Effect of food supplementation on nutritional and morbidity status of hiv infected adults receiving antiretroviral therapy

Abstract

Clinical studies to evaluate the role of supplementary foods or nutrition therapy in reversing malnutrition and its impact on health and survival have not been done in Human immunodeficiency virus-infected individuals living in resource poor settings. The main objective of this study was to assess the effect of food supplementation on nutritional status and morbidity experience of malnourished human immunodeficiency virus infected adults receiving antiretroviral therapy. The study was conducted from July 2006 to April 2007, as part of a larger study located in three sites within Kenya, in Maragua District Hospital, "Mathare North Health Centre and Riruta City Council Hospital. A total of 147 clients receiving antiretroviral therapy and nutritional counseling were recruited. Of these clients, 83 as study group and we~e put on 300g food supplement per day for a period of three months, while 64 served as the control group. The food supplement was a blend of maize, soya, sugar, palm oil, and micronutrients pre-mix, composed of 45% of the total energy required by an adult in the symptomatic stage according to World Health Organization recommendation. Data were also collected on demographic; and socio-economic characteristics, anthropometry, morbidity experience, dietary patterns and adherence to supplement intake regime. Data on anthropometry and morbidity were collected initially and at monthly intervals during the feeding trials, while demographic and socio-economic data were collected at baseline only; and dietary patterns both at baseline and after 3 months. Data were analysed using Statistical Package for .Social Sciences version 12.0, and excel. Difference in the outcome variables were tested at p<0.05. A greater proportion (60 %) of clients in the study sample were females. Most clients were in monogamous marriages and had some formal education. The mean age was 35.1±2.9 while the mean household size was 3.7±7.3. There was a significant difference (p=O.OOO)in the main source of income between the two groups. The clients on food supplement relied on casual labor and remittances while the control group relied on farming as their main source of income. At baseline there was no significant difference in weight and body mass index between groups while the mid upper arm circumference among the food supplement group was significantly lower. After three months of follow-up, the mean body mass index of the food supplement group was significantly higher (p=0.019) than that of the control group. Although mean mid upper arm circumference and body mass index increased in both groups, the increments were significantly higher among the food supplement group than the control group. After three months of nutrition counseling, both groups showed a similar increase in consumption of diverse foods. Morbidity experience significantly reduced in both groups by the third month of follow up. This study concludes that combined food supplementation and nutritional counseling significantly improves the anthropometric status, morbidity experience and dietary intake of HIV infected adults on antiretroviral therapy. While nutrition counseling alone also impacts positively , to nutritional status, morbidity experience and dietary intake the effect is even better when coupled with food supplement in resource poor communities with poor purchasing power. It is recommended that nutrition education among HIV positive people in resource poor communities be strengthened, coupled with activities that improve and strengthen their resource capacities and purchasing power to improve food security.