2. FOOD BANKING FOR IMPROVED NUTRITION OF HIV+ CHILDREN: Emerging Evidence from Quality Improvement Teams in Food Insecure Regions of Kiambu, Kenya Presenter: Muhamed Akulima 1 Co-Authors: Rudia Ikamati 1, Sam Muhula 1, Margaret Mungai 1, Meshack Ndirangu 1, Josphat Nyagero 1, Sarah Karanja 1, 1 Amref Health Africa in Kenya

3. Introduction  Est12.3m out of 137m children under 5yr in Sub Saharan Africa, are malnourished (UNICEF 2011)  Est 2.3m children 0–14yr HIV+ & estm 5% of under 5yr mortality is due to HIV (UNICEF 2011)  Of 2.5m OVC in Kenya, over 500,000 live in Central/Eastern Kenya (MGCS 2013)  Amref Health Africa in Kenya provides care and support to 140,000 (28%) through PEPFAR USAID- APHIAplus KAMILI Project (2011-2015)  Two food banks initiated as response to food challenges of 103 HIV infected OVC  Two sites, Lari (20 OVC), Ngoliba (83 OVC) first formed a Quality Improvement Team (QIT) & established a food bank  Food banks applied the concept of “banking’’ within food & nutrition mechanisms

4. Introduction  QITs promoted depositing, borrowing & repayment to food banks in Kiambu  Food banks Services: Depositing harvests,‘withdrawal’ & borrowing  Repaid with interest in kind: sustain the costs for maintaining the banking  Food bank linkages: health facilities, commercial millers and agriculture depts.  Two assessments conducted: before & after the food banking initiative  This paper aims to assess and demonstrate the role of community food banking in improving the nutrition status of HIV+ OVC in food insecure regions

5. Methods  Pre and post test design study, lasting 12 months (Oct 2013 - September 2014)  Conducted in two sites: Kiambu County, Kenya covering 103 HIV+ OVC  Child Status Index (CSI) & Middle Upper Arm Circumference (MUAC) tools were used in data collection at households at intervals of 6-12 months  Data collection done by volunteers, Quality Improvement Team members, CHWs, centre nutrition nurses and Local Implementing Partners staff  Orientation on use of CSI & MUAC conducted before implementation  Paired t-test: applied for analysing MUAC data  Wilcoxon test: applied for analysing CSI scores respectively

6.  HIV+OVC distribution by sex: Female (61%) > males (42%) by 19%  Ages: 5-9 years predominant (44%), 10-14(30%) 15-19yr(8%)  HIV+ OVC nutrition status improved from 'bad' CSI Median (IQR) score 2(2-1) before food banking to 'fair' - score 3(4-3) after intervention (p=< 0.001)  MUAC increased from Mean (SD) of 5.6(2.6) before intervention to 7.2(2.8) after food banking (p=< 0.001)  All 103 HIV+OVC remained alive (100% -no death) during 12-month study period  HIV+OVC ranking: Severe Acute Malnutrition(SAM) at start of study reduced from 25.2% to 3.9% (21.3%),Normal increased from 40.8% to 62.1%.( 21.3%)  Some HIV+ OVC had NO significant changes: MUAC - 3.9% (SAM), 2.9% (MAM) Results

7. Food Security: Assessed food sufficiency and access for HIV+ OVC at pre-intervention and post-intervention (N=103)  Pre-intervention Very Bad(CSI=1) & Bad(CSI=2 moved to Fair(CSI=3) & Good(CSI=4) at post-intervention  No Fair(CSI=3) and Good(CSI=4 at Pre-intervention  Post intervention :NO ratings of Very Bad(CSI=1) and Bad(CSI=2

8. Nutrition and Growth: Assessed child growth for HIV+ OVC at pre-intervention and post-intervention (N=103)  Pre-intervention Very Bad(CSI=1) & Bad(CSI=2 moved to Fair(CSI=3) & Good(CSI=4) at post-intervention  No Fair(CSI=3) and Good(CSI=4 at Pre-intervention  Post intervention :NO ratings of Very Bad(CSI=1) and Bad(CSI=2

9. Middle Upper Arm Circumference Comparisons before and after food banking intervention (N=103)  Pre-intervention: (Severe Acute +Moderate Acute+ Mild-at- risk ) was > normal  Post-intervention: OVC (Normal) > (Mild-at- Risk+Severe Acute+Moderate)  Reduction of severe malnutrition towards less severe malnutrition

10. Middle Upper Arm Circumference Movement from more severe to less severe malnutrition (N=103)

11. Conclusion  Food banking is a community-based nutritional intervention that can address factors of food access, affordability and availability  Food banking is a sustainable way to contribute to improved access and quality nutrition & reduced malnutrition among HIV+ OVC  Food banking contributes to reduced malnutrition-related deaths among HIV+ OVC  Despite the food banking intervention, some HIV+ OVC had no change in nutrition

12. Recommendations  Scale up community-based Food Banks so as to increase availability, affordability & access to quality nutrition for HIV+ OVC and their families  Promote food banking through QITs to achieve a collective, participatory and sustainable community food security for HIV+ OVC and their families  Carry further impact evaluation/ research on effectiveness of food banks as an intervention – eg using more rigorous designs such as cluster randomised control trials  Some HIV+ OVC required different nutrition intervention (other than Food Banking) for improved nutrition, this requires further study

13. Ngoliba Food bank:

14. Ngoliba Food Bank: Visit by Government of Kenya official

15. Acknowledgement  Amref Health Africa in Kenya & Corporate  Government of Kenya  PEPFAR/USAID-APHIAplus KAMIL Project  Ngoliba Volunteers WB, QITs, Cordinator,staff & volunteers  Cheer up CBO staff and coordinators, QIT & volunteers  Ngoliba Health Centre –in-charge, CHWs & Nurse  Lari Health Centre CHWs and nutritionists