Breast Feeding, Malnutrition and HIV
HIV-exposed infants are at extremely high risk for poor cognitive development, chronic illness and death. Sadly, 50% of HIV-infected children living in resource-limited settings die by their second birthday (Lancet, 2004), and the HIV negative children of HIV positive mothers are twice as likely as children who are born to HIV negative mothers to die by two years of age(Pediatric Infectious Diseases, 2007). HIV-exposed infants face unique challenges that increase their risk of malnutrition, a condition that plays a major role in these statistics.
The Ihangane Project’s Nutrition for HIV-exposed Infants (NHI) Program addresses these challenges through a series of short and long term interventions that focus on the underlying causes of malnutrition amongst these children and their families. The multi-tiered design of this community-driven program will ultimately address risk factors for malnutrition amongst all families, regardless of HIV status, in the catchment area of Ruli District Hospital.
Our program begins with a pilot group of HIV-exposed infants between 6 months and 24 months of age at one health center. Each family is provided with age-appropriate food supplements. Once the pilot project has been successfully initiated and evaluated, it is expanded to all HIV-exposed infants in this age group at the same health center. Once one health center has a strong program in place, the program will be expanded to another health center in a similar manner until all health centers have a program in place.
An NHI pilot project was initiated at Ruli Health Center in November, 2009, and the program was recently expanded to include all HIV-exposed infants between the ages of 6 and 24 months at this site. The HIV + women from the pilot project have been linked to a job training program that can provide income generation and support long term food security. The Ihangane Project has worked with the Ruli HIV Medical Team to develop a simple monitoring and evaluation tool that has been integrated into the program. Not only will this allow us to monitor the impact of the program, but it will also allow for the implementation of Quality Improvement activities. The staff members of the HIV Medical Team actively participate in the decision-making process, and the input of program recipients are gathered through periodic focus groups. In addition, the NHI program is designed with the flexibility to address changing Rwandan Ministry of Health Protocols and World Health Organization (WHO) Guidelines.
The Ihangane Project works within the infrastructure created by Rwandan Ministry of Health protocols for HIV and Malnutrition. This approach allows us to leverage existing resources to build a cost-effective and sustainable program. The Ihangane Project is working with Ruli District Hospital, Ruli’s Malnutrition Center, and local authorities to address long term food security through the development of demonstration gardens, farming cooperatives, and local production of fortified sosoma (fortified porridge). William Davidson Institute Global Impact MBA Intern, Greg Thorne, has created a detailed report that highlights two potential business models for local sosoma production.