Prevalence of malnutrition and its associated factors among adult people living with HIV/AIDS receiving anti-retroviral therapy at Butajira Hospital, southern Ethiopia

Food insecurity and its severity among adults receiving antiretroviral therapy in health facilities, northcentral Ethiopia: a multi-facility-based cross-sectional study

Background

Food insecurity plays a crucial role in predicting the spread of HIV due to the adverse effects of coping mechanisms adopted to mitigate it. However, there is a scarcity of context-specific evidence regarding food insecurity among HIV-infected adults. Therefore, this study aimed to assess the context-specific magnitude of food insecurity and associated factors among adults receiving antiretroviral therapy (ART) in health facilities in the North Shewa Zone, Ethiopia, ultimately contributing to the achievement of the 95-95-95 HIV treatment target in the local context.

Methods

A multi-facility cross-sectional study was conducted among 865 HIV-infected adults receiving ART and being followed up for their treatment. We included health facilities that provide ART, including four hospitals and six health centers. A log-binomial regression model was fitted to identify the association between food insecurity and independent variables. Adjusted prevalence ratios (APRs) with a 95% confidence interval were computed to measure the strength of the association.

Results

In this study, 290 (33.7, 95% CI: 30.60, 36.91) of the HIV-infected adults studied had food insecurity during their treatment and follow-up, of which 152 (52.41, 95% CI: 46.64, 58.13) and 110 (37.93%, CI: 32.50, 43.68) of them were found to have severe and moderate forms of food insecurity, respectively. We found that being younger (APR = 2.27, 95% CI: 1.12, 4.60), being female (APR = 1.87, 95% CI: 1.03, 3.39), lacking formal education (APR = 10.79, 95% CI: 14.74, 24.58), having lower educational status (APR = 5.99, 95% CI: 2.65, 13.54), being a daily laborer (APR = 6.90, 95% CI: 2.28, 20.85), having low monthly income (APR = 1.89, 95% CI: 1.11, 3.22), advanced WHO clinical stage (APR = 2.34, 95% CI: 1.08, 5.10), and receiving ART for less than 4 years (AOR = 2.28, 95% CI: 1.09, 4.74) were significantly associated with a high proportion of food insecurity among HIV-infected adults.

Conclusion

The magnitude of food insecurity among HIV-infected adults receiving ART was high, with an extremely high magnitude of severe food insecurity. The finding suggests the need for culture- and context-specific nutritional interventions to address the gender dynamics of food insecurity, attention to the early stage of ART, and the integration of strategies to improve educational status and enhance income-generation activities of HIV-infected adults. This requires an emphasis on the link between food insecurity and HIV in Ethiopia's national food and nutrition policy.

Dietary diversity and nutritional status of adults living with HIV during the COVID-19 era

BACKGROUND

The coronavirus Disease 2019 (COVID-19) pandemic has brought about unique challenges in healthcare and nutrition, particularly for people living with HIV (PLHIV). Understanding their dietary patterns and nutritional status is crucial for developing targeted interventions and improving health outcomes. Therefore, this study assessed the dietary diversity and nutritional status of PLHIV during the COVID-19 era.

METHODS

We adopted a facility-based cross-sectional study design to enroll 220 PLHIV from two hospitals in the Central Region of Ghana. Dietary intakes were assessed using 24-hour recall. Anthropometric and body composition data were collected with a stadiometer and a body composition monitor. Dietary diversity was evaluated using the FAO's Individual Dietary Diversity Score (IDDS). Data analysis was conducted with SPSS version 20. Significance level was set p-value less than 0.05.

RESULTS

A significant proportion (33.2%) of PLHIV had low dietary diversity, with the majority (55.5%) categorized as needing dietary improvement. Approximately 2 out of every 10 of the participants were identified as underweight. Participants aged 40 to 59 years were more likely to exhibit higher dietary diversity (adjusted odds ratio (AOR) = 1.966, 95% Confidence Interval (CI): 1.045-4.987). Participants who consumed meals at least three times daily were more likely to have a high IDDS (AOR = 1.641, 95% CI: 1.221, 8.879). Employed participants (public sector and private sector) were also more likely to have a high IDDS compared to unemployed participants (AOR = 1.448, 95% CI: 1.028-3.042; AOR = 1.165, 95% CI: 1.030-9.329, respectively). Factors associated with undernutrition included being female (AOR = 1.829, 95% CI: 1.294, 3.872) and first-line antiretroviral therapy ART (AOR = 1.683, 95% CI: 1.282-2.424).

CONCLUSION

The study emphasizes the need for nutritional interventions for PLHIV, particularly during crises. It advocates for a policy collaboration to address food insecurity and promote resilient health outcomes.

Associated factors of diet quality among people living with HIV/AIDS in Ghana

INTRODUCTION

Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body's immune system.

OBJECTIVE

This study aimed to assess diet quality and its associated factors among PLHIV.

METHODS

A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO's individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05.

RESULTS

Most of the PLHIV (73%) consumed from 'Starchy staple" food group. Less than 20% of the study sample consumed 'Fruits' and 'Vegetables' (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD = 1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to "diet needing improvement', 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR = 0.966: 95%CI: 0.936-0.997: p = 0.031), married (AOR = 4.634: 95%CI: 1.329-16.157: p = 0.0016), separated (AOR = 0.0203: 95%CI: .036-0.994: p = 0.049), and daily meal frequency (AOR = 0.441: 95%CI: .478-1.948: p = 0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square = 0.196).

CONCLUSION

This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.

Oral pathologies and underweight conditions among people living with HIV/AIDS in a health facility in Yaoundé, Cameroon: a study of 205 cases

BACKGROUND

Human immunodeficiency virus (HIV) infection is a public health concern worldwide. The clinical manifestations include underweight and oral lesions. The objective of this study was to assess the relationship between oral pathologies and underweight among HIV-positive patients in Yaoundé, Cameroon.

METHODS

We conducted a cross-sectional study between February 1st and 30th June 2021 at Yaoundé Central Hospital in Cameroon. A total of 205 HIV positive patients aged at least 18 years were recruited via consecutive sampling. The questionnaire consisted of sociodemographic information, anthropometric data, dietary habits, HIV history and treatment and oral examination data. The data were analysed with R software. Multivariate analysis was used to assess the risk of being underweight among HIV-positive patients with oral pathologies. A p value < 0.05 was considered to indicate statistical significance.

RESULTS

The prevalence of oral pathologies was 52.7% (95% CI: 45.6-59.6), and the main pathologies were candidiasis (40.5%, 95% CI: 33.7-47.5) and linear erythema (32.2%, 95% CI: 25.9-39.1). The prevalence of underweight was 20% (95% CI: 14.88-26.26). Binary logistic regression revealed that HIV-positive patients with oral pathologies were 10.89 (95% CI: 2.28-16.63) times more likely to be underweight than were HIV positive and AIDS patients without oral pathologies (p = 0.002).

CONCLUSION

Oral candidiasis and linear erythema were common in HIV positive and AIDS patients. HIV-positive and AIDS patients with these oral pathologies were at higher risk of being underweight than were those without oral pathologies. The effective medical care of these patients must include oral and nutritional management.

Nutritional outcomes of therapeutic feeding program and its predictors among undernourished adult HIV positive patients at healthcare facilities of West Guji Zone, Southern Ethiopia: A retrospective cohort study

BACKGROUND

For those living with HIV/AIDS, malnutrition is a significant issue everywhere, but it is particularly prevalent in Sub-Saharan Africa. A nutritional support program is becoming a more and more common strategy to prevent malnutrition in HIV-positive persons. Thus, this study aimed to assess nutritional treatment outcomes and their predictors among adult HIV-positive undernourished individuals in West Guji Zone healthcare facilities.

METHOD

A facility-based retrospective cohort study was conducted among 348 randomly selected adult HIV- positive patients in the West Guji Zone healthcare facilities between January 2018 and December 2022. Data were collected using the data extraction tool. Entered into Epi Data version 3.1 and exported to SPSS version 26 for analysis. The Kaplan-Meier survival curve and log-rank test were used to predict the time to recovery and to compare survival curves across categorical variables. A Cox proportional hazard regression model was fitted to identify an independent predictor of the recovery rate. Statistical significance was declared at a p-value of < 0.05.

RESULTS

In the final analysis 348 undernourished HIV-positive persons were included. Based on preset exit criteria, approximately 198, 56.9% of patients enrolled in the RUTF program were able to recovered, with an incidence of 9.83 (95% CI: 3.12, 13.44) per 100 person-month observations. Being divorced (AHR = 0.21; 95% CI: 0.06, 0.69) and being in the WHO advanced stage (AHR = 0.42; 95% CI: 0.23, 0.79) was a negative predictor. Being in the age range of 18-29 and 30-39 and having a working functional status (AHR = 2; 95% CI: 1.25, 3.23) were positive predictors.

