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

Abstract

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.

Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study

“…One study from South Africa showed a prevalence of 13% in mixed urban, semi-urban, and rural areas [ 32 ]. A recent meta-analysis from sub-Saharan Africa showed a pooled prevalence of undernutrition of 24% with studies originating mostly from Ethiopia [ 33 ]. Partly, this might be explained by the fact that 49% of patients had a WHO stage 3/4 and 49% had a CD4 cell count <200 cells/mm 3 , both factors associated with undernutrition [ 33 ].…”

Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift

“…[ 26 ] Undernutrition studies conducted in Tanzania and Ethiopia among PLWHA reported high levels of nutritional insufficiencies (27.7% and 26%, respectively) in PLWHA. [ 27 , 28 ] Recently, Seid et al [ 29 ] in their meta-analysis review of the prevalence of undernutrition and associated factors among HIV-infected adults taking ART in sub-Saharan Africa reported 23.74%. These figures are relatively high and of serious health concern, given that undernutrition escalates the likelihood of developing opportunistic infections and increased mortality and morbidity.…”

“…These figures are relatively high and of serious health concern, given that undernutrition escalates the likelihood of developing opportunistic infections and increased mortality and morbidity. [ 25 ] According to Seid et al, [ 29 ] reduced CD4 + counts, male gender, advanced disease stage, younger age, delayed initiation of ART, and nonadherence to ART escalate the risk of undernutrition in PLWHA.…”

Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis

“…Compared to healthy individuals, adult HIV/AIDS-positive patients require 10% more energy consumption when asymptomatic, 20–30% more when symptomatic, and 30% more when recovering 4 , 6 . In this context, in Sub-Saharan African (SSA) countries, nearly one-fourth (23.7%) of peoples living with HIV/AIDS are undernourished 11 . Similarly, the pooled prevalence of under nutrition among HIV-positive adults in Ethiopia is estimated to be 26% 12 , with a wide variation across regions.…”