Tuesday, January 12, 2010

This is how we do (Kite may want to skim this blurb)

So I realize that some of you might be unclear on what exactly I do 5 days a week. The purpose of the project is twofold: treatment of malnourished children and research about how best to accomplish that goal. During the week, we visit different sites around rural Malawi. Some sites are visited weekly, others biweekly.

At each site we work with Malawian HSAs (Health Services Aides I think) who are hired by the government to run vaccination clinic and screen for basic ailments such as malaria (diagnosed by a fever) or pneumonia (diagnosed by labored breathing). We pay these HSAs an additional stipend: partly to help us run our clinic (fill out forms with the mothers, hold heads on the height board etc) but mostly to “sensitize” (recruit) mothers and encourage them to bring their malnourished children to our clinic.  As these HSAs live in or near the villages we visit, they are better able to communicate with the villagers.

Once we arrive at our site we screen all of the mothers that the HSAs have brought. Screening is accomplished using internationally accepted standards for weight for height. Any child more than 2 standard deviations from the internationally accepted mean are considered moderately malnourished, children more than 3 SDs are severely malnourished. We also check each child for edema (a swelling due to malnutrition). Any child who has edema is diagnosed as kwashiorkor, and is automatically severely malnourished.

We are conducting three separate studies. One deals with the type of supplementary food best suited to treating moderate malnutrition and one deals with the type of antibiotic most effective at treating severe malnourishment. The third study is conducted independently and deals with the bacterial composition of stool for twins (malnourished and healthy).

Every child, once categorized as severe or moderately malnourished, is enrolled in the appropriate study. Those who don’t qualify (if they are over 5, developmentally delayed, handicapped etc) are still given the appropriate food. We are testing three different types of therapeautic foods (but none are the RUTF- Chiponde which is described below).

I am working on the study that examines severe malnutrition. All children who are severly malnourished are given a RUTF (Ready-to-Use Therapeutic Food) called Chiponde.

Chiponde is comprised of peanut butter, oil, powdered milk, sugar and a vitamin supplement. It’s a more effective alternative to milk-based therapies that are administered in an inpatient setting (the hospital). It is a very conducive to outpatient therapy because it has no water and thus resists bacterial contamination for months without refrigeration.

In addition to the Chiponde, we are trying to determine which antibiotic (if any) helps alleviate severe malnutrition.

That is a basic overview of the three studies. I’ll make another post later about the actual grunt work and what happens when we get to the site.

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