CONCLUSION

Nutritional recovery in this study lower than WHO Sphere requirements. Age between 18 and 39 and working functional status were good indicators of nutritional recovery, whereas advanced WHO clinical stage and divorced marital status were negative predictors.

Predictors of underweight among adult patients receiving antiretroviral therapy in Bishoftu general hospital, central Ethiopia: Case-control study

BACKGROUND

Underweight affects the overall clinical outcome and quality of life and increases the risk of mortalities in Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) patients. Though studies have examined the various determinants of being underweight in people living with HIV/AIDS (PLHIV), scanty evidence exists about the influence of dietary diversity scores and dietary counseling on underweight HIV patients in Ethiopia. This study aimed to identify the determinants of being underweight among adult patients receiving antiretroviral therapy at Bishoftu General Hospital, central Ethiopia.

METHODS

An institution-based unmatched case-control study was conducted among 279 participants (93 cases and 186 controls) from April to May 2022. Cases were selected consecutively as they occur, and then two subsequent controls that visited the antiretroviral therapy(ART) clinic were interviewed until the sample size was attained. Data were collected using a pretested structured questionnaire and involved patient interviews and chart review. Bivariate and Multivariable logistic regression was used to identify determinants of underweight. The presence of statistically significant association was declared with p-value <0.05, and a 95% confidence interval was used to show the precision in the measure of the strength of association.

RESULTS

The response rate of participants was 91.2% for each of the cases and controls. Monthly income of patients ≤2000 birr (AOR = 6.63, 95% CI: 2.96-14.85), absence of support giver (AOR = 3.22, 95% CI: 1.38-7.50), being having an eating problem (AOR = 14.48, 95% CI: 5.06-41.40), dietary diversity score of four to five (AOR = 2.36, 95% CI: 1.92, 6.08), not getting dietary counseling support and advice (AOR = 2.53, 95% CI: 1.11, 5.72) and chewing khat (AOR = 3.36, 95% CI: 1.99,11.33) were determinants of underweight in adult HIV patients.

CONCLUSIONS

This study revealed that household dietary diversity, counseling and education on nutrition, monthly income, eating problems, support giver, and khat chewing were predictors of being underweight in HIV patients. This inquires an integrated nutritional intervention including income-generating activities, counseling and education on nutrition and bad habits, and regular monitoring of the nutritional status during clinic visits.

Rural-urban disparities in nutritional status among women in Ethiopia based on HIV serostatus: a cross-sectional study using demographic and health survey data

BACKGROUND

Ethiopia is one of the sub-Saharan African countries most affected by the human immunodeficiency virus (HIV) epidemic and also by severe undernutrition, which is particularly prevalent among women. HIV infection, reproductive biology, and their role in society increase the vulnerability of women to malnutrition. Various factors including urbanization could cause differences in the nutritional status of rural and urban residents. In this study, we aimed to assess rural-urban disparities in nutritional status among women of reproductive age based on HIV serostatus in Ethiopia.

METHOD

Data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 were used. Among 15,683 women included in the survey, 8822 non-pregnant women aged 15-49 years, including those who gave birth two months before the DHS survey were included in this study. Multinomial logistic regression was used to determine the relative risk ratios (RRR) for the associations between study variables.

RESULTS

Generally, the prevalence of underweight among women of reproductive age was higher in rural residents (28.9%) than in urban residents (12.3%) in Ethiopia. Being overweight was more prevalent among urban women than rural women, (35.1% vs. 4.8%). About 32% of HIV-positive women were underweight in both rural and urban areas. About 29% of HIV-positive urban women were overweight compared to 3.4% of HIV-positive rural women. Among urban residents, HIV-positive women were about 4 times more likely to be underweight than their HIV-negative counterparts, RRR 3.8 (95% CI: 1.58, 9.26). However, there was no significant difference in nutritional status between HIV-positive and HIV-negative women living in rural areas. Anemic women were more likely to be underweight while, wealthy women were less likely to be underweight in both rural and urban areas. Women aged 25-49 years were generally more likely to be overweight/obese and less likely to be underweight compared to younger women aged [Formula: see text]years.

CONCLUSION

Malnutrition was more prevalent among HIV-positive women living in urban Ethiopia. Targeted nutritional interventions for HIV-positive women of reproductive age living in urban areas could be considered. Furthermore, efforts should be made to improve the nutritional status of women of reproductive age across the country.

Prevalence of undernutrition and associated factors among adults taking antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

Undernutrition (Body Mass Index < 18.5 kg/m2) is a common problem and a major cause of hospital admission for patients living with HIV. Though sub-Saharan Africa is the most commonly affected region with HIV and malnutrition, a meta-analysis study that estimates the prevalence and correlates of undernutrition among adults living with HIV has not yet been conducted. The objective of this study was to determine the pooled prevalence of undernutrition and associated factors among adults living with HIV/AIDS in sub-Saharan Africa.

METHODS

Studies published in English were searched systematically from databases such as PubMed, Google Scholar, and gray literature, as well as manually from references in published articles. Observational studies published from 2009 to November 2021 were included. The data extraction checklist was prepared using Microsoft Excel and includes author names, study area, publication year, sample size, prevalence/odds ratio, and confidence intervals. The results were presented and summarized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standard. Heterogeneity was investigated using the Q test, I2, τ2, τ and predictive interval. STATA version 17 was used to analyze the data. A meta-analysis using a random-effects model was used to determine the overall prevalence and adjusted odds ratio. The study has been registered in PROSPERO with a protocol number of CRD42021268603.

RESULTS

In this study, a total of 44 studies and 22,316 participants were included. The pooled prevalence of undernutrition among adult people living with HIV (PLWHIV) was 23.72% (95% CI: 20.69-26.85). The factors associated with undernutrition were participants' age (AOR = 0.5, 95% CI: 0.29-0.88), gender (AOR = 2.08, 95% CI: 0.22-20.00), World Health Organization (WHO) clinical stage (AOR = 3.25, 95% CI: 2.57-3.93), Cluster of Differentiation 4 (CD4 count) (AOR = 1.94, 95% CI: 1.53-2.28), and duration of ART (AOR = 2.32, 95% CI: 1.6-3.02).

CONCLUSION

The pooled prevalence of undernutrition among adult PLWHIV in sub-Saharan Africa remained high. WHO clinical stage, CD4 count, duration of ART treatment, age, and sex were found to be the factors associated with undernutrition. Reinforcing nutrition counseling, care, and support for adults living with HIV is recommended. Priority nutritional screening and interventions should be provided for patients with advanced WHO clinical stages, low CD4 counts, the male gender, younger age groups, and ART beginners.

Clinical and behavioral factors associated with undernutrition among highly active antiretroviral therapy users in Southwest Ethiopia

Background

Globally, about 1.9 billion adults are overweight or obese, while 462 million are underweight. These are primarily found in countries with low and middle incomes, such as Ethiopia. Undernutrition is a frequent health problem among people living with HIV/AIDS; however, no large-scale research, including several health facilities, has been conducted in Ethiopia. Thus, this study aimed to assess the nutritional status and nutrition-related factors among highly active antiretroviral therapy (HAART) users in public hospitals in Southwest Ethiopia.

Methods

A cross-sectional facility study design was conducted in all public hospitals in Southwest Ethiopia from January to March 2021. A systematic sampling technique was used to select the study participants. The collected data were entered into EpiData 3.1 and then exported to SPSS version 24 for statistical analysis. Binary logistic regression analysis was done to identify the factors associated with the outcome variable. The level of significance was declared at a P-value of <0.05, with their corresponding 95% confidence level.

Results

A total of 402 HAART users have participated with a 100% response rate. The proportion of undernutrition (BMI <18.5 kg/m2) and patients with overweight or obesity (BMI ≥25 kg/m2) were 29.3% [95% CI: (24.6-33.5)] and 10% [95% CI: (6.6-12.9)], respectively. Out of undernutrition patients, severe undernutrition (BMI <16 kg/m2) accounted for 5.6%. Factors, such as food insecurity [AOR: 3.21, 95% CI: (1.76-5.91)], history of diarrhea [AOR: 2.86, 95% CI: (1.96-6.78)], CD4 cell count ≤ [AOR: 4.72, 95% CI: (2.14-12.13)], and substance user [AOR: 4.12, 95% CI: (2.31-7.30)], were the independent factors of undernutrition.

Conclusion

This study found that the prevalence of undernutrition was high compared with other settings. The government should also pay due attention to improving the treatment of HIV/AIDS by offering nutritional support services in hospitals. Moreover, policymakers and healthcare professionals consider the effects of these factors on nutrition while providing ART services.

