Health & nutritional status of HIV infected children in Hyderabad, India

Stunting and its associated factors among children living with HIV/AIDS: a cross-sectional study

Background

Growth failure is a common feature of children living with HIV/AIDS. This study was intended to assess the level of stunting and its associated factors among children living with HIV/AIDS.

Methods

An institution-based cross-sectional study was conducted among 218 children living with HIV/AIDS. An interviewer-administered data collection tools and anthropometric measurements were used to collect data. Bivariable and multivariable logistic regression analyses were used to identify independent variables. Adjusted odds ratio with a 95% CI at a P value of 0.05, which was considered to declare statistical significance.

Result

The level of stunting among children infected with HIV/AIDS in selected northwest comprehensive specialized hospitals in western Amhara was 56.9%. Poor anti-retroviral therapy (ART) adherence [adjusted odds ratio (AOR)=6.15, 95% CI, (3.88-9.69)], lack of co-trimoxazole prophylaxis [AOR=2.0, 95% CI, (1.88-2.98)], opportunistic infection [AOR=4.66, 95% CI, (3.24-6.11), and feeding twice [AOR=3.88, 95% CI, (1.94-5.14)] and feeding three times [AOR=1.52, 95% CI, (1.23-3.89)] were significantly associated with stunting.

Conclusion

Stunting among HIV/AIDS-infected children was very high. Poor ART adherence, lack of co-trimoxazole prophylaxis, opportunistic infection, and low feeding frequency were significantly associated to stunting among HIV/AIDS-infected children. Strategies need to be devised to address factors amenable to modification to improve the growth of children living with HIV/AIDS.

Health-Related Physical Fitness Evaluation in HIV-Diagnosed Children and Adolescents: A Scoping Review

BACKGROUND

Health-related physical fitness has been widely used to investigate the adverse effects of HIV infection/ART in children and adolescents. However, methods/protocols and cut-points applied for investigating health-related physical fitness are not clear. The aim of this scoping review was to map the literature to identify gaps in knowledge regarding the methods/protocols and cut-points.

METHODS

A scoping review, following the Joana Briggs Institute (JBI) guidelines, was conducted through ten major databases. Search followed the PCC strategy to construct block of terms related to population (children and adolescents), concept (health-related physical fitness components) and context (HIV infection).

RESULTS

The search resulted in 7545 studies. After duplicate removal, titles and abstracts reading and full text assessment, 246 studies were included in the scoping review. Body composition was the most investigated component (n = 244), followed by muscular strength/endurance (n = 23), cardiorespiratory fitness (n = 15) and flexibility (n = 4). The World Health Organization growth curves, and nationals' surveys were the most reference values applied to classify body composition (n = 149), followed by internal cut-points (n = 30) and cut-points developed through small populations (n = 16). Cardiorespiratory fitness was classified through cut-points from three different assessment batteries, as well as cut-points developed through studies with small populations, muscular strength/endurance and flexibility were classified through the same cut-points from five different assessment batteries.

CONCLUSIONS

The research on muscular strength/endurance, cardiorespiratory fitness and flexibility has been scarcely explored. The lack of studies that investigated method usability as well as reference values was evidenced.

Malnutrition in HIV infected children on antiretroviral drugs in a cohort of Ghanaian children

Background

HIV infected children are at increased risk of malnutrition which worsens the depressed immune system, leading to poor disease prognosis.

Aim

To assess the nutritional status of children between 6-12 years on antiretroviral drugs (ARV) at two health facilities in Accra.

Methods

The study design was cross sectional among children between 6 and 12 years being administered with antiretroviral drugs at two hospitals in Accra. A purposive sample of 100 children was used. Height and weight measurements were taken and used to compute z-scores for stunting, underweight and wasting. Haemoglobin status was obtained from their folders. A semi-structured questionnaire was used to obtain sociodemographic data and a 24-hour dietary intake used to assess nutrient intakes. Data was analyzed using IBM SPSS version 20.0. Nutrient analysis was done using Micro diet version 3.0. Data was summarized using means and percentages. Chi-squared test was used to test for associations and statistical significance set at p < 0.05.

Results

The prevalence of stunting, underweight and wasting was reported as 28%, 16% and 13% respectively. Girls were more stunted and wasted compared to boys. Mean haemoglobin concentration was 10.12 ± 2.77 g/dl. Mild, moderate and severe anaemia were reported in 14.2%, 41.1% and 12.5% of the children respectively. Apart from carbohydrates, less than 50% of the children were able to meet their requirements for the other nutrients”.

