Dietary patterns and nutritional status of asymptomatic HIV-l seropositive and HIV-l seronegative women in Nairobi-Kenya

Abstract

A clinic based five months cross-sectional, but comparative study was carried out on 204, randomly selected asymptomatic HIV Seropositive (cases) and my Seronegative (controls) in a health facility in a Nairobi maternal child health clinic. The aim of the study was to establish dietary patterns among my seropositive and HIV seronegative women enrolled in a longitudinal cohort study .. Data was collected using a structured questionnaire.: focus group discussions, anthropometric measurements and analysis of blood for the determination of my status, haemoglobin levels and CD4 +/CD8 + absolute cell counts and ratios respectively. Nutritional status was determined using Body mass index, Midupper arm circumference, Subscarpula skinfold thickness, Triceps skinfold thickness and haemoglobin levels. Nutrient adequacy of diets consumed by respondents was computed using food frequency method, where different combinations of responses were used to calculate indices of proteins, vitamins, carbohydrates, and fat consumption. These indices were then compared, to the recommended number of servings of various foods per day considered adequate as suggested by the daily food guide. The results show that the study group was relatively young, mean age 30 years, with the mean age of index child 1.87 years (s.d 0.46). The majority, in both the cases and controls, about 48% and 60.8% respectively were married. About 57.8% cases and 52.9% controls had attained primary school education. In total about a third 30.4% of the respondents were self employed. This accounted for 28.4% cases and 32.4% controls. The type of activities the respondents were engaged in, were mainly petty businesses such as hawking or food vending. The majority in both cases and controls were in the middle income group according to the Government of Kenya income classification 1994 (earned less than Kshs. 2,500 per month equivalent to US $ 45). The diets consumed for both cases and controls were deficient in proteins and carbohydrates but were relatively adequate in vitamins and fats. The differences in both cases and controls were however not statistically significant .The morbidity prevalence was also quite high among the cases and controls with cough being the most prevalent condition, this was found to be significantly related to the nutritional status for both study groups (p<O.OOl). Apart from Body mass index, all other nutritional status indices showed statistically significant differences with mv status. Using Mid-upper arm circumference(cut off-point <28.5 em- 90% standard),about 7.7% cases and 2.0% controls were malnourished while using Subsarpula skinfold thickness (cut off- point <13.7mm -90% standard),a higher proportion 39.2% and 30.4% of . cases and controls respectively were malnourished. Approximately 30.4% and 26.5% of cases and control respectively fell below the Triceps skinfold thickness(cut off-point <16.5mm). A high proportion of cases also 52.0% fell below the Haemoglobin (cut off- point <12 g/dl for anaemia) as compared to 48% for controls. In each of the stated instances, the differences were statistically significant for cases and controls. The results show that mv status is likely to affect nutritional status even at an early phase of the disease. The factors associated with poor nutritional status (p< 0.05) were Subscarpuar skinfold thickness, Mid-upper. arm circumference, Triceps skinfold thickness, Haemoglobin levels(Anaemia), education in years, lack of nutritional counselling and constraints in dietary planning. Nutritional knowledge and the dietary patterns between the two groups generally compared well and there were no statistical significant differences noted in the two study groups. This study has established that poor nutritional status, lack of nutritional counselling, low education levels, low social economic capability among other factors are associated with malnutrition in asymptomatic mv seropositive and HIV seronegative women. The recommendations are that aggressive nutritional intervention in form of adequate nutritional counselling at the asymptomatic phase 'With support of income generating activities would be key strategies to achieve early dietary intervention, to counteract disease related malnutritional manifestations that may, compromise on the nutritional status and increase the cost of healthcare which is a limiting factor among the low income group hence reduce maternal morbidity and mortality.