Anaemia and Nutritional Status during HIV and Helminth Coinfection among Adults in South Africa

Sub-Saharan Africa is burdened with helminthiasis and HIV/AIDS, and there is a significant overlap between these infections. However, little is known about the extent of anaemia and malnutrition in HIV/AIDS and helminth coinfected adults. The study investigated the anaemia profiles and nutritional status of HIV and helminth coinfected adult South Africans. Stool samples were collected from participants (N = 414) for parasite detection using the Kato−Katz and Mini Parasep® SF techniques. Blood was collected to determine participants’ HIV status, micro- and macronutrients, haematological parameters, and Ascaris lumbricoides-specific IgE and IgG4 levels. Thereafter, participants were stratified into single infection (HIV or helminths), coinfection, and uninfected controls (no HIV and helminth) groups. The majority (74.9%) of participants had CD4 counts of >500 cells/μL, indicating no significant immunosupression. The coinfected group had an overall anaemia prevalence of 16.9%, which was lower than that of the HIV-infected group (44.6%) and higher than helminth infected group (15.4%). Overall helminth prevalence was 33%, with Ascaris lumbricoides being the most prevalent. The coinfected group also had lower vitamin A (p = 0.0107), calcium (p = 0.0002), and albumin (p < 0.0001) levels compared to HIV/helminth uninfected controls. Unexpectedly, the coinfected group had the highest serum iron levels, followed by the helminth-infected and control groups, both of which had similar iron levels, and finally, the HIV-infected group, which had the lowest iron levels (p = 0.04). Coinfected adults may be prone to micronutrient deficiency and anaemia. Further research and intervention programmes are required in this neglected field.

Prevalence of overweight and obesity and associated factors among people living with HIV attending a tertiary care clinic in Uganda

Background:

Overweight and obesity are significantly increasing among people living with HIV (PLWH), contributing to the risk of major adverse cardio-metabolic events. However, little is known on its prevalence among PLWH in sub-Saharan Africa. In this study, we report the prevalence and factors associated with overweight and obesity among PLWH in a large tertiary HIV clinic in Kampala, Uganda.

Methods:

A cross-sectional, retrospective review of electronic database of all PLWH that attended the Adult Infectious Diseases Institute clinic between November 2018 and April 2019 was conducted. Demographic, body mass index (BMI) [kg/m²] and clinical variables were extracted. Based on BMI, nutritional status was classified as undernutrition (< 18.5kg/m²), normal (≥ 18.5 < 25kg/m²), overweight (≥ 25 < 30kg/m²) and obesity (≥ 30kg/m²). Poisson regression analysis was performed to determine factors associated with overweight and obesity.

Results:

Overall, 7,818 participants were included in the analysis, 64% (n = 4,976) were female, with a median age of 44 years (interquartile range (IQR): 36–51) and a median BMI of 24.2 (IQR: 21.2–28.1). The prevalence of overweight and obesity combined was 46% (55% female versus 30% male), obesity 18.2% (24.6% female versus 7.1% male) and overweight 27.8% (30.4% female versus 22.9% male). Factors associated with overweight and obesity were: Females (adjusted prevalence ratio [aPR]: 1. 8, 95%CI:1.69–1.87), age category 25—59 years (aPR: 1.9, 95%CI: 1.63–2.24) and ≥ 60 years (aPR: 1.8, 95%CI:1.49–2.12); duration on antiretroviral therapy (ART) for 6—10 years (aPR: 1.1, 95%CI:1.08–1.18), CD4 count 200–500 (aPR:0.08, 95%CI:0.01–0.15) and > 500 (aPR:0.46, 95%CI:0.39–0.54) and having at least one noncommunicable disease (NCD) (aPR: 1.1, 95%CI:1.07–1.18).

Conclusion

There is a high burden of overweight and obesity among PLWH in Uganda. Nutrition and weight management programs particularly targeting high risk groups such as females and persons with underlying NCDs should be integrated into HIV care.

Levels of undernutrition and associated factors among adults receiving highly active anti-retroviral therapy in health institutions in Bench Maji Zone, Southwest Ethiopia in 2018

Background

Nutritional issues are common in people with Human Immune Virus (HIV). At some point, almost everyone living with HIV faces challenges in maintaining good nutrition. There is insufficient evidence-based information on undernutrition in adults living with HIV on Highly Active Anti-Retroviral Therapy.

Objective

To assess the magnitude of undernutrition and associated factors among patients receiving Highly Active Anti-Retroviral Therapy in health facilities in the Bench Maji Zone, southwest Ethiopia in 2018.

Methods

A facility-based cross-sectional study design was employed from 1 May to 30 June 2018 on 1,007 study subjects and the participants were selected by using a consecutive sampling technique. Five health facilities were selected through a simple random sampling technique. Data were entered into Epi Data Statistical software version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software version 21.0. Logistic regression analysis was used to identify factors associated with undernutrition in adults receiving ART. Odds ratios with 95 % confidence intervals were used to examine associations between dependent and independent variables.

Result

Of the total 1,007 study subjects, 961 participated in the study. More than half of the participants were female (61.2%), 57.2% were married and 42.9% were in the 30–39 years age group. In this study, the level of undernutrition among patients on antiretroviral therapy was 16%. Age ≥50 [AOR 2.5, 95% CI (1.1–5.6)], being single [AOR 2.2, 95% CI (1.4–3.7)], developing gastrointestinal symptoms [AOR 2.6, 95% CI (1.5–4.4)] and in WHO-defined clinical stages III and IV of HIV/AIDS [AOR 2.8, 95% CI (1.3–6.0)] were found to have a statistically significant association with undernutrition.

Conclusion

Significant numbers of people on highly active antiretroviral therapy in the study area were undernourished. This demonstrated that HIV/AIDs and its treatment directly or indirectly impacted the nutritional status of the patients, who need a critical follow-up from health workers. Age, marital status, progressing to WHO-defined clinical stage of disease, and development of gastrointestinal symptoms were identified as factors that contribute to undernutrition among patients on highly active antiretroviral therapy. The health care workers and experts working at the ART clinic should focus on patient counseling regarding the early prevention, detection, and treatment of opportunistic infections. Early health-seeking behaviors before the AIDs stage and critical follow-up are the first actions to identify undernutrition.

Lipid-based nutrient supplement at initiation of antiretroviral therapy does not substitute energy from habitual diet among HIV patients – a secondary analysis of data from a randomised controlled trial in Ethiopia

Introduction: Malnutrition is common among people with HIV in sub-Saharan Africa. Nutritional supplementation at initiation of antiretroviral treatment (ART) has shown beneficial effects, but it is not known if supplementation replaces or supplements the habitual energy intake in a context of food insecurity. Methods: As part of a randomised controlled trial among people with HIV initiating ART in Ethiopia, we assessed whether the provision of a lipid-based nutrient supplement (LNS) affected energy intake from the habitual diet. People with HIV aged ≥18 years with a body mass index (BMI) >17 were randomly allocated 2:1 to receive either early (month 1–3 after ART initiation) or delayed (month 4–6 after ART initiation) supplementation with LNS (≈4,600 kJ/day). Participants with BMI 16–17 were all allocated to early supplementation. The daily energy intake from the habitual diet (besides the energy contribution from LNS) was assessed using a 24-h food recall interview at baseline and at monthly follow-up visits. Linear mixed models were used to compare habitual energy intake in (1) early versus delayed supplementation groups and (2) supplemented versus unsupplemented time periods within groups. Results: Of 301 participants included, 67% of the participants were women, mean (±standard deviation [SD]) age was 32.9 (±8.9) years and 68% were living in moderately or severely food insecure households. Mean (±SD) reported habitual energy intake at baseline was 5,357 kJ/day (±2,246) for women and 7,977 kJ/day(±3,557) for men. Among all participants, there were no differences in mean habitual energy intake between supplemented and unsupplemented groups in neither the first 3 (P = 0.72) nor the following 3 months (P = 0.56). Furthermore, habitual energy intake did not differ within groups when comparing periods with or without supplementation (P = 0.15 and P = 0.20). The severity of food insecurity did not modify the effect of supplementation in habitual energy intake (P = 0.55). Findings were similar when participants with BMI 16–17 were excluded. Conclusion: Our findings indicate that the LNS provided after ART initiation supplement, rather than substitute, habitual energy intake among people with HIV, even among those who are food insecure. This supports the feasibility of introducing nutritional supplementation as part of HIV treatment.

Under-nutrition and associated factors among children infected with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

In the developing world, such as the sub-Saharan African region, HIV/AIDS has worsened the impact of under-nutrition in children. HIV infected children are highly vulnerable to under-nutrition. Therefore, the objective of this systematic review and meta-analysis was to estimate the pooled prevalence of under-nutrition, and the pooled effect sizes of associated factors among HIV-infected children in sub-Saharan Africa.

