Household food and nutrition security in association with HIV progression: a comparative study of highlands and lowlands in Wundanyi Division, Coast Province, Kenya

Abstract

Household food security that includes household food availability, accessibility and utilization, is Abstract synergistically associated with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) on the basis of nutrition status. Poor nutrition increases the risk and progression of the disease in turn the disease exacerbates malnutrition. Therefore it has been under assumption that high food potentiality (food security) generally contributes to better Human Immunodeficiency Virus (HIV) mitigation on nutritional basis. This study at the Coastal region of Kenya was done to determine the relationship between household food and nutrition security and HIV progression among infected individuals. The project entailed initial documentation of food potentiality/security of two study sites: Wundanyi-118 households and Paranga-80 households, which were selected on the grounds of variation in agro ecological zones (lowlands and highlands). A retrospective study comprising of 768 People Living With HIV/AIDS (PLWHA) clients (highlands: 404, lowlands: 364) was conducted to asses and compare the HIV progression trend in the zones. The indicators sought for food security included: food production, food handling and preservation methods, dietary diversity, sanitation and hygienic practices (implications), anthropometric measurements; while those for Hl V progression were: anthropometry (weight), Total lymphocytes and T cell counts, World Health Organization symptomatic staging. Data were analyzed using Statistical Package for Social Sciences (SPSS) software that included basic (descriptive analysis and graphical presentations) and advanced (chi-square, independent ttest) statistics at 95% confidence interval (p value of 0.05) , to determine strength of relationship between the two parameters -household food security and HIV progression. The results indicated significantly higher proportion of households in the lowlands (Paranga) to be having low household dietary diversity score (HODS <5) than the highlands (Wundanyi: 12%, Paranga: 30%). A higher proportion, of statistical significance, of the highland households as compared to the lowland households was able to sell their subsistence produce (Wundanyi: 86.4%, Paranga: 38.8%). There was significant difference in average proportion of income expenditure on food, between the zones, with lowlands spending higher on food as compared to the highlands (Wundanyi: 41.6% and Paranga: 59.6%). In addition the general HIV progression trend was similar in both zones despite variation in household food security as indicated by similar rates of weight change and progression from one stage to the next using WHO staging. Interestingly, no significant variation existed in inhabitants' nutritional status between the zones as evidenced by the similar anthropometric results on children less than five years in both zones. In conclusion, despite statistical significance in some of the household food security between the ,. highlands and lowlands in the coast region of Kenya, the mean rate of HIV progression for clients on highly active antiretroviral therapy, is the same. Ultimately, nutritional HIV mitigation of clients on HAART is not directly related to the agro-ecological zone as it is indicated that the two zones could be different in the level of food potentiality but not to a magnitude that triggers variation in nutritional status-that directly mitigates HIV manifestation. To attain better nutritional mitigation, this study recommends more emphasis on nutrition security in both agro-ecological zones by the actors/policy makers to strengthen the prevailing household food security situation. Foremost adequate training on simple affordable food production and preservation techniques is necessary to minimize wastage and increase food consumption and utilization. Other sustainable interventions that can improve nutritional status of People Living With HIV/AIDS like micronutrient supplementation, food fortification and accessibility to well balanced diet should be implemented. A direct assessment of household and nutrition security for People Living With HIV /AIDS, in association with HIV progression can further improve this prognosis as food potentiality in a region is just a seasonal overview information. A detailed study is also necessary to determine conclusive relationship between Total Lymphocyte Counts and CD4 counts in order to validate fully the reliance on the affordable Total Lymphocyte Count tests in administering Highly Active Antiretroviral Therapy. This would indirectly support HIV nutritional mitigation.