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NUTRIENT COMPOSITION AND HEALTH BENEFITS OF HIV PATIENTS
1.0 INTRODUCTION AND BACKGROUND
Twenty years after the first clinical evidence of AIDS was reported, HIV/AIDS remains the most devastating disease, accounting for approximately 33.2 million people in the world currently living with HIV/AIDS. Of these, 32.9 million are adults. In 2007, approximately 2.5 million people were newly infected and over 2.1 million people died of HIV/AIDS. The number of new infections continues to increase daily (up to 1500). Africa has the highest HIV prevalence rates in the world ranging from <0.1%-28.0%. Sub-Saharan Africa (SSA) remains the worst hit region with AIDS as the leading cause of death in the region. Up to 90% of all HIV positive adults live in the Sub-Saharan Africa region (UNAIDS, 2008).
HIV/AIDS was discovered in Uganda in 1982 and the epidemic progressed and spread very fast throughout the country reaching a national prevalence of 18.3%, with some areas registering prevalence above 30%, by the end of 1992. By January 2006, over 2 million Ugandans were infected with HIV/AIDS and half of these died of HIV/AIDS related illness including malnutrition (UHDS, 2006). In 2007, the national prevalence stood at 6.4%. Overall, infections are higher in urban areas than in rural areas. Kampala District, the capital city of Uganda has the highest HIV/AIDS prevalence nationally at about 8% (UNAIDS, 2008).
In 1988, the importance of nutritional support was highlighted in preventing severe malnutrition, boosting the immune response and optimizing quality of life especially in improving response to treatment (Resler S, 1998). Nutrition is an important component of comprehensive care for the People living with HIV/AIDS (PHA’s) and is particularly so in resource-limited settings where malnutrition and food insecurity are endemic. There is similarity in the cellular effects of malnutrition and HIV on the immune system compromising it by decreasing CD4 T-cells, suppression of delayed hypersensitivity, and abnormal B-cell responses (Scrimshaw et al, 1997). Providing sufficient food and nutrition to meet people’s basic needs for health, growth and
development has been a long-standing challenge for African countries. This challenge is farther exacerbated by the emergence of HIV/AIDS. The effect of poor nutrition in the case of PHA’s is more horrendous as they have to grapple with opportunistic infections. Dietary management of PHA’s is key to sustaining the ability to continue participating in the workforce and contribute to socioeconomic development (Soyiri IN & Laar AK, 2004). Eating a diversity of foods is an internationally accepted recommendation for a healthy diet, and is associated with positive health outcomes such as reduced incidence of mortality (Michels et al, 2002). Dietary diversity is therefore a key concept that should be promoted in managing the nutrition situation of PHA’s.
Dietary diversity is a qualitative measure of food consumption that reflects household access to a wide variety of foods, and is also a proxy of the nutrient adequacy of an individual’s diet. Individual dietary diversity score (IDDS) aims to capture nutrient adequacy and many studies amongst people of different age groups have shown that its increase is related to increased nutrient adequacy of the diet. Dietary diversity scores have been positively correlated with increased mean micronutrient density adequacy of complementary foods (FANTA, 2006) and micronutrient adequacy of the diet in adults (Ogle et al, 2001; Foote et al, 2004).
Uganda has taken remarkable steps in addressing HIV/AIDS impact on nutrition, by developing the National Nutrition Guidelines for PHA’s, which highlights the importance of good nutrition in HIV/AIDS (Uganda MOH, 2006). In addition to providing HIV/AIDS treatment, care and support, Uganda has also tried to address food insecurity by providing food aid and support for income-generating activities, a holistic approach to managing HIV/AIDS. Despite this, the gap between nutritional guidelines/packages and actual practice remains wide. The amount of nutrition education and counselling provided is not matched by the desired nutritional behavioural change.
The medical care, open to patients four days a week, includes clinical care, nutritional care and support, psychosocial and spiritual counselling, physiotherapy, laboratory services, dental care, occupational therapy and social welfare. Sixty six percent of all patients seen at TMC are adults above the age of 18 years (TMC annual report, 2008). There are eight full time doctors including a physician. The nursing department consists of a team of nine registered nurses who triage participants and care for the very weak and sick patients as they wait to be seen by the doctors.
The nutritional unit under the family welfare department attends to an average of 70 patients per month and provided food aid to an average 30 families by April 2008. Thirty five percent of the patients seen for nutritional care and support are adults. Nutritional care for adults is provided through out patient services which include both the clinical and nutritional advice. This involves prescription of nutrient supplements or medications such as vitamins, minerals and heamatenics and provision of nutritional education for those who complain and present with symptoms and signs of nutritional deficiencies but also might have predisposing factors to inadequate dietary intake. Despite all these efforts, there is limited information about the diversity of foodstuffs consumed by the clients seen at the centre and no information is available on what factors influence it.