Poor Nutrition Status and Associated Feeding Practices among HIV-Positive Children in a Food Secure Region in Tanzania: A Call for Tailored Nutrition Training

Abstract

Undernutrition among HIV-positive children can be ameliorated if they are given adequate foods in the right frequency and diversity. Food insecurity is known to undermine such efforts, but even in food rich areas, people have undernutrition. As yet no study has examined feeding practices and their associations with nutrition status among as HIV-positive children in regions with high food production. We therefore examined the magnitude of undernutrition and its association with feeding practices among HIV-positive children in a high food production region in Tanzania.MethodsWe conducted this mixed-method study among 748 children aged 6 months-14 years attending 9 of a total of 32 care and treatment centers in Tanga region, Tanzania. We collected quantitative data using a standard questionnaire and qualitative data through seven focus group discussions (FGDs).ResultsHIV-positive children had high magnitudes of undernutrition. Stunting, underweight, wasting, and thinness were prevalent among 61.9%, 38.7%, 26.0%, and 21.1% of HIV-positive children, respectively. They also had poor feeding practices: 88.1% were fed at a frequency below the recommendations, and 62.3% had a low level of dietary diversity. Lower feeding frequency was associated with stunting (β = 0.11, p = 0.016); underweight (β = 0.12, p = 0.029); and thinness (β = 0.11, p = 0.026). Lower feeding frequency was associated with low wealth index (β = 0.06, p<0.001), food insecurity (β = −0.05, p<0.001), and caregiver's education. In the FGDs, participants discussed the causal relationships among the key associations; undernutrition was mainly due to low feeding frequency and dietary diversity. Such poor feeding practices resulted from poor nutrition knowledge, food insecurity, low income, and poverty.ConclusionFeeding practices and nutrition status were poor among HIV-positive children even in food rich areas. Improving feeding frequency may help to ameliorate undernutrition. To improve it, tailored interventions should target children of poor households, the food insecure, and caregivers who have received only a low level of education.

High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania--a call to include nutrition care and treatment in the test and treat model

“…Like in other studies conducted in similar settings among HIV-positive children [9,10], adults were more likely to succumb to undernutrition when they had poor feeding practices such as consuming foods with low dietary diversity. Moreover, only a small proportion consumed protein-rich foods, fruits, or vegetables in their routine meals, similar to other studies [18][19][20].…”

“…Like in other contexts, undernutrition among pre-ART individuals was associated with low wealth index [10,24]. Previous models have established associations between poverty and undernutrition, especially among PLWHIV [8].…”

“…Studies have revealed a link between poor feeding practices with food insecurity, poverty, and other social demographic characteristics [8]. However, in the context of Tanzania, even in areas with high yields of agricultural products, HIV-positive individuals succumb to selective food insecurity and therefore undernutrition [10]. Nutrition specific and sensitive interventions should be integrated within ART services to complement care for these populations [23].…”

“…The most commonly demonstrated negative outcomes have been nutritional status, adherence to medication, and psychological wellbeing [8]. In Tanzania, poor feeding practices are widespread and have been associated with undernutrition [9,10]. Despite this evidence, nutrition integrated HIV care is lacking in Tanzania, representing a substantial missed opportunity.…”

Risk factors associated with underweight status in children under five: an analysis of the 2010 Rwanda Demographic Health Survey (RDHS)

“…One previous study estimating contributions of different factors to the burden of under-nutrition attributed 43 % of the reduction in the prevalence of underweight children between 1970 and 2005 in developing countries to increases in women's secondary education [14]. Previous studies have shown that women with secondary education are better informed about optimal child care practices [8], have better practices in terms of hygiene [27,28], feeding [18] and childcare during illness [18,21,22], have a greater ability to use the health system [29], are more empowered to make decisions [28] and are more likely to have financial resources to care for and feed children [18]. There has been a slight increase in the percentage of women who have completed secondary education in Rwanda, from 1.2 % in 2005 [30] to 2.8 % in 2010 [10], and we hypothesize that further gains in women's education may translate into improved child nutrition outcomes [7,31,32].…”