Nutritional Recovery among Moderately Malnourished Adults Living with HIV in Clinical Nutritional Care in Addis Ababa
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Date
2015-06
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Addis Abeba Universty
Abstract
Background: Infection with HIV is one of the greatest challenges to global health. HIV infected person needs extra calorie than non-infected of the same age group. Malnutrition and HIV/AIDS exacerbate one another. PLWHIV are prone to develop malnutrition and malnourished PLWHIV have rapid disease progression and increase risk of mortality. National Clinical Nutritional Care Program provides therapeutic and supplementary food along with nutritional assessment and counseling to malnourished HIV positive individuals. However, to the investigators’ best knowledge no published research that examined the recovery rate of moderately malnourished adults living with HIV on nutritional care program and its determinants. Objective: This study aimed to evaluate the nutritional outcomes and associated factors among moderately malnourished adults living with HIV who were in the treatment care plan of nutritional care program.
Method: A retrospective before after study design (without a control group) was employed. For this purpose, we used medical records (FBP registration book) from 41 health facilities in Addis Ababa. Individuals' weight, height and clinical signs measured at baseline data and at the end of the 3 month follow up was analyzed and compared. In addition, we interviewed 15 health care providers' to get their insight about the program and understand the possible reasons for recovery/failure of the nutritional supplementation program. Result: A total of 383 classified and treated as moderately malnourished clients data were reviewed from 41 health facilities (30 health centers and 11 hospitals). More than half of the study population, 223(58.2%) were females with a median age of 36.6 years. Overall the majority 284(74.2%) gained weight, while 13.8% lost their weight and 46(12%) discharged with the same weight of admission. The analysis showed there was significant improvement in the mean BMI score from 17.4kg/m2 during admission and to discharge at 18.2kg/m2 (P-value <0.01) With 133 (34.7%) getting out of malnutrition (reaching a BMI ≥18.5kg/m2), of those who recovered from under-nutrition 67.6% were treated in health centers while 32.3% were treated in hospitals (with recovery rate of 33% & 39.1% in health center and hospital respectively). Sharing of the product within the household, selling and patient dislike of the product was explained as a main reason for failure.
Conclusion: There was significant change in weight but reaching the intended BMI still questionable only a minority of patients achieved stated programmatic goals. Further study should include duration of treatment, exit criteria and associated factor. The findings revealed clients who were admitted to nutritional care program in hospitals & with symptomatic disease were more likely to recover at discharge compared to their counterparts who were admitted to health center and without symptomatic disease. More in-depth study is recommended to understand the reasons and replicate the positive experience of hospitals in health centers. Product quality especially the taste takes a part in nutritional failure so further research is also needed to evaluate and design a better product which is preferred by adults.
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Nutritional Recovery among Moderately Malnourished