Undernutrition among HIV-positive children in Dar es Salaam, Tanzania: antiretroviral therapy alone is not enough

Abstract

BackgroundThe prevalence of HIV/AIDS has exacerbated the impact of childhood undernutrition in many developing countries, including Tanzania. Even with the provision of antiretroviral therapy, undernutrition among HIV-positive children remains a serious problem. Most studies to examine risk factors for undernutrition have been limited to the general population and ART-naive HIV-positive children, making it difficult to generalize findings to ART-treated HIV-positive children. The objectives of this study were thus to compare the proportions of undernutrition among ART-treated HIV-positive and HIV-negative children and to examine factors associated with undernutrition among ART-treated HIV-positive children in Dar es Salaam, Tanzania.MethodsFrom September to October 2010, we conducted a cross-sectional survey among 213 ART-treated HIV-positive and 202 HIV-negative children in Dar es Salaam, Tanzania. We measured the children's anthropometrics, socio-demographic factors, food security, dietary habits, diarrhea episodes, economic status, and HIV clinical stage. Data were analyzed using both univariate and multivariate methods.ResultsART-treated HIV-positive children had higher rates of undernutrition than their HIV-negative counterparts. Among the ART-treated HIV-positive children, 78 (36.6%) were stunted, 47 (22.1%) were underweight, and 29 (13.6%) were wasted. Households of ART-treated HIV-positive children exhibited lower economic status, lower levels of education, and higher percentages of unmarried caregivers with higher unemployment rates. Food insecurity was prevalent in over half of ART-treated HIV-positive children's households. Furthermore, ART-treated HIV-positive children were more likely to be orphaned, to be fed less frequently, and to have lower body weight at birth compared to HIV-negative children.In the multivariate analysis, child's HIV-positive status was associated with being underweight (AOR = 4.61, 95% CI 1.38-15.36 P = 0.013) and wasting (AOR = 9.62, 95% CI 1.72-54.02, P = 0.010) but not with stunting (AOR = 0.68, 95% CI 0.26-1.77, P = 0.428). Important factors associated with underweight status among ART-treated HIV-positive children included hunger (AOR = 9.90, P = 0.022), feeding frequency (AOR = 0.02, p < 0.001), and low birth weight (AOR = 5.13, P = 0.039). Factors associated with wasting among ART-treated HIV-positive children were diarrhea (AOR = 22.49, P = 0.001) and feeding frequency (AOR = 0.03, p < 0.001).ConclusionHIV/AIDS is associated with an increased burden of child underweight status and wasting, even among ART-treated children, in Dar es Salaam, Tanzania. In addition to increasing coverage of ART among HIV-positive children, interventions to ameliorate poor nutrition status may be necessary in this and similar settings. Such interventions should aim at promoting adequate feeding patterns, as well as preventing and treating diarrhea.

High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania--a call to include nutrition care and treatment in the test and treat model

“…Like in other studies conducted in similar settings among HIV-positive children [9,10], adults were more likely to succumb to undernutrition when they had poor feeding practices such as consuming foods with low dietary diversity. Moreover, only a small proportion consumed protein-rich foods, fruits, or vegetables in their routine meals, similar to other studies [18][19][20].…”

“…Such unprecedented magnitude of undernutrition is not uncommon in this [9,11] and other areas with similar context [12]. A syndemic theory can help explain such high magnitude of undernutrition in this context.…”

“…The most commonly demonstrated negative outcomes have been nutritional status, adherence to medication, and psychological wellbeing [8]. In Tanzania, poor feeding practices are widespread and have been associated with undernutrition [9,10]. Despite this evidence, nutrition integrated HIV care is lacking in Tanzania, representing a substantial missed opportunity.…”

Measuring Food and Nutrition Security: Tools and Considerations for Use Among People Living with HIV

“…The HFIAS has been used in several HIV cohorts in the US [47,48], and among HIV-positive populations in Zambia, Uganda and Kenya [49][50][51]. The Household Food Security Scale-Short Form (HFSS-SF) was recently applied in cohorts of PLHIV in Tanzania [52] and Vietnam [53].…”

Factors associated with food consumption among adolescent orphans in Nigeria

“…However, Magadi 5 reported that the risk of malnutrition was particularly high among infants aged 1 year whose mothers were HIV positive. Another study suggested that one of the factors associated with underweight and wasting was feeding frequency among ART treated HIV positive children below 2 years old 6 . Therefore, several factors may contribute to 2014;80 4 :199 207 Original Article…”