Life-Saving Services for Malnourished Children in Nigeria

OCTOBER 2009 — Nutrition is an integral component of Family Health International's comprehensive approach to caring for people living with HIV. Good nutrition is critical for people living with HIV, because HIV can increase the body's metabolic rate and deplete more quickly the protein the human body needs to function. Without good nutrition, HIV can gain the upper hand over the immune system, opportunistic infections proliferate, and antiretroviral drugs will be less easily absorbed and more difficult to tolerate.

Nutritional assessments and nutritional counseling have been integral components of FHI/Nigeria's work since 2004, with the initiation of the PEPFAR-funded GHAIN Project. Activities centered on nutritional assessments and counseling at GHAIN-supported health clinics and other facilities and on the production of information, education, and communication (IEC) materials for HIV-positive clients and their families, caregivers, and home-based care providers.

In 2007, GHAIN's efforts to improve the health status of children who are severely malnourished (and often HIV-affected) won support from the Clinton HIV/AIDS Initiative (CHAI) to provide malnourished children with a nutritional supplement called Plumpy'nut, a peanut butter-like paste laced with vegetable oil, milk powder, and vitamins and minerals that promote rapid growth.

Unlike other supplements, Plumpy'nut does not require the addition of water or any cooking or refrigeration. Another advantage of Plumpy'nut is that it comes in sealed, sanitary, single-serving packets. This ready-to-use therapeutic food is appealing even to children who are sick, lethargic, or without appetite, and significant weight gains can be achieved in some cases within a few weeks.

Plumpy'nut Successes in Lagos, Oyo, and Calabar
When 9-month-old twins Taiwo and Kehinde Lawal were diagnosed as malnourished at Massey Street Children's Hospital in Lagos, Taiwo weighed no more than a healthy newborn and Kehinde's weight was that of a 3-month-old. They had rejected their mother's breastmilk at 3 months as well as several infant formulas, but they accepted Plumpy'nut. After only four weeks both look chubby and strong. Taiwo weighed nearly 15 lbs and her twin sister nearly 19 lbs.

Emmanuel Olufemi was 20 months old in May 2009 when he was seen at State Hospital Oyo in Oyo State. He weighed just 15 lbs and was losing weight rapidly. Emmanuel's parents are both HIV-positive, and his father is taking anti-TB drugs. Emmanuel's weight loss was found to be due to TB and malnutrition. After only two weeks on Plumpy'nut, he weighed nearly 18 lbs, was active and eating well, and looked like a different child.

Faith Bassey Peter, age 13 and HIV-positive, experienced a similarly dramatic transformation. She weighed only 30 lbs in April 2009 when she came to Calabar General Hospital, Cross River State. She was able to initiate ART after two weeks on Plumpy'nut. After two months of consuming two packages a day, her weight doubled, she was sleeping well and felt strong enough to return to school. The smiling, robust-looking girl in the photo is no longer called "stick" by her classmates. 

What Else FHI Is Doing
In addition to providing nutritional supplements and services, GHAIN is training healthcare workers to routinely screen all children for malnutrition, a diagnosis that can also trigger HIV case-finding and care and treatment. In addition, there are plans to employ staff who will be responsible for IEC nutritional materials, staff training, and collaboration with organizations providing nutritional services.

FHI/Nigeria is integrating nutritional counseling into the curriculum used to train providers of community- and home-based care, and is training caregivers on how to make a local nutritional supplement composed of soya beans, wheat, millet, and peanuts—a popular porridge in West Africa called "Tom Brown."

FHI/Nigeria has plans to expand nutritional activities into communities so community health workers can identify malnourished children, provide them with appropriate nutritional services, and monitor their progress.

PHOTO: (Top) Faith Bassey Peter, 13, weighed just 30 lbs in April 2009. She has experienced a dramatic transformation thanks to a nutritional supplemention. (Bottom) Faith, two weeks after starting Plumpy'nut.