METHODS

The primary studies for this review were retrieved from PubMed/ MEDLINE online, Science Direct, Hinari, web of science, CINHAL, EMBASE, WHO databases, Google, and Google Scholar databases. The articles selected for this meta-analysis were published between 2010 and 2020. The last search date was 18 October 2021. The data was extracted in Microsoft Excel format and exported to STATA Version 14.0. A random effect meta-analysis model was used. Heterogeneity was evaluated by the I2 test. The Egger weighted regression test was used to assess publication bias.

RESULTS

We retrieved 847 records from these databases. Of which records, 813 were excluded due to different reasons and 34 studies were included in the final analysis. The pooled prevalence of stunting, underweight and wasting in HIV infected children was 46.7% (95% CI; 40.36-53.07, I2 = 98.7%, p < 0.01), 35.9% (95% CI; 30.79-41.02, I2 = 97.4% p < 0.01), and 23.0% (95% CI; 18.67-27.42, I2 = 96.9%, p < 0.01) respectively. The advanced WHO HIV/AIDS clinical staging (III&IV) [OR = 6.74 (95%: 1.747, 26.021), I2 = 94.7%] and household food insecurity were associated with stunting [OR = 5.92 (95% CI 3.9, 8.87), I2 = 55.7%]. Low family economic status [OR = 4.737 (95% CI: 2.605, 8.614), I2 = 31.2%] and increased feeding frequency [OR = 0.323 (95% CI: 0.172, 0.605), I2 = 69.8%] were significantly associated with under-weight. Anemia [OR = 2.860 (95% CI: 1.636, 5.000), I2 = 74.8%] and diarrhea in the previous month [OR = 4.117 (95% CI: 2.876, 5.894), I2 = 0.0%] were also associated with wasting among HIV infected children in sub-Saharan Africa.

CONCLUSIONS

The pooled prevalence of under-nutrition among HIV infected children was high. Nutritional assessment and interventions need great attention as a part of HIV care for HIV positive children. The implementation of policies and strategies established by national and international stakeholders in ART care centres should take a maximum emphasis on reducing under-nutrition among HIV infected children.

Undernutrition and Its Associated Factors Among Human Immunodeficiency Virus Infected Children on Follow Up in Amhara Region Referral Hospitals, Ethiopia, 2020

Background. Undernutrition is a global problem and the biggest threat to human life and economic progress. It is the main cause of child morbidity and mortality especially in sub-Saharan Africa including Ethiopia. The severity of the problem is even worse when children are infected with human immunodeficiency virus. However the seriousness of the problem, there were limited studies conducted in the study area. Therefore, this study was conducted to assess the magnitude of undernutrition and its associated factors among HIV-infected children on follow up in Amhara Region Referral Hospitals. Methods. A facility-based cross-sectional study was conducted from February to April 2020. The data were collected through an interviewer-administered questionnaire. The collected data were coded and entered into Epi data 3.1 and exported to SPSS 26.0 for analysis. P-value <.05 was considered as statically significant. Results. The magnitude of undernutrition in this study was 30.3%. Dietary diversity (AOR = 1.73; CI 1.07-2.81), nutritional counseling (AOR = 2.42; CI 1.45-4.04), family size (AOR = 0.50; CI 0.27-0.93), WHO staging (AOR = 1.77; CI 1.08-2.88), and adherence to antiretroviral therapy (AOR = 1.75; CI 1.06-2.87) were predictors of undernutrition. Conclusions. Nearly one-third of the children included in this study had undernutrition. Poor dietary diversity, adherence to ART, nutritional counseling, family size, and WHO staging were factors significantly associated with undernutrition. Early screening and treatment of opportunistic infections, close attention to dietary counseling for caregivers and proper feeding habits will alleviate the problem.

Challenges to nutrition management among patients using antiretroviral therapy in primary health 'centres' in Addis Ababa, Ethiopia: A phenomenological study

INTRODUCTION

Nutritional management is a fundamental practice of concern to all patients infected with the human immunodeficiency virus (HIV). The nature of HIV/AIDS and malnutrition impacts are interlocked and intensify one another.

OBJECTIVE

This study aimed to explore nutrition management challenges among people living with HIV on antiretroviral therapy (ART) in primary health centres in Addis Ababa, Ethiopia.

METHODS AND MATERIALS

We used a hermeneutic (interpretive) phenomenological study design. The study used in-depth interviews to describe lived experiences among adult patients aged 18 and above. We selected the participants purposively until the saturation of the idea reached. We maintained the scientific rigor and trustworthiness by applying credibility, transferability, dependability, and conformability, followed by translation and re-reading of the data has been achieved. The data have been analyzed through inductive thematic analysis assisted by NVIVO version 12 pro software.

RESULT

Nutrition management challenges for HIV patients have been described using six significant themes. The major themes were: acceptance of the disease and the health status; facilitators and barriers to treatment adherence; behavioural changes in eating patterns; experience of food insecurity issues; nutrition knowledge; and support. The themes have explained how patients using ART have been challenged to manage their nutrition ever since their diagnosis. Of all challenges, food insecurity is found to be the core reason for poor nutrition management.

CONCLUSION AND RECOMMENDATION

We found that many factors in managing their nutrition challenged patients with HIV. There should be an increasing interest in managing food insecurity issues as food insecurity has been strongly related to other factors.

Prevalence of Food Insecurity and Its Associated Factors among Adult People with Human Immunodeficiency Virus in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Food insecurity is the shortage of both the quantity and quality of food and a negative impact on the overall nutritional and health status of people with human immunodeficiency virus (HIV). Ethiopia is intensely affected by food insecurity which is about 87.4% of adult people living with human immuno deficiency virus (HIV) are still facing shortage to have access to safe, sufficient, and nutritious food for themselves and their family. However, there is no concrete scientific evidence established at the national level in Ethiopia. Hence, this review gave special emphasis on adult people with human immunodeficiency virus (HIV) to estimate the pooled prevalence of food insecurity and its associated factor at the national level in Ethiopia.

METHODS

Studies were retrieved from selected electronic data bases, including PubMed/Medlin, Cochrane library, Sciences Direct, Google, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled prevalence of food insecurity and its associated factors at 95% confidence interval with odds ratio (OR) using statistical R-software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias was checked using the funnel symmetry test, and heterogeneity was checked using forest plot and inverse variance square (I 2). The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search.

RESULT

A total of 650 articles were identified through the initial search of which 20 studies were included in the final review yielding a total sample size of 7,797 adult people with human immunodeficiency virus (HIV). The pooled prevalence of food insecurity was 52% (95% CI, 40%, 63%). Cluster of differentiation 4 (CD4) count < 350 cell/mm3 [AOR = 1.29 (95% CI, 1.08, 1.54)], develop opportunistic infection [AOR = 4.09 (95% CI, 2.47, 6.78)], rural residence [AOR = 1.59 (95% CI, 1.09, 2.34)], and World Health Organization (WHO) clinical stages III and IV [AOR = 1.98 (95% CI, 1.23, 3.19)] was among the significantly associated factors.

CONCLUSION

In this review, there was a high prevalence of food insecurity among adult people with human immunodeficiency virus. Therefore, the responsible stockholders should strengthen the system and procedure for early diagnosis of opportunistic infection, under nutrition, screening of underlying problems.

Underweight and Its Predictors Among Patients on Anti Retroviral Therapy at Selected Health Facilities of Addis Ababa, Ethiopia, 2020

Objective

The study aimed at assessing the prevalence of underweight and its predictors in patients on ART, in health facilities of Addis Ababa, Ethiopia, 2020.

Methods

A multi-center-based cross-sectional study was conducted among 319 patients on ART selected on the basis of stratified sampling method in Addis Ababa from July 01 to August 30, 2020. An interviewer-administered structured questionnaire was used for collection of the data, after which informed consent was obtained from all the included participants. Descriptive statistics for the summarization of the data was used. Binary (Bivariate and multivariate) logistics regression was applied for the identification of predictors of underweight and its strength of association with their respective 95% confidence intervals and less than 5% p-values as statistically significant association.

Findings

The prevalence of underweight among patients on ART was 19.1% (95% CI: 15.0-23.9%), while more than one-tenth (14.4%) of the participants were overweight (95% CI: 10.8-18.8%). A higher level of Educational level, being married, widowed, divorced, a lower family size and poor ART drug adherence level were statistically significantly associated with an increased risk of underweight among patients on ART in the study settings (p<0.05).

Conclusion

Educational level, marital status, family size, and adherence status of the participants were identified predictors of underweight among patients on ART. The lower the educational level, lower family size, being either married, divorced, or widowed, having had of poor ART drug adherence level of the participants, the higher their risk of sustaining underweight. Concerned bodies were suggested to work over the identified determinants of underweight among patients on ART in the study settings.

Episodes of Undernutrition and its Predictors among Clients on Antiretroviral Treatment in Southwest Ethiopia: A Record Review

Background

More than a quarter of people living with human immune virus had increased burden of malnutrition leading to poor disease progression and survival. However, evidence on predictors for episodes of malnutrition is limited despite its importance for targeted interventions. This paper assessed the episodes of undernutrition and its predictors among HIV-positive adults on treatment in southwest Ethiopia.

