Gender difference in health related quality of life and associated factors among people living with HIV/AIDS attending anti-retroviral therapy at public health facilities, western Ethiopia: comparative cross sectional study

Abstract Background Though HIV/AIDS has multidimensional consequences on quality of life, there is a gap in measuring and monitoring health related quality of life of HIV/AIDS patients. Hence, this study intended to measure health related quality of life domains and associated determinants among people living with HIV/AIDS in western Ethiopia. Methods A comparative cross-sectional study was conducted among 520 HIV/AIDS patients on anti-retroviral therapy in public health facilities in West Shoa Zone, Western Ethiopia from April to May, 2016. Participants were selected using simple random sampling method. Quality of life was measured using WHOQOL-HIV BREF and depression was assessed using Beck Depression Inventory, Second Edition (BDI-II). Data were analyzed using SPSS version 22. An independent sample t-test was used to compare quality of life domains between men and women and logistic regression analysis was used to determine independent predictors. Results Females had significantly lower quality of life in physical, psychological, independence and environmental domains as compared with males except social relationship and spiritual domains. Depressed HIV patients had significantly lower quality of life in all domains as compared with HIV infected patients without depression in both genders. Malnutrition and anemia were significantly associated with poor physical, psychological, independence and environmental domains. Anemic women had 1.9 times lower independence quality of life compared with women who had no anemia (AOR = 1.9, 95%CI: 1.4, 3.5). Tuberculosis was also predictor of physical, psychological, independence and social domains in both genders. TB/HIV co-infected females had 2.0 times poorer environmental health compared to only HIV infected females (AOR = 2.0, 95%CI: 1.2, 3.5). Family support, education and occupation were also independent significant predictors of QOL domains in both genders. In females, residence was significantly associated with independence (AOR = 1.8, 95%CI: 1.2–3.8) and environmental (AOR = 1.5, 95%CI: 1.1–3.2) domains. Conclusions Females had significantly lower quality of life compared with males. The findings indicted poor socio-economic status and co-infections significantly associated with poor quality of life among HIV/AIDS patients. So, due emphasis should be given to improve socio-economic status and enhance integrated early detection and management of malnutrition, depression, tuberculosis and anemia among HIV/AIDS patients in Ethiopia

Food Insecurity, Nutritional Status, and Factors Associated with Malnutrition among People Living with HIV/AIDS Attending Antiretroviral Therapy at Public Health Facilities in West Shewa Zone, Central Ethiopia

Background. In resource limited settings, HIV/AIDS patients lack access to sufficient nutritious foods, which poses challenges to the success of antiretroviral therapy. HIV/AIDS and malnutrition are still major public health problems in Ethiopia. Though measuring nutritional status is an essential part of ART program, little evidence exists on food insecurity and nutritional status of HIV/AIDS patients in Ethiopia. Hence, the study aimed to determine food insecurity and nutritional status and contextual determinants of malnutrition among HIV/AIDS patients in West Shewa Zone, Ethiopia. Methods. Institution-based cross-sectional study was conducted among HIV/ADIS patients who have been attending antiretroviral therapy at public health facilities in West Shewa Zone from April to May 2016, Ethiopia. The sample size was 512 and study participants were selected from each facilities using systematic random sampling method. Data were collected using pretested questionnaire by trained data collectors. Data were entered to Epi-Info 3.5.1 for Windows and analyzed using SPSS version 22. Logistic regression analyses were conducted to determine independent factors associated with malnutrition. Results. Prevalence of malnutrition was 23.6% (95% CI: 19.7%–27.4%) and prevalence of household food insecurity was 35.2% (95% CI: 31.1%–39.0%). Factors significantly associated with malnutrition among HIV/AIDS patients were unemployment (AOR = 3.4; 95% CI: 1.8–5.3), WHO clinical stages III/IV (AOR = 3.3; 95% CI: 1.8–6.5), CD4 count less than 350 cells/μl (AOR = 2.0; 95% CI: 1.8–4.2), tuberculosis (AOR = 2.3; 95% CI: 1.3–4.9), duration on antiretroviral therapy (AOR = 1.8; 95% CI: 1.2–2.9), and household food insecurity (AOR = 5.3; 95% CI: 2.5–8.3). Conclusions. The findings revealed high prevalence of malnutrition and household food insecurity among HIV/AIDS patients attended ART. The negative interactive effects of undernutrition, inadequate food consumption, and HIV infection demand effective cross-sectorial integrated programs and effective management of opportunistic infections like tuberculosis

Multi-mycotoxin profiling in maize reveals prevalence of Fusarium

Multi-mycotoxin exposure data are missing to guide risk assessment and legislation in Ethiopia. This study therefore aimed to determine mycotoxin contamination levels in maize samples from 176 randomly selected household storages in three agro ecological zones of South (Sidama zone) and West (Jimma zone) Ethiopia, and to examine the post-harvest practices and household processing. Liquid chromatography coupled to tandem mass spectrometry was used to quantify 23 mycotoxins. The majority of the households regularly consumed maize (more than once per day). More (77%) samples in Sidama were contaminated with Fusarium mycotoxins deoxynivalenol than in Jimma (29%) (P0.05). In Sidama, only one sample was contaminated with the Aspergillus mycotoxin aflatoxin B-2 and another sample with aflatoxin B-1. From all samples, 40% were contaminated with 3-5 types of Fusarium mycotoxins and only 4% of the samples were contaminated with 6-8 types of mycotoxins. After the harvested maize was dried on the field, the majority of respondents in Jimma reported that they removed the maize within one day, which was less practiced in Sidama. The majority of households in Sidama, and some in Jimma, reported that they dried maize before storage, mainly using the sun. Close to two third of the study participants in the two zones reported that they applied the chemical dichloro-diphenyl-trichloroethane (DDT) during maize storage. All households in both zones reported that they sorted visible mouldy maize grains before preparation of maize flour while most of them kept the mouldy maize for animal feed. Protective strategies of Fusarium mycotoxin contamination, with special focus on deoxynivalenol and zearalenone, should be well promoted in the study areas as they are possible human and animal health threats