Conclusions

Our findings reveal high level of malnutrition among the children receiving ARV. There is the need for targeted nutrition interventions to improve the nutritional status of the 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.

The Effect of Community-Based Nutritional Interventions on Children of Women Living With Human Immunodeficiency Virus in Rural India: A 2 × 2 Factorial Intervention Trial

BACKGROUND

Malnutrition is a common clinical concern among children in low-income communities affected by human immunodeficiency virus (HIV). We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India.

METHODS

We assigned women living with HIV and their child (oldest 3-8 years) to 1 of 4 programs: (1) community-based HIV care program, (2) program 1 + nutrition education, (3) program 1 + food supplement, and (4) all elements of programs 1-3. Study data were collected at baseline and months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4+ T-cell counts (children with HIV only).

RESULTS

Overall, 600 mother-child pairs were enrolled (150/group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in program 4 had higher weight gain than those in programs 1, 2, and 3 at all time points (adjusted P < .001). We found a higher increase in CD4+ T cells across all time points among participants in programs 3 and 4 compared with program 1 (adjusted P < .001). Factorial analysis suggested a synergistic effect of combining nutrition education and food supplements for weight gain but not for increase in CD4+ T cells.

CONCLUSIONS

A combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4+ T cells, and such interventions can be integrated into HIV-care programs in low-income settings.

Undernutrition Among HIV-Positive Adolescents on Antiretroviral Therapy in Southern Ethiopia

Purpose

Adolescents living with HIV are vulnerable to undernutrition secondary to elevated nutritional needs imposed by growth spurt and HIV-infection. Yet, in low-income countries, evidence on the epidemiology of undernutrition among adolescents living with HIV is scarce. We assessed the prevalence and predictors of stunting and thinness among adolescents receiving anti-retroviral therapy (ART) in Hawassa city, Southern Ethiopia.

Methods

In this facility-based cross-sectional study, we enrolled 260 adolescents (10–19 years of age) living with HIV on ART in two public hospitals and three health centers. Anthropometric measurements, household food insecurity and dietary diversity were measured following standard approaches. Predictors of stunting and thinness were identified using multivariable logistic regression analyses and interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI).

Results

One-third of the adolescents were stunted, and 20% were thin. The prevalence of severe stunting (7.7%) and severe thinness (7.3%) was also high. Significant proportions of the adolescents (38.5%) were from food insecure households, and 28.1% had low or medium dietary diversity. Significant predictors of stunting were lack of food or financial support (AOR=2.71; 95% CI: 1.36–5.39); meal skipping (AOR=2.13; 95% CI: 1.16–3.91); recent history of opportunistic infections (AOR=2.25; 95% CI: 1.11–4.55) and disclosure of HIV status to the adolescent (AOR=1.88; 95% CI: 1.12–4.34). History of opportunistic infection was the only significant predictor of thinness (AOR=3.21; 95% CI: 1.54–6.73).

Conclusion

The burden of undernutrition among adolescents living with HIV is disturbingly high. Prevention of opportunistic infections promoting social support and discouraging practice of meal skipping may help to reduce the problem.

An assessment of the nutritional status of ART receiving HIV-orphaned and vulnerable children in South-West Nigeria

Introduction

Good nutritional status is pertinent to the optimal outcome of effective ART among children. Against this backdrop, the objective of the current study is to assess the nutritional indices of children receiving ART in South-West Nigeria.

Methods

The study was cross-sectional in design. We randomly selected three urban and six rural ART sites from the ones offering ART services in Oyo state. All consented children receiving ART treatments in the aforementioned sites participated in the study. A total of 390 HIV-positive children and adolescents aged 6–18 years were interviewed using a semi-structured interviewer-administered questionnaire. Children were assessed and growth curves were constructed using the 2007 World Health Organisation (WHO) growth reference standard for children as well as adolescents. Data were presented using descriptive statistics.

Results

About 52% of the children are male, 136 (34.9%) have lost at least one parent, 52 (13.3%) have lost either parent to HIV/AIDS. Among the males, 19%, 27%, and 27% were underweight, stunted and thin, respectively when compared with 17%, 23% and 23%, respectively, among females. The male and female weight-for-age average z-score were (-0.98 vs -1.04), height-for-age (-1.12 vs -1.07), and BMI-for-age (-1.19 vs -1.18). Irrespective of age, sex, parental survival, and residence, weight-for-age and BMI-for-age analysis revealed substantial underweight, with the worst outcomes being among those orphaned by HIV/AIDS.

