme may be explained if the food did not actually reach the families. Often these families have no one to carry large sacks of food home from the distribution point. Oil is more effective because it provides a concentrated form of energy for the patient and the families can sell it and buy other essentials such as charcoal and water.

The World Food Programme’s policy of providing food supplements needs to be reviewed as choosing certain families to receive food supplements in very poor areas is divisive. The study suggests the following alternatives may be more useful than providing food supplements in a township environment:

• Families living with HIV in urban areas are likely to have lost one or two incomes, so they should receive money rather than food.
• Two small trials in Bangkok and Tanzania suggest that vitamin supplements may delay the progression of AIDS.
• Food that is ready to use could be given to the patients along with their treatment. The locally produced food would be high energy, high protein and fortified with vitamins. It would not need cooking or keeping cool.

Source(s):
‘An assessment of food supplementation to chronically sick patients receiving home based care in Bangwe, Malawi: a descriptive study’, Nutrition Journal 4(12), by Cameron Bowie, Linda Kalilani, Reg Marsh, Humphrey Misiri, Paul Cleary and Claire Bowie, 2005 Full document.

Funded by: College of Medicine, University of Malawi; Malawi National AIDS Commission; World Food Programme

id21 Research Highlight: 21 November 2006

Further Information:
Cameron Bowie
Department of Community Health
College of Medicine
University of Malawi
Blantyre
Malawi

Tel: +265 1524 282
Fax: +265 1524 297
Contact the contributor: cam.bowie@malawi.net

College of Medicine, University of Malawi, Blantyre

Other related links:
'Caring for AIDS patients at home in Malawi'

'Community treatment for HIV-related malnutrition in Malawi'

'Is cash the best way to assist poor and vulnerable people?'

'Using local knowledge to overcome HIV/AIDS in Swaziland'

'The southern Africa crisis: food insecurity, HIV/AIDS and the international response'

'Hunger crisis: learning from southern Africa'

'A vicious circle: poverty and HIV/AIDS in South Africa'