Assessment of Dietary Pattern and Nutritional Status of People Living With HIVAIDs Attending Some Voluntary and Counselling Test (VCT) Units in Kaduna Metropolis

Assessment of Dietary Pattern and Nutritional Status of People Living With HIV/AIDs Attending Some Voluntary and Counselling Test (VCT) Units in Kaduna Metropolis

Chapter One

AIM AND OBJECTIVES

Aim

To investigate the dietary pattern and nutritional status of People Living with HIV/AIDS (PLWHA) attending voluntary and counseling test (VCT) units of some Hospitals in Kaduna metropolis.

Specific objectives

The specific objectives of the study are:

To assess the socio-economicand demographic characteristics of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna metropolis.
To determine the anthropometric characteristics of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna
To assess some biochemical parameters of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna
To correlate the micronutrient status with some biochemical parameters of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna
To determine the dietary pattern of People Living with HIV/AIDS attending voluntary and counseling test units in Kaduna

CHAPTER TWO

LITERATURE REVIEW

HIV Prevalence

More than 33.2 million people are living with HIV throughout the world. The greatest burden of the disease is concentrated in developing countries, the least able to cope. In these regions, HIV/AIDS has deepened poverty and exacerbated food insecurity (UNAIDS & WHO 2009). HIV/AIDS and malnutrition effects are interrelated and exacerbate one another in a vicious cycle. HIV specifically affects nutritional status by increasing energy requirements, reducing food intake, and adversely affecting nutrient absorption and metabolism. Asymptomatic and symptomatic adults have energy requirements by 10% and 30% respectively to maintain body weight and physical activity (Steinhart, 2011). HIV prevalence was higher in the urban location (5.7%) than rural (3.7%) areas except in the Southeast zone of Nigeria (FMOH, 2008). The difference was more pronounced in the Southwest and Northeast. Generally, about 65% of all new adults HIV infections occur in young men and women of less than 30years old, (FMOH, 2008). The human immune-deficiency virus (HIV) targets the immune system, making an infected person susceptible to infections and neoplasm because of an impaired ability to mount an adequate immune response. Malnutrition and its‘ complication have been largely found to render HIV infected persons susceptible to opportunistic infection and reduce effectiveness and tolerance to medication and other therapies, (Castlemanet al.,2004). Nutritional status is easily compromised during any type of infection. Generalized infections often result in low intake and absorption of nutrients, (Friis,2006). Inadequate nutrient intake or disturbance in the body‘s ability to process nutrients can result in lean body mass and wasting (Kotler,2000). Death occurs when a person‘s weight reaches about 60% of his/her ideal body weight regardless of the cause, (Kotler,2000).Evidence has shown that adequate nutrition for a person living HIV (PLHIV) is necessary to maintain and improve the overall health and nutritional status.

Promising developments have been seen in recent years in global efforts to address AIDS epidemic by increasing access to effective treatment and prevention programmes.

NUTRITIONAL STATUS

HIV and nutrition are interrelated and as antiretroviral drug become increasingly available in the poorest parts of the world, critical questions are emerging about how well the drugs work in people if they are short of food, and for those already receiving treatment, side effects such as body fat changes are a daily concern (Bartlett, 2003). Maintaining a good nutritional status is important to support the overall health and immune function of people living with HIV/AIDS (PLWHA). Adequate nutrition refers to intake of a diet which meets the specific nutritional needs for the specific individual for that specific period in time (Bartlett, 2003). The sole aim of adequate nutrition is to meet the growth and developmental demands of the unique, specific individuals‘ body (Walsh et al., 2003).

Inadequate nutrition in people with HIV infection may result from many factors including nausea, vomiting and anorexia that may prevent adequate intake of nutrients and medications; diarrheal infections that prevent absorption of nutrients and medications; Oral health conditions that interfere with chewing or tasting food like Oral Candidiasis in patients who present late; systemic illness (including HIV itself) that create a catabolic state; and psychological conditions such as depression that impair patients‘ ability to nourish themselves (Bartlett, 2003; Steinhart, 2011). In addition, financial constraints may limit patients‘ access to nutritious food (Walsh et al., 2003). Adequate nutrition helps to maintain and improve the nutritional and immunological status of a person with HIV/AIDS and delay the progression from HIV to AIDS-related diseases (Walsh et al., 2003). It can therefore improve the quality of life of PLWHA. Adequate nutrition will complement the effects of antiretroviral therapies and will help to maintain body weight and fitness, as well as improve the performance of the immune system already compromised by the infection (Walsh et al., 2003). Whereas starving people tend to lose fat first, the weight lost during HIV infection tends to be in the form of lean tissue such as muscle mass; this has been attributed to ARTs like Polymerase Inhibitors. This means there may be changes in the makeup of the body even if the overall weight stays the same (WHO, 2005; WHO, 2008). One factor behind HIV-related weight loss is increased energy expenditure (Newell etal., 2003; Batterham, 2005).