Methods

A facility-based cross-sectional study using secondary data was conducted among 519 randomly selected records of adult clients on antiretroviral treatment. Malnutrition was assessed using the records of weight and height at different points of follow-up (0, 6, 12, 18, and 24 months of ART follow-up). Analysis of variance, covariance, and spaghetti plot were done to compare the mean change in body mass index. To assess predictors of malnutrition episodes, a linear mixed model was used with parameter estimate with 95% confidence interval and P-values were estimated via maximum likelihood method. Akaike's information criteria was used for model fitness.

Results

A total of 480 records were reviewed with a mean age of 36 years (±9 years). A total of 354 (73.8%) and 34.6% of clients got dietary counseling and support, respectively. Statistically significant improvement in mean BMI after initiating treatment (P-value=0.0001) was observed. Being male (β=−0.72; P=0.044), having problems of eating difficulty (β=−1.61; P=0.0001), anemia (β=−1.51; P=0.003), shorter follow-up intervals (β=0.04; P=0.129), not getting nutritional counseling (β=0.63; P=0.32), and diarrheal disease (β=−0.04; P=0.129) were predictors of undernutrition.

Conclusion

Improvement in nutritional status after initiation of ART was seen. The presence of eating disorder, anemia, not getting nutritional counseling, and the short follow-up interval predict undernutrition.

Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study

Background

Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia.

Methods

An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients' charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery.

Result

From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9–17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22–31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27–0.85), no formal education (ARR = 0.24, 95% CI: 0.13–0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08–0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17–0.59) decrease the probability of nutritional recovery.

Conclusion

Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.

Strongyloidiasis in Africa: Systematic Review and Meta-Analysis on Prevalence, Diagnostic Methods, and Study Settings

BACKGROUND

Strongyloidiasis is an intestinal parasitic infection mainly caused by Strongyloides stercoralis. Although it is a predominant parasite in tropics and subtropics where sanitation and hygiene are poorly practiced, the true prevalence of strongyloidiasis is not known due to low-sensitivity diagnostic methods.

OBJECTIVE

This systematic review and meta-analysis is aimed at determining the pooled prevalence of strongyloidiasis in African countries, stratified by diagnostic methods, study settings, and patients.

METHODS

Cross-sectional studies on strongyloidiasis published in African countries from the year 2008 up to 2018 in PubMed and Google Scholar databases and which reported at least one Strongyloides spp. infection were included. Identification and screening of eligible articles were also done. Articles whose focus was on strongyloidiasis in animals, soil, and foreigners infected by Strongyloides spp. in Africa were excluded. The random effects model was used to calculate the pooled prevalence of strongyloidiasis across African countries as well as by diagnostic methods and study settings. The heterogeneity between studies was also computed.

RESULT

A total of 82 studies were included. The overall pooled prevalence of strongyloidiasis was 2.7%. By individual techniques, the pooled prevalence of strongyloidiasis was 0.4%, 1.0%, 3.4%, 9.3%, 9.6%, and 19.4% by the respective direct saline microscopy, Kato-Katz, formol ether concentration, polymerase chain reaction, Baermann concentration, and culture diagnostic techniques. The prevalence rates of strongyloidiasis among rural community, school, and health institution studies were 6.8%, 6.4%, and 0.9%, respectively. The variation on the effect size comparing African countries, diagnostic methods, study settings, and patients was significant (P ≤ 0.001).

CONCLUSIONS

This review shows that strongyloidiasis is overlooked and its prevalence is estimated to be low in Africa due to the use of diagnostic methods with low sensitivity. Therefore, there is a need for using a combination of appropriate diagnostic methods to approach the actual strongyloidiasis rates in Africa.

Undernutrition and associated factors among adult HIV/AIDS patients receiving antiretroviral therapy in eastern zone of Tigray, Northern Ethiopia: a cross-sectional study

Background

Undernutrition and HIV/AIDS are highly prevalent in sub-Saharan Africa, Ethiopia inclusive as linked in a vicious cycle. Thus, several studies have documented that undernutrition among HIV/AIDS patients increases the risk of mortality, decrease survival rates, affect the overall clinical outcome and quality of life.Despite this fact, information about the burden of undernutrition and associated factors among adults receiving antiretroviral therapy is lacking in the particular study area. Hence, this study aimed to examine the prevalence of undernutrition and associated factors among adult HIV/AIADS patients receiving antiretroviral therapy patients in Eastern Zone of Tigray, Northern Ethiopia.

Methods

A cross-sectional research design was adopted in data collection while systematic sampling technique was employed to sample and select the study subjects. A structured questionnaire was used to collect information from 394 study subjects through face to face method.Also, data on demographics, laboratory and anthropometric variables were collected from each selected patients sampled.The data collected were entered and analyzed using SPSS version 22.. Bivariate and multivariable logistic regression analysis with 95% confidence interval were used to find factors associated with undernutrition. The adjusted odds ratio was calculated to show the strength of the association. Variables with p-value of < 0.05 were considered statically significant.

Results

The mean age of the respondents was 41 (± 10). Out of 394 study respondents, about 42.9% of them were undernourished (95% CI: 37.8-47.7).Respondents who had CD4+ count less than 200 cells/μl (AOR = 1.84; 95% CI: 1-3.36), being advanced clinical staging (AOR = 3.6; 95% CI: 2.11-6.18), and not taking co-trimoxazole preventive therapy (AOR = 2.38; 95% CI: 1.21-4.6) were independently associated with undernutrition.

Conclusion

The result of this study indicated that the prevalence of undernutrition was high.Respondents with advanced clinical stage of CD4+ count less than 200 cells/ul and those that were not taking co-trimoxazole preventive therapy was found to be positively associated with undernutrition.Therefore, the implementation of nutritional programs is very crucial to improve the nutritional status of HIV/AIDS patients in the particular study.

Epidemiology of HIV Infection in the Amhara Region of Ethiopia, 2015 to 2018 Surveillance Data Analysis

Background

Globally, over 37.9 million people are living with HIV in 2018 and sub-Saharan Africa carries 71% of the global HIV epidemics. In Ethiopia, there were an estimated 613,000 HIV cases in 2017. This study aimed to assess the trend of HIV incidence in the Amhara Region, Ethiopia.

Methods

A retrospective descriptive study was conducted using routine HIV data from 2015 to 2018. We extracted HIV records from the Amhara Regional Health Bureau database. Data confidentiality was secured through data anonymity. Data were entered, cleaned and analyzed by IBM SPSS version 22 (Armonk, NY, USA). Various descriptive statistics such as counts, proportions and trends were computed to see the magnitude of HIV in the study area.

Results

A total of 57,293 new HIV cases were reported from 2015 to 2018 and 33,720 (59%) were females. The majority, 40,054 (70%), of HIV cases were among people in 25−49 years. The overall incidence rate of HIV from 2015 to 2018 was 6.9 per 1000 population. The annual HIV incidence rates were 7.3. 6.3, 7.4 and 6.63 per 1000 population in 2015, 2016, 2017 and 2018, respectively. The incidence rate per 1000 population was high in Dessie town (5.74), Bahir Dar city (4.27) and Gondar town (3.00). About 49,564 (86.5%) of HIV cases have started ART and 33% of them had TB infection where 54% of them were females. Only 14869 (30%) people on ART had normal nutritional status.

Conclusion

HIV remains a public health concern in the Amhara Region and the burden varied by place, time, gender and age groups. Improving awareness creation and community mobilization, managing TB infection and undernutrition problems, and making HIV screening services available in all healthcare facilities are crucial to decrease HIV infection. Special attention is also required to avoid risk factors that increased HIV incidence among females.

Nutritional status and the associated factors among people living with HIV: an evidence from cross-sectional survey in hospital based antiretroviral therapy site in Kathmandu, Nepal

BACKGROUND

Nutritional status is the key concern among the people living with HIV but this issue has been failed to be prioritized in HIV strategic plan of Nepal. This study aims to assess the nutritional status among people living with HIV and determine their associated factors.

METHODS

A hospital based cross-sectional study was conducted where 350 people living with HIV attending the ART clinic were selected using systematic random sampling technique. Nutritional status among people living with HIV was assessed through anthropometry, body mass index; Underweight (body mass index < 18.5 kg/m2) and overweight/obesity (body mass index > 23 kg/m2). HIV related clinical factors such CD4 count, WHO stage, opportunistic infection, antiretroviral therapy regimen etc. were collected from the medical records. Socio-demographic data were collected using pretested structured questionnaire through interview technique. Multiple linear regression method was employed to determine the association between different independent factors and body mass index score.