Conclusion

All nutritional indices considered in this study fell short of the WHO standard. HIV positive children in the ART sites included in this study are faced with a high burden of undernourishment despite been placed on daily ART regimens. In addition to efficient ART, interventions to ameliorate poor nutritional status is needed.

Clinico-Epidemiological Profile of Children Orphaned due to AIDS Residing in Care Giving Institutions in Coastal South India

Background

HIV/AIDS has a greater impact on children. Besides being orphaned by the untimely demise of one or both parents due to the disease, these children are more prone for discrimination by the society.

Methods

In this cross-sectional study 86 children orphaned by AIDS residing in care giving institutions for HIV positive children in Mangalore were assessed for their clinico-epidemiological profile and nutritional status. Institutional Ethics Committee clearance was obtained before the commencement of the study. The collected data were analyzed using SPSS (Statistical Package for Social Sciences) version 11.5 and the results expressed in mean (standard deviation) and proportions. BMI was calculated and nutritional status assessed using WHO Z scores (BMI for Age) for children between 5 and 19 years separately for boys and girls.

Results

The mean age of the children was 13.2 ± 3 years. Majority (n = 56, 65.1%) of the children were double orphans. Most of the children orphaned by AIDS (n = 78, 90.7%) had a history of both the parents being HIV positive. The median CD4 count of participants at the time of our study was 853.5 (IQR 552–1092) cells/microliter. A higher percentage of orphans were malnourished compared to nonorphans. (41.1% vs. 36.7%). All the educational institutions, wherein the children orphaned by AIDS were enrolled, were aware about their HIV status. Five of the participants felt discriminated in their schools. Only two of the participants felt discriminated by their friends because of their HIV status.

Conclusion

From our study we draw conclusion that even though the children orphaned due to AIDS are rehabilitated in terms of having shelter and provision of education and health care, much needs to be done in terms of improving the nutritional status of these children and alleviating the discriminatory attitude of the society towards them.

Morbidity profile of orphan children in Southern India

Background:

Orphan children globally and in India are increasing. Magnitude of their health problems is unknown. The present study was carried out to assess the morbidity pattern of orphan children aged 10–16 years, assess their knowledge about signs and symptoms of common childhood morbidities and treatment-seeking practices.

Methods:

One hundred institutionalized orphan children aged 10–16 years were studied for 6 months. Data was collected by trained investigators regarding sociodemographic background, awareness about common morbidities and treatment seeking practices. Thorough clinical examination and anthropometric measurements were done. Distribution of morbidities was shown.

Results:

80% of the boys and 68% of the girls had low BMI. 78% suffered from multiple morbidities of which 76% had infections of skin and appendages while 74% had ear problems. 26% had diarrhea and 21% had B-complex deficiency. The mean duration of all diseases was 7±1.1 days. Awareness about diseases and their complications was low; and self-care was highly prevalent for most health problems.

Conclusions:

Orphan children in South India suffer from many morbidities about which their awareness and treatment seeking is low.

Dietary patterns and nutritional status of HIV-infected children and adolescents in El Salvador: A cross-sectional study

Introduction

The present study aimed to assess the nutritional status, the dietary patterns and its associated factors in the HIV-infected population of children and adolescents on antiretroviral treatment at the El Salvador reference center for pediatric HIV care (CENID).

Methods

A cross-sectional survey was carried out between December 2010 and December 2011. Socio-demographic and clinical characteristics were collected from 307 children and adolescents aged 2–18 years and receiving antiretroviral therapy. Nutritional status was assessed by height-for-age, weight-for-height and body mass index-for-age. Dietary data was collected through a 24 hour recall, and through a weekly food frequency questionnaire. Dietary patterns were identified by principal component analysis. Bivariate and multivariable statistical methods were used to assess the factors associated with “high adherence” to the “healthy diet” pattern.

Results

More than a third of the study group (33.2%) were stunted, 3.3% were identified as being wasted, and 10% were overweight or obese. Their diets were predominantly based on a high consumption of cereals, beans, eggs and processed foods and a low consumption of fruits, vegetables and dairy products. Three dietary patterns were identified: “healthy diet”, “high fat/sugar diet” and “low diversity diet”. Being female (OR: 1.63; 95%CI: 0.97–2.75), younger (OR: 2.37; 95%CI: 1.28–4.36) and institutionalized (OR: 14.5; 95%CI: 5.35–39.50) increased the odds to adhere to the “healthy diet” pattern.

