Nutritional Knowledge, Attitudes, and Practices of Women Living with HIV in Eastern Uganda

HIV and AIDS have posed various medical, nutritional, social and economic problems, female-headed households being the most affected. Poor nutritional knowledge and dietary practices common among the most affected households significantly contribute to the rapid progression of HIV. However, very little data exist concerning these aspects of nutrition among women living with HIV and AIDS in resource-limited settings, such as Uganda. The aim of the study was to investigate the gaps in nutritional knowledge, attitudes, and practices and their relationship with sociodemographic characteristics in an urban population of women living with HIV and AIDS in Uganda. In total, 133 women living with HIV were interviewed using a pretested questionnaire. Most (89.5%) women reported being trained on the importance of nutrition for people living with HIV and AIDS (PLWHA) and believed that it is very important to consume a balanced diet (99.5%). On the contrary, only 21.8% consumed at least three meals per day and 39.8% at least six food-groups. They also reported higher dependency on starchy staples while foods of animal origin and fruits that play vital immunity and protective roles were inadequately consumed. Results of bivariate analysis indicated that consumption of a diversified diet was significantly associated with access to food-aid (p=0.006), possibly because access to food-aid reportedly enhances the ability of the household to access other food items. However, much is still needed to understand the drug-food interaction and dietary diversification and enhance proper dietary practices through sustainable projects that ensure increased access to food. Support groups of the PLWHA are a good vehicle for communication of nutrition information and implementation of nutrition-related projects

Nutritional Knowledge, Attitudes, and Practices of Women Living with HIV in Eastern Uganda

HIV and AIDS have posed various medical, nutritional, social and economic problems, female-headed households being the most affected. Poor nutritional knowledge and dietary practices common among the most affected households significantly contribute to the rapid progression of HIV. However, very little data exist concerning these aspects of nutrition among women living with HIV and AIDS in resource-limited settings, such as Uganda. The aim of the study was to investigate the gaps in nutritional knowledge, attitudes, and practices and their relationship with sociodemographic characteristics in an urban population of women living with HIV and AIDS in Uganda. In total, 133 women living with HIV were interviewed using a pretested questionnaire. Most (89.5%) women reported being trained on the importance of nutrition for people living with HIV and AIDS (PLWHA) and believed that it is very important to consume a balanced diet (99.5%). On the contrary, only 21.8% consumed at least three meals per day and 39.8% at least six food-groups. They also reported higher dependency on starchy staples while foods of animal origin and fruits that play vital immunity and protective roles were inadequately consumed. Results of bivariate analysis indicated that consumption of a diversified diet was significantly associated with access to food-aid (p=0.006), possibly because access to food-aid reportedly enhances the ability of the household to access other food items. However, much is still needed to understand the drug-food interaction and dietary diversification and enhance proper dietary practices through sustainable projects that ensure increased access to food. Support groups of the PLWHA are a good vehicle for communication of nutrition information and implementation of nutrition-related projects

A randomised controlled trial of the effects of albendazole in pregnancy on maternal responses to mycobacterial antigens and infant responses to bacille Calmette-Guérin (BCG) immunisation [ISRCTN32849447]

BACKGROUND: Maternal schistosomiasis and filariasis have been shown to influence infant responses to neonatal bacille Calmette-Guérin (BCG) immunisation but the effects of maternal hookworm, and of de-worming in pregnancy, are unknown. METHODS: In Entebbe, Uganda, we conducted a randomised, double-blind, placebo-controlled trial of a single dose of 400 mg of albendazole in the second trimester of pregnancy. Neonates received BCG. Interferon-gamma (IFN-γ) and interleukin (IL)-5 responses to a mycobacterial antigen (crude culture filtrate proteins (CFP) of Mycobacterium tuberculosis) were measured in a whole blood assay. We analysed results for binary variables using χ(2 )tests and logistic regression. We analysed continuous variables using Wilcoxon's tests. RESULTS: Maternal hookworm was associated with reduced maternal IFN-γ responses to CFP (adjusted odds ratio for IFN-γ > median response: 0.14 (95% confidence interval 0.02–0.83, p = 0.021). Conversely, maternal hookworm was associated with subsequent increased IFN-γ responses in their one-year-old infants (adjusted OR 17.65 (1.20–258.66; p = 0.013)). Maternal albendazole tended to reduce these effects. CONCLUSION: Untreated hookworm infection in pregnancy was associated with reduced maternal IFN-γ responses to mycobacterial antigens, but increased responses in their infants one year after BCG immunisation. The mechanisms of these effects, and their implications for protective immunity remain, to be determined

Modelling the impact of stunting on child survival in a rural Ugandan setting

Abstract Background Uganda ranks among the top 10 countries in the world for newborn and child mortality rates and among the top 34 for burden of stunting. This study was conducted to model the impact of stunting on child mortality in the southwest region of Uganda where the prevalence of stunting and child mortality are of great public health concern. Methods The study was conducted in Buhweju district in the southwest region of Uganda. The study was cross-sectional involving use of a structured household questionnaire, focus group discussions and interviews with key informants in order to gather relevant information on infant and young child feeding (IYCF) and coverage of antenatal care (ANC) and vaccination programs. The survey of stunting, vaccination and ANC services covered 221 children aged 6–59 months while the assessment of IYCF practices covered 83 children aged 0–23. The Lives Saved Tool (LiST) was used to estimate the impact of stunting on child mortality and cases of stunting averted. Results The study findings indicated that only 33% of the mothers had knowledge of optimal IYCF and 39% of the sampled children were exclusively breastfed. The majority of the mothers (57%) breastfed their children for less than 2 years and only 31% of the mothers practiced appropriate introduction of complementary foods at 6 months. Only 17% of the 0–23-month-olds received a good standard of IYCF. Only 37% of the mothers reportedly attended ANC 4 times or more during pregnancy and among children aged 6–59 months, only 28% were fully vaccinated. The high impact LiST model estimated that 1297 children under 5 years would be saved and 24,850 cases of stunting averted in the study district. Conclusions The study concludes that IYCF practices and coverage of expanded programme on immunization (EPI) and ANC in the study population are sub-optimal thus the high prevalence of stunting and child mortality in the region. LiST demonstrated that prevention of stunting would reduce child mortality in rural Uganda. Therefore, increased investment in cost-effective child survival interventions targeting rural areas of Uganda would have a significant impact on stunting and child mortality

Nutritional aspects of HIV-associated wasting in sub-Saharan Africa1234

The twin global epidemics of HIV infection and food scarcity disproportionately affect sub-Saharan Africa, and a significant proportion of patients who require antiretroviral therapy (ART) are malnourished because of a combination of HIV-associated wasting and inadequate nutrient intake. Protein-calorie malnutrition, the most common form of adult malnutrition in the region, is associated with significant morbidity and compounds the immunosuppressive effects of HIV. A low body mass index (BMI), a sign of advanced malnutrition, is an independent predictor of early mortality (<6 mo) after ART initiation in several analyses, and recent studies show an association between early weight gain when receiving ART and improved treatment outcomes. The cause of the observed increase in mortality is uncertain, but it is likely due in part to malnutrition-induced immune system dysfunction, a higher burden of opportunistic infections, and metabolic derangements. In this article, we describe the epidemiology of HIV infection and malnutrition in sub-Saharan Africa, potential causes of increased mortality after ART initiation among patients with a low BMI, recent studies on post-ART weight gain and treatment outcome, and trials of macronutrient supplementation from the region. We close by highlighting priority areas for future research