RESULTS

The prevalence of underweight was found to be 18.3% (95% CI: 14.3-22.6). Most of the study participants were overweight/obese (39.1%). After subjection to multiple linear regression analysis, it was found that age, being male, being married, being in business occupation, smoking, hemoglobin level and antiretroviral therapy duration were significantly associated with body mass index score. Majority of the participants in our study lacked diversified food (62.3%).

CONCLUSION

Overweight/obesity is an emerging problem among people living with HIV. This group of participants should be screened for the presence of non-communicable disease. This study also highlights the importance of nutritional program being an integral part of HIV/AIDS continuum of care. Therefore, an effort should be made to address the burden of malnutrition by addressing the identified determinants.

Undernutrition among Ethiopian adults living with HIV: a meta-analysis

Background

Malnutrition and human immunodeficiency virus (HIV) are interlaced in a vicious cycle and worsened in low and middle-income countries. In Ethiopia, even though individuals are dually affected by both malnutrition and HIV, there is no a nationwide study showing the proportion of malnutrition among HIV-positive adults. Consequently, this review addressed the pooled burden of undernutrition among HIV-positive adults in Ethiopia.

Methods

We searched for potentially relevant studies through manual and electronic searches. An electronic search was carried out using the database of PubMed, Google Scholar, and Google for gray literature and reference lists of previous studies. A standardized data extraction checklist was used to extract the data from each original study. STATA Version 13 statistical software was used for our analysis. Descriptive summaries were presented in tables, and the quantitative result was presented in a forest plot. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I² test. Finally, a random-effects meta-analysis model was computed to estimate the pooled proportion of undernutrition among HIV-positive adults.

Results

After reviewing 418 studies, 15 studies met the inclusion criteria and were included in the meta-analysis. Findings from 15 studies revealed that the pooled percentage of undernutrition among HIV-positive adults in Ethiopia was 26% (95% CI: 22, 30%). The highest percentage of undernutrition (46.8%) was reported from Jimma University specialized hospital, whereas the lowest proportion of undernutrition (12.3%) was reported from Dilla Hospital. The subgroup analyses of this study also indicated that the percentage of undernourishment among HIV-positive adults is slightly higher in the Northern and Central parts of Ethiopia (27.5%) as compared to the Southern parts of Ethiopia (25%).

Conclusion

This study noted that undernutrition among HIV-positive adults in Ethiopia was quite common. This study also revealed that undernutrition is more common among HIV-positive adults with advanced disease stage, anemia, diarrhea, CD4 count less than 200 cells/mm³, and living in rural areas. Based on our findings, we suggested that all HIV-positive adults should be assessed for nutritional status at the time of ART commencement.

Prevalence of malnutrition and associated factors among adult patients on antiretroviral therapy follow-up care in Jimma Medical Center, Southwest Ethiopia

BACKGROUND

Malnutrition especially undernutrition is the main problem that is seen over people living with HIV/AIDS and can occur at any age. Multiple factors contributed to undernutrition of HIV/AIDS patients and it need immediate identification and prompt action. The objective of this study was to assess the nutritional status of patients and identify factors associated with undernutrition among HIV/AIDS patients on follow-up care in Jimma medical center, Southwest Ethiopia.

METHODS

A cross-sectional study design was conducted from March-April 2016. Data were collected retrospectively from clinical records of HIV/AIDS patients enrolled for follow up care in ART clinic from June 2010 to January 2016. Bivariate and multivariate logistic regression analysis were performed to identify independent predictor of undernutrition.

RESULTS

Data of 1062 patients were included in the study. The prevalence of undernutrition (BMI<18.5 kg/m2) and overweight or obesity were 34% and 9%, respectively. Out of undernourished patients, severely malnourished patients (BMI<16 kg/m2) accounted of 9%. Undernutrition was more likely among widowed patients (AOR = 1.7, 95% CI, 1.03-2.79), patients with no access to water supply (AOR = 1.69, 95% CI, 1.16-2.47) and patients in the WHO clinical stage of three (AOR = 2.0, 95% CI, 1.33-2.97) and four (AOR = 3.0, 95% CI, 1.74-5.07). Moreover, the odds of undernutrition was more likely among patients with CD4 cell count of <200 cells/mm3 (AOR = 2.0, 95% CI, 1.38-2.47) and patients with a functional status of bedridden (AOR = 3.6, 95% CI, 1.55-8.35) and ambulatory (AOR = 2.4, 95% CI, 1.66-3.51), respectively.

CONCLUSION

Both undernutrition and overweight or obesity were prevalent among HIV/AIDS patients in Jimma Medical Center, Ethiopia. Undernutrition was significantly associated with clinical outcome of patients. Hence, nutritional assessment, care and support should be strengthened. Critical identification of malnourished patients and prompt interventions should be undertaken.

Nutritional status of tuberculosis patients, a comparative cross-sectional study

Background

Each year, more than 13.7 million people became an active case of tuberculosis and more than 1.5 million cases of TB patient will die. The association between TB and malnutrition is bi-directional, TB leads the patient to malnutrition, and malnutrition increases the risk of developing active TB by 6 to 10 times. Improving the nutrition of individual greatly reduces tuberculosis. The aims of this study were to assess the nutritional status and determinants of underweight among TB patients.

Methods

A comparative cross-sectional study design was implemented. The sample size was calculated using 95% CI, 90% power, the prevalence of malnutrition in TB patients 50%,

TB patients to TB free resident ratio of 3, the design effect of 2 and a 5% non-response rate. Systematic random sampling was used to select TB patients and simple random sampling technique was used to select TB free residents. The data were collected from July 2015–May 2018. The data were collected by interviewing the patient, measuring anthropometric indicators and collecting the stool and blood samples. The data were entered into the computer using Epi-info software and analyzed using SPSS software. Descriptive statistics were used to find the proportion of malnutrition. Binary logistic regression was used to identify the determinants of malnutrition.

Results

A total of 5045 study participants (1681 TB patients and 3364 TB free residents) were included giving for the response rate of 93.1%. The prevalence of underweight among TB patients was 57.17% (95% CI: 54.80, − 59.54%) and 88.52% of TB patients were anemic. The prevalence of malnutrition (underweight) among TB free residents was 23.37% (95% CI: 21.93–24.80). The nutritional status of TB patients was determined by site of infection AOR: 0.68 [0.49–0.94], sex of the patient AOR: 0.39 [0.25–0.56], residence AOR: 3.84 [2.74–5.54], intestinal parasite infection AOR: 7 [5.2–9.95], problematic alcohol use AOR: 1.52 [1.17–2.13].

Conclusion

High proportions of TB patients were malnourished. TB patients were highly susceptible to malnutrition and even a very distal reason for malnutrition in the community became a proximal cause for TB patients.

Determinants of chronic energy deficiency among adults living with HIV in Shebel Berenta District, East Gojjam, Amhara region, North West Ethiopia, 2017: case control study

OBJECTIVE

To assess determinants of chronic energy deficiency in adults living with HIV in Shebel Berenta District Anti-Retroviral Therapy (ART) site health centers, East Gojjam, Amhara region, Ethiopia, 2017. An institutional based unmatched case control study design was employed and simple random sampling was used to select the desired sample size for both cases and controls. Data were entered to Epi-Data 3.1, exported to SPSS version 20 for analysis. Binary logistic regression was used to identify the determinants of chronic energy malnutrition among Human Immune Deficiency Virus positive adult patients.

RESULTS

A total of 473 (118 cases and 355 controls) People Living with Human Immune Deficiency Virus (PLHIV) adult patients were participated. PLHIV who started ART at world health organization (WHO) clinical stage I (AOR: 0.285, CI 0.10, 0.81), rural residents (AOR: 0.38, CI 0.17, 0.83), had family size ≤ 3 (AOR: 0.114, CI 0.03, 0.48) and changed their feeding style (AOR: 0.075, CI 0.038, 0.150) decreased the risk of chronic energy deficiency. However, the baseline CD4 cell < 200/mm3 (AOR: 13.398; CI 4.83, 37.19), monthly family income ≤ 500 Ethiopia Birr (AOR: 6.9, CI 1.07, 44.62) and interrupted treatment (AOR: 2.28, CI 1.02, 5.09) were increasing the risk of chronic energy deficiency. Therefore; the government and partners should focus on the above determinants to improve the nutritional status of the clients.

Determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a case-control study design

Background

A complex and negatively reinforcing relationship exists between infection with Human Immune Deficiency Virus (HIV) and malnutrition. HIV-induced immune impairment and its resulting opportunistic infections (OIs) can lead to malnutrition and nutritional deficits, can, in turn, hasten the progression of HIV infection and reduce chances of survival. The determinants of undernutrition among patients receiving antiretroviral therapy (ART) is poorly understood in Ethiopia, despite a high prevalence of food-insecurity that overlaps with a generalized HIV/AIDS epidemic. Therefore, this study aimed to assess determinants of undernutrition among adult patients receiving antiretroviral therapy at Debre Markos Referral Hospital in Northwest Ethiopia.