Conclusion

Our findings reveal a high prevalence of stunting and overweight in HIV-infected children in El Salvador. Institutionalized children were more likely to adhere to a healthy dietary pattern whereas children in poverty were more likely to have less varied and healthy diets. These results highlight the need to assess the dietary patterns of HIV-infected children and adolescents in order to guide public policies to design healthy life style interventions for this population at risk.

High Prevalence of Lipid Abnormalities and Insulin Resistance Among Antiretroviral Naïve HIV-infected Children in India

BACKGROUND

As large numbers of children are accessing antiretroviral therapy (ART) in India, we evaluated the dietary intake, growth pattern and risk of metabolic complications like dyslipidemia and insulin resistance among ART-naïve HIV-infected children (CLHIV).

METHODS

CLHIV 2-12 years of age, at the time of initiating ART in Chennai and Bangalore, were assessed for their dietary intake, anthropometry, blood CD4 cell count, HIV-1 viral load, fasting serum lipids, glucose and insulin. Homeostatic model assessment-insulin resistance was derived.

RESULTS

Three hundred and ninety CLHIV (mean age [SD]: 8 [3] yrs; median viral load: 141,000 [25,876-436,000] copies/mL) were started on non-nucleoside reverse transcriptase inhibitor-based ART. Perinatal infection was documented among 97%. Sixty percent of children were in stage 3 or 4 of World Health Organization clinical staging of HIV/AIDS. Food insecurity was seen in 40% of households. A total of 204 children (52.4%) were stunted and 224 (57.6%) were underweight. Stunting seemed to be more prevalent with increasing age (0-4 years: 48%; >9 years: 60%). Mean intakes of calories, iron, folate and calcium were significantly less than recommended dietary allowances across all age groups. Dyslipidemia, in terms of any abnormal triglycerides or total cholesterol or low-density lipoprotein cholesterol (excluding high-density lipoprotein cholesterol), was seen in approximately 40% of children; insulin resistance in 17%; and C-reactive protein in risk range of metabolic syndrome in 24% of children.

CONCLUSIONS

In the background of high food insecurity and malnutrition, cardiometabolic abnormalities were seen in 20%-35% of ART-naïve CLHIV in India emphasizing close monitoring of these children for long-term cardiovascular morbidities after initiation of ART.

Malnutrition is associated with HIV infection in children less than 5 years in Bobo-Dioulasso City, Burkina Faso: A case-control study

Pediatric human immunodeficiency virus (HIV) infection and malnutrition are still 2 major health issues in sub-Saharan Africa including Burkina Faso where few studies have been conducted on child malnutrition and HIV infection. This study assessed the effects of antiretroviral therapy (ART) in HIV infection and also compared the prevalence of malnutrition in terms of an inadequate diet, underweight, stunting, and wasting among HIV-infected and uninfected children less than 5 years in Bobo-Dioulasso city, Burkina Faso.This was a case-control study matching for age and sex in 164 HIV-infected and 164 HIV-uninfected children. The sociodemographic characteristics of mothers and children, household food security, drinking water source, child feeding and care practices, and child anthropometric data such as body weight, height, and mid-upper arm circumference were collected.The prevalence of food insecurity and inadequate diet was 58% and 92% of children less than 5 years of age, respectively. The prevalence of underweight, stunting, and wasting was 77% versus 35%, 65% versus 61%, and 63% versus 26% in HIV-infected and uninfected children less than 5 years of age, respectively. Out of 164 HIV-infected children, 59% were on ART initiation during data collection and the median of CD4 cell counts was 1078 cells/μL. HIV-infected children on ART had greater CD4 cell counts (P = .04) and higher weight-for-age Z (P = .01) and weight-for-height Z scores (P = .03) than those without ART. HIV infection was a risk factor for those who had inadequate dietary intake [adjusted odds ratio (AOR) = 2.17, 95% confidence interval (CI) 1.17-3.62, P = .04]. In addition, HIV-infected children were more likely of being underweight (AOR = 10.24, 95% CI 4.34-24.17, P < 0.001) and wasting (AOR = 5.57, 95% CI 2.49-12.46, P < 0.001) than HIV-uninfected children less than 5 years of age.High prevalence of malnutrition was observed in HIV-infected children compared with HIV-uninfected children. Except for ART, nutritional assessment and support should be included in pediatric HIV management.