Nourishing inmates in Malagasy prisons

Madam

The letters you have recently published from John Waterlow⁽Reference Davys¹⁾ and Glyn Davys⁽Reference Waterlow²⁾ prompt me to acquaint you with my own experience. I am Chief Medical Officer and Director of the Charity Medicap, whose priority is alleviation of chronic malnutrition in prisoners in the prisons of Madagascar. Since we received our first tonne of leaf concentrate late in 2003 we have been using it as an optional dietary supplement as follows.

Inclusion criteria were BMI < 18·5 kg/m² for adults or weight-for-height <90 % median weight for youths. These calculations were made monthly and listed. When an individual reached BMI > 19 kg/m² he or she left the programme.

In June 2008, out of the total 4373 prison population, 677 were receiving concentrate. The nurse knew from the list which of the prisoners should take it. The dose is 10 g/d. The concentrate is given with a glass of water in some prisons or, in others, mixed into their meals. The daily ration for prisoners consists of 500–700 g (dry weight) of cassava (manioc) supplying about 8400 kJ/d (2000 kcal/d).

Results when leaf concentrate was added to the minimum of 500 g cassava/d:

• • Weight gains of 0·5–4·0 kg for prisoners in 1–3 months, provided that the concentrate was accompanied by the minimum of 500 g of starchy staple (if the ration fell to 400 g there was failure to gain weight).

• • The concentrate stimulated the appetite: the prisoners often searched for something to eat during the day.

• • The mortality rate fell.

• • The supplemented prisoners become more energetic and active.

• • Several have ceased to suffer from vertigo.

• • Disappearance of ‘night blindness’.

• • Disappearance of oedema.