Methods

We conducted an institution-based, unmatched, case-control study with 636 adult patients receiving antiretroviral therapy. We randomly selected 212 patients with poor nutritional outcomes (cases) and 424 without undernutrition (controls) and then conducted a chart review to collect information on their treatment, socio-economic, and demographic background. Data were analyzed using bivariable and multivariable logistic regression to identify factors associated with under nutrition.

Results

We found that greater age (AOR = 1.02, 95% CI: 1.01,1.05), fair or poor adherence (AOR = 2.77, 95% CI: 1.40, 5.50 and AOR = 4.72, 95% CI: 1.92, 11.6), and the presence of OIs (AOR = 1.70, 95% CI: 1.12, 2.52), anemia (AOR = 1.81, 95% CI: 1.07, 3.07), or eating problems (AOR = 3.40, 95% CI: 2.27, 5.10), were all independently and positively associated with under nutrition. Starting treatment with a medium or low CD4 count was protective (AOR = 0.61, 95% CI: 0.39, 0.96 and AOR = 0.49, 95% CI: 0.27, 0.88). Having social support (AOR = 0.64, 95% CI: 0.43, 0.95), and having a source of informal care-giving (AOR = 0.48, 95% CI: 0.27, 0.84), reduced the odds of undernutrition.

Conclusion

Our findings support calls for treating HIV infection early and aggressively, while closely monitoring patients for opportunistic infections that might affect eating and drug side effects that may affect appetite. The role of disclosure, peer-caregivers and age in preventing undernutrition should be explored in future research.

Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis

Background

Anemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level.

Methods

Studies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively.

Result

A total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/μl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M² with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors.

Conclusion

This review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.

Food Insecurity, Nutritional Status, and Factors Associated with Malnutrition among People Living with HIV/AIDS Attending Antiretroviral Therapy at Public Health Facilities in West Shewa Zone, Central Ethiopia

BACKGROUND

In resource limited settings, HIV/AIDS patients lack access to sufficient nutritious foods, which poses challenges to the success of antiretroviral therapy. HIV/AIDS and malnutrition are still major public health problems in Ethiopia. Though measuring nutritional status is an essential part of ART program, little evidence exists on food insecurity and nutritional status of HIV/AIDS patients in Ethiopia. Hence, the study aimed to determine food insecurity and nutritional status and contextual determinants of malnutrition among HIV/AIDS patients in West Shewa Zone, Ethiopia.

METHODS

Institution-based cross-sectional study was conducted among HIV/ADIS patients who have been attending antiretroviral therapy at public health facilities in West Shewa Zone from April to May 2016, Ethiopia. The sample size was 512 and study participants were selected from each facilities using systematic random sampling method. Data were collected using pretested questionnaire by trained data collectors. Data were entered to Epi-Info 3.5.1 for Windows and analyzed using SPSS version 22. Logistic regression analyses were conducted to determine independent factors associated with malnutrition.

RESULTS

Prevalence of malnutrition was 23.6% (95% CI: 19.7%-27.4%) and prevalence of household food insecurity was 35.2% (95% CI: 31.1%-39.0%). Factors significantly associated with malnutrition among HIV/AIDS patients were unemployment (AOR = 3.4; 95% CI: 1.8-5.3), WHO clinical stages III/IV (AOR = 3.3; 95% CI: 1.8-6.5), CD4 count less than 350 cells/μl (AOR = 2.0; 95% CI: 1.8-4.2), tuberculosis (AOR = 2.3; 95% CI: 1.3-4.9), duration on antiretroviral therapy (AOR = 1.8; 95% CI: 1.2-2.9), and household food insecurity (AOR = 5.3; 95% CI: 2.5-8.3).

CONCLUSIONS

The findings revealed high prevalence of malnutrition and household food insecurity among HIV/AIDS patients attended ART. The negative interactive effects of undernutrition, inadequate food consumption, and HIV infection demand effective cross-sectorial integrated programs and effective management of opportunistic infections like tuberculosis.

Mortality from adverse drug reaction-related hospitalizations in south-west Ethiopia: A cross-sectional study

WHAT IS KNOWN AND OBJECTIVE

Adverse drug reactions (ADRs) are an important cause of mortality during medical care. To our knowledge, no Ethiopian studies have reported on mortality due to ADRs in patients presenting to hospital from the community setting. The aim of this study was to determine the mortality rate attributable to ADRs in patients presenting to hospital, identify drugs implicated in the ADR-related deaths and identify factors contributing to ADR-related mortality at Jimma University Specialised Hospital (JUSH), south-west Ethiopia METHODS: This cross-sectional study included 1001 patients aged ≥18 years consecutively admitted to medical wards from May 2015 to August 2016. ADR-related mortality was determined through detailed review of medical records, laboratory tests and patient interviews followed by causality assessment by the Naranjo algorithm and expert consensus.

RESULTS

Of 1001 patients, 15, 1.5% (95% confidence interval [CI]: 0.80%-2.30%) died with an ADR. The primary suspected causes of death were drug-induced hepatotoxicity (7, 43.8%) followed by acute kidney injury (4, 25.0%). Isoniazid (6, 33.3%), pyrazinamide (3, 16.7%), efavirenz (2, 11.1%) and tenofovir (2, 11.1%) were commonly implicated drugs. The majority of ADRs (14, 93.8%) were preventable. Unadjusted bivariate comparisons suggested patients who died with ADRs were more likely to have pre-existing liver disease (40.0% vs 7.0%; 95% confidence interval [CI]: 8.1%-57.8%), a history of ADRs (40% vs 1.4%; 95% CI: 13.8%-63.4%), a lower mean (±SD) body mass index (BMI, 17.6 ± 2.1 vs 20.0 ± 2.9 kg/m² ; 95% CI = 0.9-3.9), exposure to antitubercular (46.7% vs 18.9%; 95% CI: 2.3%-53.1%) and antiretroviral (40.0% vs 7.7%; 95% CI: 7.5%-57.2%) therapies, and a higher mean number of medications (7.1 ± 3.3 vs 3.8 ± 2.1; 95% CI: 2.2-4.4) and Charlson Comorbidity Index (3.9 ± 2.9 vs 1.6 ± 1.8; 95% CI: 1.4-3.2) than surviving patients without ADRs.

WHAT IS NEW AND CONCLUSION

Fatal ADRs were common in patients presenting to hospital. The drugs implicated were mostly antitubercular and antiretroviral therapies, reflecting the high burden of HIV and tuberculosis in the study population. ADR-related deaths were significantly associated with poor nutritional status. The majority of ADR-related deaths were preventable, highlighting the need to develop a multidisciplinary approach to closely monitor patients who are prescribed antitubercular and antiretroviral therapies, particularly in patients with hepatic disease, a history of ADRs, who are malnourished and who are exposed to multiple medications.

Predictors of adverse drug reaction-related hospitalisation in Southwest Ethiopia: A prospective cross-sectional study

BACKGROUND

Adverse drug reactions (ADRs) are important causes of morbidity and mortality in the healthcare system; however, there are no studies reporting on the magnitude and risk factors associated with ADR-related hospitalisation in Ethiopia.

OBJECTIVES

To characterise the reaction types and the drugs implicated in admission to Jimma University Specialized Hospital, Southwest Ethiopia, and to identify risk factors associated with ADR-related hospitalisation.

METHODS

A prospective cross-sectional study was conducted from May 2015 to August 2016 among consenting patients aged ≥18 years consecutively admitted to medical wards taking at least one medication prior to admission. ADR-related hospitalisations were determined through expert review of medical records, laboratory tests, patient interviews and physical observation. ADR causality was assessed by the Naranjo algorithm followed by consensus review with internal medicine specialist. ADR preventability was assessed using Schumock and Thornton's criteria. Only definite and probable ADRs that provoked hospitalisation were considered. Binary logistic regression was used to identify independent predictors of ADR-related hospitalisation.

RESULTS

Of 1,001 patients, 103 (10.3%) had ADR-related admissions. Common ADRs responsible for hospitalisation were hepatotoxicity (35, 29.4%) and acute kidney injury (27, 22.7%). The drug classes most frequently implicated were antitubercular agents (45, 25.0%) followed by antivirals (22, 12.2%) and diuretics (19, 10.6%). Independent predictors of ADR-related hospitalisation were body mass index (BMI) <18.5 kg/m2 (adjusted odd ratio [AOR] = 1.69; 95% confidence interval [CI] = 1.10-2.62; p = 0.047), pre-existing renal disease (AOR = 2.84; 95%CI = 1.38-5.85, p = 0.004), pre-existing liver disease (AOR = 2.61; 95%CI = 1.38-4.96; p = 0.003), number of comorbidities ≥4 (AOR = 2.09; 95%CI = 1.27-3.44; p = 0.004), number of drugs ≥6 (AOR = 2.02; 95%CI = 1.26-3.25; p = 0.004) and history of previous ADRs (AOR = 24.27; 95%CI = 11.29-52.17; p<0.001). Most ADRs (106, 89.1%) were preventable.

