Abstract:
The goal of nutritional care and support for PLWHA is to improve nutrition,
health, quality of life and duration of survival. Good dietary practices play an
important role in the comprehensive management of HIV/AIDS because it
improves nutritional status, the immune system, boosts energy and helps in
recovery from opportunistic infections. Though HIV/AIDS is a widespread
problem in Kenya, there is little information about the dietary practices of
PLWHA in the country. The extent to which those infected or affected can
maintain good nutritional status of the infected varies widely.
An observational longitudinal study with an aim of determining dietary practices
and nutritional status was carried out among PLWHA in Thika District during a
period of nine months. The study intervention was dietary counseling involving
nutrition education and good dietary practices among PLWHA during the study
period. The study centres were Thika District Hospital and JKUAT Hospital
Comprehensive Care Clinics (CCC).
Changes in nutritional status were assessed using BMI. The analysis of BMI as
a continuous variable was used to evaluate change over time using the linear
mixed effects model. The model was used to statistically assess effects of
dietary practices and other factors on the nutritional status over time.
Multivariate evaluation of participants’ characteristics was managed using
standard regression techniques. Statistical significance was set at 95% CI and
for all statistical tests p ≤ 0.05 was considered significant. Results showed that sex and education were significantly associated with
nutritional status as measured by BMI. Females on average had 3.31 units of
BMI higher than men (p<0.0001), while participants with secondary education
and above had 2.22 and 3.15 units of BMI respectively higher compared to
those with only primary education (p=0.035 and p=0.006), respectively based
on multivariate Wald test. Those living in permanent quarters had BMI lower
than those living in semi-permanent/temporary and this was statistically
significant (p=0.014). The study also showed that income was not significantly
associated with change in BMI over time, (p>0.05). Time as measured by visit
month did not have a significant effect on mean BMI (P = 0.76). The
predominantly consumed foods for lunch and supper were starchy
carbohydrates.
In conclusion, the study has shown that being female and having education
higher than primary school level were significantly associated with enhanced
nutritional status. This study also found that nutritional counseling during followup
did not significantly influence changes in weight and therefore BMI over
time. The participants with a mean BMI of ≤18.5 kg/m2 were 8.1% while those
with BMI ≥ 24.9 kg/m2 were 33.7% over time. Therefore, the total proportion of
participants with malnutrition (both under and over nutrition) was 41.8%. The
implication and recommendations of these findings is that malnutrition is a
public health concern in Thika District and nutritional counseling and education
alone may not lead to good dietary practices. It is also important to routinely
evaluate the various interventions instituted at the comprehensive care clinics in order to determine their effectiveness and plan for appropriate changes when
necessary.
