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.

TheUniversity of Malawi, based in the city of Blantyre, looked at the effect that foodsupplements are having on families living with HIV and AIDS in Malawi. Thestudy included around 360 people living in Bangwe, atownship of 40,000 people next to Blantyre. They were adults who needed to becared for at home and had been ill for more than a month. Most of the patientswere in an advanced stage of AIDS. Less than five percent had other conditions,such as paralysis.

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

• At the beginning of thefood programme half of the patients were malnourished while one quarter were severely malnourished.
• A third of patients diedwithin four months of first being seen. Half of the patients survived 14months.
• Food supplements did notimprove survival rates of patients but they did gain a small amount ofweight.
• The patients who receivedoil had higher survival rates but they did not gain more weight than otherpatients.

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

TheWorld Food Programme’s policy of providing food supplements needs to bereviewed as choosing certain families to receive food supplements in very poorareas is divisive. The study suggests the following alternatives may be moreuseful than providing food supplements in a township environment:

• Families living with HIV inurban areas are likely to have lost one or two incomes, so they shouldreceive money rather than food.
• Two small trials inBangkok and Tanzania suggest that vitamin supplements may delay theprogression of AIDS.
• Food that is ready to usecould be given to the patients along with their treatment. The locallyproduced food would be high energy, high protein and fortified withvitamins. It would not need cooking or keeping cool.