Research Brief 10-01-HNP

Food insecurity limits capacity to meet the specific nutritional needs of HIV/AIDS affected people. HIV infection itself undermines food security and nutrition by reducing work capacity and productivity and jeopardizing household livelihoods. The HIV Nutrition Project’s (HNP) food intervention study funded by the GL-CRSP through USAID has the improvement of household food security through an increased intake of animal source foods as one of the core objectives. In addition to health and nutritional status assessment, the proxy measures being used by HNP to capture changes in a household’s ability to access food over time include the Household Food Insecurity Access Scale (HFIAS) with a range of 0-27, the Household Dietary Diversity Score (HDDS) with a range of 0-12, and the Months of Adequate Household Food Provisioning (MAHFP) score with a range of 0-12. Of the 104 HIV-infected drug naïve women enrolled in the study thus far, 49% live on less than USD 1.00 per day and spend less than USD 5.00 per year for purchases of medicine. Preliminary findings show that at baseline, their mean (SD) age, CD4 cell count, Hemoglobin (Hb), and Body Mass Index (BMI) were 34.8 (7.0), 502 (212), 12.4 (1.6), and 22.4 (3.7), respectively. The HFIAS score (SD) of 7 (2.4) and a 42.7% prevalence of severe food insecurity reflected household worry due to inadequate food, and the consumption of fewer or small meals. The MAHFP score (SD) was 5.24 (2.7) with majority of the households having limited access to food during the months of July (74%), August (83%), and September (72%). The HDDS (SD) of 6.10 (1.9) suggests a prevalence of low food diversity in diets. With the exception of milk, which is mostly consumed in tea, there was very minimal consumption of animal source foods. The scores for these proxy measures of household food insecurity indicate that though the current CD4 counts and Body Mass Indices (BMI) of the study population are within the normal range, their habitual diets are likely to be poor due to the high prevalence of food insecurity.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Lipid-soluble Vitamins A, D, and E in HIV-Infected Pregnant women in Tanzania.

There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions

Vitamin A, vitamin E, iron and zinc status in a cohort of HIV-infected mothers and their uninfected infants

Introduction We hypothesized that nutritional deficiency would be common in a cohort of postpartum, human immunodeficiency virus (HIV)-infected women and their infants. Methods Weight and height, as well as blood concentrations of retinol, α-tocopherol, ferritin, hemoglobin, and zinc, were measured in mothers after delivery and in their infants at birth and at 6-12 weeks and six months of age. Retinol and α-tocopherol levels were quantified by high performance liquid chromatography, and zinc levels were measured by atomic absorption spectrophotometry. The maternal body mass index during pregnancy was adjusted for gestational age (adjBMI). Results Among the 97 women 19.6% were underweight. Laboratory abnormalities were most frequently observed for the hemoglobin (46.4%), zinc (41.1%), retinol (12.5%) and ferritin (6.5%) levels. Five percent of the women had mean corpuscular hemoglobin concentrations < 31g/dL. The most common deficiency in the infants was α-tocopherol (81%) at birth; however, only 18.5% of infants had deficient levels at six months of age. Large percentages of infants had zinc (36.8%) and retinol (29.5%) deficiencies at birth; however, these percentages decreased to 17.5% and 18.5%, respectively, by six months of age. No associations between infant micronutrient deficiencies and either the maternal adjBMI category or maternal micronutrient deficiencies were found. Conclusions Micronutrient deficiencies were common in HIV-infected women and their infants. Micronutrient deficiencies were less prevalent in the infants at six months of age. Neither underweight women nor their infants at birth were at increased risk for micronutrient deficiencies

Barriers To Exclusive Breastfeeding Among Infants Aged 0-6 Months In Eldoret Municipality, Kenya

Objective: Breast milk is the best source of nutrients for young infants’. It promotes optimal growth and development. WHO recommends Exclusive Breastfeeding (EBF) for the first 6 months of life as the best way of feeding an infant. EBF Prevalence in Kenya is low, there is need to find out barriers to EBF, hence the study. The objective of the study was to establish barriers to EBF to 6 months among infants aged 0-6 months.Methods: The study was cross-sectional involving 384 mother-infant pair visiting Huruma and West, maternal and child health (MCH)clinics. This study was done in the urban setting of Eldoret. Simple random sampling technique was used to get the desired sample size of384. A questionnaire was used to collect data. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 12.0.Results: Maternal age was categorized into mothers with; 35 years (n=24, 6.3%). Over half (n=198, 51.5%) of infants were female and 48.5 %( n= 186) were male. The median and mean age ofinfants in the study was 2.3 and 2 months respectively. Reported barriers to exclusive breastfeeding included; breast milk unsatisfying tothe infant (n=157, 64.4%), insufficient breast milk production (n=35, 14.3%), to improve nutritional status of the infant (n=18, 7.4%), forthe infant learns to feed on other foods (n=19, 7.7%) and in order for mothers to resume work (n=15, 6.1%).Conclusion: Barriers to EBF in the study may be attributed to inadequate breastfeeding knowledge among the mothers. This study is important in devising strategies that will increase EBF in the community