Cash or Food? Which Works Better to Improve Nutrition Status and Treatment Adherence for HIV Patients Starting Antiretroviral Therapy

The overall objective of this DFID-funded study was to understand whether cash or food transfers were more effective for HIV-positive individuals starting antiretroviral therapy (ART) in improving nutrition, health status and adherence to ART. HIV-positive individuals initiating ART at the St Francis Mission Hospital in Katete District, Eastern Province, were randomly allocated to two treatment groups (cash and food), and given a food basket or its cash equivalent monthly, for eight months. Both treatment groups saw significant increases (p-value <0.001) in Body Mass Index (BMI), Household Dietary Diversity Score, good adherence to ART, and in mean CD4 count, but there were no significant differences between the two treatment groups in these measures. The study concluded that the provision of cash or food for eight months when clients start ART confers similar and significantly positive effects in improving clients’ nutrition and health. Providing cash is likely to be more cost-effective

Assessing the impact of a food supplement on the nutritional status and body composition of HIV-infected Zambian women on ARVs

Background Zambia is a sub-Saharan country with one of the highest prevalence rates of HIV, currently estimated at 14%. Poor nutritional status due to both protein-energy and micronutrient malnutrition has worsened this situation. In an attempt to address this combined problem, the government has instigated a number of strategies, including the provision of antiretroviral (ARV) treatment coupled with the promotion of good nutrition. High-energy protein supplement (HEPS) is particularly promoted; however, the impact of this food supplement on the nutritional status of people living with HIV/AIDS (PLHA) beyond weight gain has not been assessed. Techniques for the assessment of nutritional status utilising objective measures of body composition are not commonly available in Zambia. The aim of this study is therefore to assess the impact of a food supplement on nutritional status using a comprehensive anthropometric protocol including measures of skinfold thickness and circumferences, plus the criterion deuterium dilution technique to assess total body water (TBW) and derive fat-free mass (FFM) and fat mass (FM). Methods/Design This community-based controlled and longitudinal study aims to recruit 200 HIV-infected females commencing ARV treatment at two clinics in Lusaka, Zambia. Data will be collected at four time points: baseline, 4-month, 8-month and 12-month follow-up visits. Outcome measures to be assessed include body height and weight, body mass index (BMI), body composition, CD4, viral load and micronutrient status. Discussion This protocol describes a study that will provide a longitudinal assessment of the impact of a food supplement on the nutritional status of HIV-infected females initiating ARVs using a range of anthropometric and body composition assessment techniques

The relationship between training farmers in agronomic practices and diet diversification: a case study from an intervention under the Scaling Up Nutrition programme in Zambia

Abstract Background Agricultural production systems are a sustainable way of providing nutritious and diversified foods especially among rural households in developing countries. Capacity building of farmers and extension workers through training on agricultural and nutrition-related topics is one of the ways to improvements in agricultural productivity. However, a few studies have shown there is a link between training in agronomic practices and crop diversification and the effect this relationship has on diet diversity. Therefore, this study was carried out in Zambia in four districts and within those districts intervention (N = 348) areas were compared to nonintervention sites (N = 194) using an individual household questionnaire to investigate the effectiveness of training sessions that were conducted under the Most 1000 Critical Days program, the scaling up of nutrition on farm production diversity and diet diversity at household level. Results The results show that there were significant differences in the proportion of farmer households that grew different types of crops (P < 0.001). The incorporation of legumes such as soybean, groundnut and beans into crop production may enrich household diets with essential macro- and micronutrients. Results further indicate that training on agronomic practices was associated with increased productivity and diversification of production and dietary intake. Conclusion This study has shown that targeted interventions aimed at increasing food crop production and dietary diversity have the potential to improve food production and dietary diversity. These findings reinforce the premise that crop diversification has a positive correlation with diet quality. Similarly, training farmers on food production, processing and dietary diversification is critical not only in improving agronomic practices but also the diet of farmers