World Bank grants Mozambique loans totalling US$145 million

Maputo, Mozambique, 24 Sept – The Mozambican government and the World Bank Friday in Maputo signed six agreements under the terms of which the bank will grant US$145 million in loans for development projects.

The biggest amount is a loan of US$93 million from the International Development Agency (IDA) to finance a project for interlinking Mozambique and Malawi, via power lines.

US$45 million will be spent in Mozambique and US$48 million in Malawi. In Mozambique the work will involve the construction of a 135 kilometer long transmission line and the expansion of a sub-station and in Malawi 75 kilometers of transmission line will be built as well as a new sub-station.

Another of the agreements signed is for a US$15 million loan for a project to supply drinking water by building 370 kilometers of new pipes in the cities of Beira, Quqlimane, Nampula and Pemba.

A further US$15 million for the same drinking water project will be provided by a loan from the Africa Catalyst Growth Fund, which was set up by the world bank in 2006.

The six agreements were signed by the minister for Planning and Development of Mozambique, Aiuba Cuereneia and by the regional director of the World Bank, Michael Baxter.

Professor fights African malnourishment

In the southeastern African country of Malawi, malnutrition is rampant. Approximately 70 percent of Malawian children are malnourished, with an estimated 13 percent dying before five years of age.

Mark Manary, a Washington University professor of pediatrics, is working to fix that.

In 2001, Manary started a non-profit organization known as the Peanut Butter Project. The project strives to overcome malnutrition by feeding moderately to severely malnourished children an enriched peanut butter during an eight-week rehabilitation period.

"The food is new because it's nutritionally everything that a kid needs to eat," said Zachary Linneman, a freshman involved with the project and who traveled to Malawi last January. "It doesn't need to be cooked, it contains no water so it won't grow any bacteria and can be stored in ambient conditions in Africa."

The enriched peanut butter, known as ready-to-use therapeutic food (RUTF), consists of a nutrient-rich mixture with peanuts, powdered milk, oil, sugar and fortified with vitamins and minerals.

"The peanut butter-feeding has been a quantum leap in feeding malnourished children in Africa," Manary told The Record. "The recovery rates are a remarkable improvement from standard therapy."

Because he is currently working at a malnutrition clinic in Malawi, Manary was not available for direct comment.

During the eight-week testing period, RUTF was fed to 1887 severely malnourished children and 686 moderately malnourished children aged six to 60 months. The progress of the children was monitored and tested on a regular basis.

For a child to be classified as recovered after eight weeks, he or she must reach 85 percent of their ideal weight-for-height based on World Health Organization standards.

The recovery rates for the severely and moderately malnourished children stood at about 89 and 85 percent, respectively. Dropouts and deaths account for the remaining percentages.

"The method is different; also, it's called home-based therapy," noted Linneman. "The idea is that kids spend most of their time at home rather than in a hospital where they could get an infection."

The Peanut Butter Project currently produces between 300 and 350 tons of RUTF each year in its Malawi factory. The funding for the factory comes from private donations.

Linneman estimates that the factory's capacity-double of that which is currently being produced-is enough to feed most of Malawi's 40,000 children.

The fact that this project sees such remarkable success in a resource-limited setting in which personnel lack medical backgrounds is truly a testament of the program's promise.

Linneman first became involved with Manary's research during his senior year in high school. A St. Louis native, Linneman used his senior service project at St. Louis University High School to aid Manary's project.

Linneman is listed as a co-author in Manary's paper on his research and one of about six volunteers who continue to be committed to the project.

"It's a big part of my life," said Linneman. "When you get the opportunity to do something that works and is helpful, stick with it."

African villages learning to rewrite their future

When a community takes ownership of relief and development, it can re-write its future.

The village of Chamoto in Malawi is a perfect example of this concept. What started as a literacy program has led to independence.

Today, villagers in Chamoto have programs running where orphans are being cared for, families have enough to eat, and more than 1,500 people are improving their reading and writing skills.

Christian Reformed World Relief Committee's partner in Malawi. Nkhoma Relief & Development (NRD), helped start the literacy program. NRD incorporated various lessons into the reading and writing curriculum. Students read passages from the Bible, but they also learned about health, agriculture, and businesses.

NRD suggested a program that would encourage local women to meet together in community groups. The group members would learn lessons about nutrition, health, agriculture, and business, and they would work together on income generating projects.

Chamoto is one of 22 centers where community workers are placed, and 15 of those centers are following the Chamoto model. CRWRC's Phil Grabowski reports: "Some of the best centers where these community workers are working. You can see the community starting to make its own plans. The community is starting to write proposals even to the government and to other organizations."

Grabowski says once the vision takes hold, ministry flourishes. "All of the community workers who are hired are Christians and are taught biblical principles. When they teach about agriculture, they teach about, 'What does the bible say about agriculture?' and about business, the same thing. So when they're doing programs, they're also sharing more about their faith."

With help, CRWRC and its partners can provide training and support for communities like Chamoto around the world.

Scientists at Central Hospital detail research in antiretrovirals

Research findings, "True outcomes for patients on antiretroviral therapy who are "lost to follow-up" in Malawi," are discussed in a new report. According to a study from Malawi, "PROBLEM: In many resource-poor countries that are scaling up antiretroviral therapy (ART), 5-25% of patients are reported as "lost to follow-up". This figure is 9% in Malawi."

"There is no published information about the true outcome status of these patients. APPROACH: In four facilities in northern Malawi, ART registers and master cards were used to identify patients who had not attended the facility for 3 months or more and were thus registered as "lost to follow-up". Clinic staff attempted to trace these patients and ascertain their true outcome status. LOCAL Of 253 patients identified as "lost to follow-up", 127 (50%) were dead, 58% of these having died within 3 months of their last clinic visit. Of the 58 patients (23%) found to be alive, 21 were still receiving ART and 37 had stopped treatment (high transport costs being the main reason for 13 patients). Sixty-eight patients (27%) could not be traced, most commonly because of an incorrect address in the register. Fewer patients were alive and more patients could not be traced from the central hospital compared with the peripheral hospitals. RELEVANT CHANGES:Better documentation of patients addresses and prompt follow-up of patients who are late for their appointments are required. ART clinics in resource-poor countries should ensure that patients addresses are correct and comprehensive," wrote J.K. Yu and colleagues, Central Hospital.

The researchers concluded: "Clinics should also undertake contact tracing as soon as possible in the event of non-attendance, consider facilitating access to ART clinics and take loss to follow-up into consideration when assessing death rates."

Yu and colleagues published their study in Bulletin of the World Health Organization (True outcomes for patients on antiretroviral therapy who are "lost to follow-up" in Malawi. Bulletin of the World Health Organization, 2007;85(7):550-4).

For more information, contact J.K. Yu, Mzuzu Central Hospital, Taiwan Medical Mission to Malawi, Mzuzu, Malawi.

Publisher contact information for the journal Bulletin of the World Health Organization is: World Health Organization, Marketing and Dissemination, CH-1211 Geneva 27, Switzerland.