Multi-mycotoxin profiling in maize reveals prevalence of Fusarium mycotoxins in South and West Ethiopia

Multi-mycotoxin exposure data are missing to guide risk assessment and legislation in Ethiopia. This study therefore aimed to determine mycotoxin contamination levels in maize samples from 176 randomly selected household storages in three agro ecological zones of South (Sidama zone) and West (Jimma zone) Ethiopia, and to examine the post-harvest practices and household processing. Liquid chromatography coupled to tandem mass spectrometry was used to quantify 23 mycotoxins. The majority of the households regularly consumed maize (more than once per day). More (77%) samples in Sidama were contaminated with Fusarium mycotoxins deoxynivalenol than in Jimma (29%) (P0.05). In Sidama, only one sample was contaminated with the Aspergillus mycotoxin aflatoxin B2 and another sample with aflatoxin B1. From all samples, 40% were contaminated with 3-5 types of Fusarium mycotoxins and only 4% of the samples were contaminated with 6-8 types of mycotoxins. After the harvested maize was dried on the field, the majority of respondents in Jimma reported that they removed the maize within one day, which was less practiced in Sidama. The majority of households in Sidama, and some in Jimma, reported that they dried maize before storage, mainly using the sun. Close to two third of the study participants in the two zones reported that they applied the chemical dichloro-diphenyl-trichloroethane (DDT) during maize storage. All households in both zones reported that they sorted visible mouldy maize grains before preparation of maize flour while most of them kept the mouldy maize for animal feed. Protective strategies of Fusarium mycotoxin contamination, with special focus on deoxynivalenol and zearalenone, should be well promoted in the study areas as they are possible human and animal health threats

Dietary mycotoxins exposure and child growth, immune system, morbidity, and mortality : a systematic literature review

The aim of this study was to systematically review associations between dietary mycotoxins exposure and child growth and morbidity of children aged 5 years or younger. Peer-reviewed literature was searched in MEDLINE, EMBASE, COCHRANE, CINAHL, Web of Science, and PsycINFO. Experimental and observational studies were considered. The exposures were dietary mycotoxins during pregnancy, lactation and childhood, and mycotoxins concentrations in the diet, breast milk, urine, and blood. From a total of 4869 references, 86 full-text papers were extracted of which 50 were included in this review. The methodological quality and risk of bias were evaluated and quality of the collective evidence was assessed using GRADE. Uncertainty remains whether mycotoxins exposure affects child growth, immunity and mortality and the overall quality of the evidence is very low. Overall however, we cannot rule out a possible association between dietary mycotoxins, in particular, AF and FUM and child malnutrition. Our analyses were limited by the reporting quality, difference in findings, heterogeneity of outcomes, mycotoxins detection methods, and the observational nature of most studies. Robust study designs with adequate sample size, use of validated biomarkers of exposure and assessment of co-occurrence of mycotoxins and their synergistic effects are required to provide the further evidence regarding a potential effect of dietary mycotoxins exposure on child growth and immunity

Associating multiple mycotoxin exposure and health outcomes : current statistical approaches and challenges

Mycotoxin contamination is a global challenge to food safety and population health. A diversity of adverse effects in human health such as organ damage, immunity disorders and carcinogenesis are attributed to acute and chronic exposure to mycotoxins. While there is a high likelihood of mycotoxin co-occurrence in the daily diet, multiple mycotoxin exposures represent a considerable challenge in understanding the accumulative effects of groups of exposures on health outcomes. Nevertheless, previous studies on mycotoxin exposure-health outcome associations have focused on a single or a limited number of exposures. To guide multi-exposure assessment, careful considerations of statistical approaches available are required. In addition, the issue of multicollinearity in high-dimensional settings of multiple exposure analysis underlies the controversy surrounding the reliability and consistency of statistical conclusions about the exposure-health outcome associations. Conventional approaches such as generalised linear regressions (GLR) in conjunction with regularisation methods, including ridge regression, lasso and elastic net, offer some clear advantages in terms of results' interpretation and model selection. However, when highly-correlated variables are observed, these methods have shown a low specificity in variable selection. Principal component analysis (PCA) that has been widely used as a dimensionality reduction technique also has the limitation to identify important predictor variables as this approach may overlook the associations between certain components and health outcomes. Recently, some alternative approaches have been introduced to address the issues of high dimensionality and highly-correlated data in the context of epidemiological and environmental research. Two of the noticeable approaches are weighted quantile sum regression (WQSR) and Bayesian kernel machine regression (BKMR). Combining different methods of inference allows us to interpret the role of certain exposures, their interactions and the combined effects on human health under diverse statistical perspectives, which ultimately facilitate the construction of the toxicological profile of multiple mycotoxins' exposure

Mycotoxins exposure of lactating women and its relationship with dietary and pre/post-harvest practices in rural Ethiopia

Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women's dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found (p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future

Fortified balanced energy-protein supplementation, maternal anemia, and gestational weight gain : a randomized controlled efficacy trial among pregnant women in rural Burkina Faso

Background Anemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG. Objectives We assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)'s recommendations, as compared with an iron-folic acid (IFA) tablet. Methods We conducted a randomized controlled trial in Burkina Faso, among pregnant women (15-40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent similar to 7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at similar to 36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements. Results Women in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: -0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses. Conclusions This trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes. This trial was registered at clinicaltrials.gov as NCT03533712