Chapter Three

Statistical analysis

Statistical analysis was performed using (SPSS) program version 20. Results obtained were expressed as mean ± standard deviation. The results obtained from the questionnaire were subjected to descriptive statistics. The data obtained from people living with HIV and controls were compared using student‘s t-test. Pearson correlation was used to test the relationship between the trace elements and CD₄ countsin patients.P-value of less than 0.05 (p<0.05) was considered as significant.

CHAPTER FOUR

RESULTS

DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS OF PEOPLE LIVING WITH HIV/AIDSATTENDING VCT UNITS IN KADUNA METROPOLIS

The demographic and socio-economic characteristics of people living with HIV/AIDS attending VCT units in Kaduna metropolis is presented in Table 4.1. The results indicate that a great fraction of the patients (39.19%) and control (40.54%) were between 26-33 years. Patients and control groups had more males (60.81% and 56.76% respectively) than females. A large proportion of patients were single (53.70%), with 5.41% cohabiting while in the control group married people had the greatest percentage (51.35%). Secondary education was attained by 62.16% of the patients and 52.70% of control. About a quarter of both control (24.32%) and patients (28.38%) were students.

CHAPTER FIVE

DISCUSSION

This present study assessed the dietary pattern and nutritional status of People Living with HIV/AIDS (PLWHA) as well as some relevant trace elements.

The result of this study showed that there was a significantly (p<0.05) lower BMI and weight of patients compared to the control group. The mean BMI of people living with HIV (PLWHIV) was 22.87kg/m² and 22.87kg/m² for the control group which indicates normal body mass. The result is in accordance with reports from Opara et al., (2007). The result of this study showed that 33.78% and 25.68% of the patients were overweight and underweight respectively. This agrees with Silva et al., (2001) and Kroll et al., (2012) who found the prevalence of overweight and underweight among PLWHA. Changes in body weight of PLWHA has been extensively studied and reported. Piwoz, (2004) reported that wasting (<18.50 kg/m²) was a major and disturbing sign of HIV/AIDS which was also a predictive mortality sign. Wasting can be caused by an extremely low energy intake, nutrients losses due to infection or combination of low intake and high nutrients losses. HIV/AIDS is associated with wasting UNICEF, (2012). Ojofeitimi and Fakande, (1998), achieved weight gain in PLWHA using nutritional counseling, food demonstration and soya bean milk.

CHAPTER SIX

SUMMARY, CONCLUSION AND RECOMMENDATIONS

SUMMARY

The major findings of this work can be summarized as follows:

Age groups between 26–33years, (39.19%) were more in the studied population with more male patients (60.81%) and more students in male and female patients (24.32%).
Nutritional status of patients based on BMI indicated that 33.78% were overweight (BMI ≥25.00) with more males (35.56%) than female (31.04%) being overweight while 25.68% was underweight with more occurrences in females (37.93%).
The serum total protein levels were significantly higher (p<0.05) in patients while no significant (p>0.05) difference was observed in their albumin

The LDL cholesterol levels were significantly (p<0.05) lower in patients with more occurrence in females (65.32%) than in males (57.78%). Low levels of HDL cholesterol (<1.0mmol/l) were also recorded in some males (33.33%) and females (41.38%) patients
Atherogenic index of patients showed no significant (p > 0.05) difference to control group.
TheCD₄ counts were significantly lower (p < 0.05) in patients and based on gender was also significantly lower (p<0.05) in males while no significant (p > 0.05) difference was observed in females.
The zinc and iron levels of the patients were significantly lower (p<0.05) and a significant (p<0.01) positive correlation was obtained when zinc and iron were correlated with their CD₄ Higher correlation was recorded for iron in females than in males while higher correlation for zinc in males than in females was recorded.
More female patients have their CD₄ at normal level (≥500 cell/µl) than male patients.
Frequency of food consumption indicated that all food groups were consumed across the time intervals. Most patients consumed bread, cereal and starch, meat, fish and poultry, Milk and dairy products on frequency consumption of 2 – 4times/week while fat and oils, and vegetables and fruits were consumed on frequency consumption of ≥5 per week and 1 – 3times/month

CONCLUSION

The nutritional status of the HIV patients studied shows minimum incidence of underweight and overweight. Lower LDL levels were also recorded in few proportions while significantly lower levels of CD4 counts were observed in HIV patients. Normal total cholesterol and HDLlevel which implies low risk of atherosclerosis.

Good dietary diversity was achieved in HIV patients as their dietary pattern showed regular intake of energy and other food groups which may account for why a lot had good BMI contrary to the usually incidence of weight loss and wasting common among PLWHIV. Normal zinc and iron levels was recorded in HIV patients which may be responsible for the normal weight observed contrary to what is observed in HIV patients with frequent diarrhea as zinc is effective in the reduction of the incidence, severity and duration of diarrhea.

RECOMMENDATIONS

The PLWHIV should be encouraged to maintain good dietary diversification with minimum consumption of four or all the food
Attention should be given to other causes of death in PLWHA such as cardiovascular diseases and
Nutrition education and practices should be encouraged in the management of HIV/AIDS.
Due to the cross sectional nature of the study, it is suggested that a longitudinal assessment be carried out in the study area in order to ascertain nutrients intake of HIV infected patient over a longer period of time.

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