CONCLUSIONS

ADRs were a common cause of hospitalisation. The majority of ADRs were preventable, highlighting the need for monitoring and review of patients with lower BMI, ADR history, renal and liver diseases, multiple comorbidities and medications. ADR predictors should be integrated into clinical pathways and pharmacovigilance systems.

Intestinal parasitic infections and its association with undernutrition and CD4 T cell levels among HIV/AIDS patients on HAART in Butajira, Ethiopia

BACKGROUND

Intestinal parasitic infections and HIV/AIDS have been the major public health problems and remain a vital cause of morbidity and mortality in developing countries. Both problems are linked in a vicious cycle. The magnitude of intestinal parasites was prevalent among people living with HIV/AIDS even in the HAART era. However, the pertinent risk factors associated with intestinal parasites among HIV/AIDS patients were not well investigated in Ethiopia particularly at Butajira town. Therefore, the aim of this study was to determine the prevalence of intestinal parasites and associated risk factors among HIV/AIDS patients on HAART in Butajira, Ethiopia.

METHOD

A cross-sectional study was conducted, and a total of 323 study subjects was involved in the study. A systematic random sampling technique was used to select each participant during data collection. Stool specimen was collected and processed using direct wet mount, formol-ether concentration technique, and modified Ziehl-Neelson staining techniques to identify both common and opportunistic intestinal parasites. Structured questionnaire was used to collect socio-demographic, environmental, clinical, and nutritional data. Both bivariate and multivariate logistic regression analyses were used to assess the association of various explanatory factors on intestinal parasites. P value ≤0.05 at 95% CI was considered statistically significant.

RESULTS

The overall prevalence of intestinal parasites was 35.9% (95% CI 31.0-40.9%). Protozoa's (Entanmoeba histolytica/dispar trophozoite, E. histolytica/dispar cyst, Giardia lamblia trophozoite, and G. lamblia cyst), helminths (Tanea species, Ascaris lumbricoides, Strongyloid stercoralis, Hookworm species and H. nana), and opportunistic intestinal parasites (Cryptosporidium parvum, Isospora belli) were observed in 57 (17.1%), 46 (14.4%), and 28 (8.7%) study participants respectively. Multivariate logistic regression analysis revealed that the presence of animals (AOR 6. 14; 95% CI 3.13, 12.0); using river water (AOR 4.87; 95% CI 1.14, 20.7); undernutrition (AOR 2.59; 95% CI 1.36-4.95); and level of immunosuppression (AOR 4.02; 95% CI 1.78-9.05 and AOR 2.84; 95% CI 1.37-5.89) were significantly associated with intestinal parasites.

CONCLUSIONS

The prevalence of intestinal parasites found to be higher among HIV/AIDS patients receiving HAART at Butajira Hospital, southern Ethiopia. Presence of animals, using river water, lower CD4 T cell count, and undernutrition were significant factors affecting intestinal parasites. Therefore, consistent detection of intestinal parasites and deworming of patients should be performed as well as improving health education on personal hygiene, avoiding contact with pit or domestic animals, and using safe or treated water. Furthermore, improving nutritional support and household food access are recommended.

The Interaction between HIV and Intestinal Helminth Parasites Coinfection with Nutrition among Adults in KwaZulu-Natal, South Africa

In South Africa few studies have examined the effects of the overlap of HIV and helminth infections on nutritional status. This cross-sectional study investigated the interaction between HIV and intestinal helminths coinfection with nutritional status among KwaZulu-Natal adults. Participants were recruited from a comprehensive primary health care clinic and stratified based on their HIV, stool parasitology, IgE, and IgG4 results into four groups: the uninfected, HIV infected, helminth infected, and HIV-helminth coinfected groups. The nutritional status was assessed using body mass index, 24-hour food recall, micro-, and macronutrient biochemical markers. Univariate and multivariate multinomial probit regression models were used to assess nutritional factors associated with singly and dually infected groups using the uninfected group as a reference category. Biochemically, the HIV-helminth coinfected group was associated with a significantly higher total protein, higher percentage of transferrin saturation, and significantly lower ferritin. There was no significant association between single or dual infections with HIV and helminths with micro- and macronutrient deficiency; however general obesity and low micronutrient intake patterns, which may indicate a general predisposition to micronutrient and protein-energy deficiency, were observed and may need further investigations.

Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia

BACKGROUND

Malnutrition hastens progression to Acquired Human Immunodeficiency Syndromes (AIDS) related illnesses; undermines adherence and response to antiretroviral therapy (ART) in resource-poor settings. However, nutritional status of people living with HIV (PLHIV) can be affected by various psychosocial factors which have not been well explored in Ethiopia. Therefore, the objective of this study was to determine psychosocial correlates of nutritional status among people living with HIV (PLHIV) on ART in Central zone of Tigray, Northern Ethiopia.

METHODS

A matched case-control study design was conducted to assess psychosocial correlates of nutritional status among PLHIV on ART. Data were collected by an interviewer-administered technique using structured pre-tested questionnaire, record review using a checklist and anthropometric measurements. Cases were selected by simple random sampling and controls purposively to match the selected cases. Conditional logistic regression was used to compute relevant associations by STATA version 12.

RESULTS

The psychosocial factors independently associated with malnutrition were ever consuming alcohol after starting ART [AOR = 4.7, 95% CI: 1.8-12.3], ever smoking cigarette after starting ART [AOR = 7.6, 95% CI: 2.3-25.5], depression [AOR = 2.8, 95% CI: 1.3, 6.1], not adhering to ART [AOR = 6.8,95% CI: 2.0-23.0] and being in the second lowest wealth quintile [AOR = 4.3,95% CI: 1.1-17.7].

CONCLUSION

Ever consuming alcohol and ever smoking cigarette after starting ART, depression, not adhering to ART and being in the second lowest wealth quintile were significantly associated with malnutrition. Therefore; policies, strategies, and programs targeting people living with HIV should consider psychosocial factors that can impact nutritional status of people living with HIV enrolled on ART.

Weight status and associated factors among HIV infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa

BACKGROUND

Underweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD).

AIM

The study determined weight status and associated factors in people with HIV infection receiving ART.

SETTING

Rural primary health care clinics in Dikgale, Limpopo province, South Africa.

METHODS

A cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m2). Data on ART duration were extracted from patients' files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques.

RESULTS

Of the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, p = 0.001) and male gender (OR: 0.29, p = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, p = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis.

CONCLUSION

A high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.

Undernutrition and associated factors among adults living with Human Immune Deficiency Virus in Dembia District, northwest Ethiopia: an institution based cross-sectional study

Background

Appropriate dietary intake determines the disease progression and success of Anti-Retroviral Therapy (ART). Undernutrition unacceptably increases the risk of mortality among adults living with Human Immune Deficiency Virus (HIV). However in resource limited settings including Ethiopia, many of HIV positive clients lack access to sufficient quantities of nutritious food. There is limited evidences showing the magnitude of undernutrition in this segment of the community, particularly in the rural residents. Therefore, this study aimed to assess undernutrition and associated factors among HIV positive adults attending ART clinic in Dembia District.

Methods

An institution based cross-sectional study was conducted in Dembia District from October 1 to 30, 2015. Systematic random sampling technique was used to recruit the study subjects. The anthropometric measurement, Body Mass Index, was computed to determine the nutritional status of the study participants. In order to identify factors associated with undernutrition a multivariable logistic regression analysis was employed. The Adjusted Odds Ratio (AOR) with 95 % Confidence Interval (CI) was calculated to show the strength of association. In multivariable analysis, variables with a P-value of <0.05 were considered as statistically significant.

Results

Of the study participants, about 23.2 % [95 % CI: 19.2, 27.2 %] were undernourished in Dembia District. The result of adjusted analysis revealed that, the odds of undernutrition was higher among adults whose age ranged between 18-29 years [AOR = 2.50, 95 % CI: 1.10, 5.69], who had a Cluster of Differentiation (CD)4 count less than 200 cells/mm³ [AOR = 6.21, 95 % CI: 2.97, 12.98), were widowed [AOR = 2.18, 95 % CI: 1.08,4.40), and anemic [AOR = 3.17, 95 % CI: 1.70, 5.92].

Conclusions

The prevalence of undernutrition among HIV positive adults was higher in the study area. Furthermore, being in the age range of 18-29 years, widowed, anemic, and having a CD4 count of less than 200 cells/mm³ were positively associated with undernutrition. Therefore, efforts should be strengthened to mitigate the higher burden of undernutrition by considering the identified determinants.