Longitudinal Episodes of Under nutrition and its Predictors among HIV Positive Adults in Public Hospitals, Guraghe Zone: Linear Mixed model

Abstract

Background: More than one-fourth of adult HIV patients had malnutrition which has high risk of relapse after treatment. Hence, assessing the longitudinal episodes and its predictors has great importance. Therefore, this study was aimed to assess the longitudinal trends of under nutrition and its predictors among HIV positive adults attending Public Hospitals in southwest Ethiopia, 2019. Methods: Longitudinal study with repeated measure was conducted among 519 randomly selected records of adult HIV clients who were on treatment. Malnutrition was assessed using the records of weight and height at different points of follow up (0, 6, 12, 18 and 24 months of ART follow up). Analysis of variance, analysis of covariance and spaghetti plot were done to compare the mean change in BMI across different repeated measures. To assess predictors of malnutrition episodes, linear mixed model was used considering fixed and random variables. Thus, parameter estimate, and p-value with 95% confidence interval was estimated via maximum likelihood method. From the model information criteria, Akaikes information criteria (AIC) were used to assess model fitness with smaller value as indicative of better model fit.Results: a total of 480 records were reviewed with mean age of 36 years (± 9 years). A total of 354(73.8%) of clients mentioned that they got dietary counseling. While, 34.6% of them got nutritional support. Statistical significant increasing trend of mean BMI score across the five follow up intervals (F statistics = 13.9, p value = 0.0001) were observed. Being male (β = -0.72; P = 0.044), with problem of eating difficulty (β = -1.61; p = 0.0001), having anemia (β = -1.51; p = 0.003), shorter follow up interval (β = 0.04.; p = 0.129), not getting nutritional counselling (β = 0.63; p =0.32) and diarrheal disease (β = -0.04; p = 0.129) were negatively associated with improvement in BMI indices. Conclusions: Improvement was seen in nutritional status after initiation of ART. Presence of eating disorder, anemia, not getting nutritional counseling, short follow interval were predictors of under nutrition. In addition to giving better nutritional counseling, the health professionals working in ART clinic should emphasize for early detection, and treatment of eating disorders, diarrheal disease and others.