High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa.

Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population

Nutritional status, food security status, and behaviors of participants in Dakar (n = 52) and Ziguinchor (n = 57), Senegal.

<p>BMI = Body Mass Index; MUAC = Mid-upper arm circumference; IDDS = Individual Dietary Diversity Scale (see text)</p><p>^aFood Insecure: HFIAS score = 2–4, Severely Food Insecure: HFIAS score = 4</p><p>*p-value for trend</p><p>Nutritional status, food security status, and behaviors of participants in Dakar (n = 52) and Ziguinchor (n = 57), Senegal.</p

Comparison of participant characteristics according to food security status^a.

<p>^aSeverely food insecure: HFIAS score = 4, Not severely food insecure: HFIAS score 1–3; BMI = Body Mass Index; MUAC = Mid-upper arm circumference; IDDS = Individual Dietary Diversity Scale (see text); HH = Household</p><p>^bEducated is defined as completed primary school or more</p><p>^cNumber of individuals per household</p><p>^dEstimated household monthly income in U.S. Dollars</p><p>^eEstimated U.S. Dollars spent on food for the household per day</p><p>*p-value for trend</p><p>**Mean and range based on raw data, p-value based on square root transformation</p><p>Comparison of participant characteristics according to food security status<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141819#t003fn001" target="_blank">^a</a>.</p

Participant characteristics in Dakar and Ziguinchor, Senegal, West Africa.

<p>^aNon-Senegalese nationalities = Guinea-Bissau, Guinea-Conakry, Gabon, Gambia, Mali</p><p>^bResidence in Dakar Region or Ziguinchor town</p><p>^cEducated is defined as completed primary school or more</p><p>^dNumber of individuals per household</p><p>^eEstimated household monthly income in U.S. Dollars</p><p>^fEstimated U.S. Dollars spent on food for the household per day</p><p>*Mean and range based on raw data, p-value based on log10 transformation</p><p>**Mean and range based on raw data, p-value based on square root transformation</p><p>Participant characteristics in Dakar and Ziguinchor, Senegal, West Africa.</p

Comparison of participant characteristics according to nutritional status.

<p>^aMalnourished = BMI <18.5</p><p>^bFood Insecure: HFIAS = 2–4, Severely Food Insecure: HFIAS score = 4; MUAC = Mid-upper arm circumference; IDDS = Individual Dietary Diversity Scale (see text); HH = Household</p><p>^cEducated is defined as completed primary school or more</p><p>^dNumber of individuals per household</p><p>^eEstimated household monthly income in U.S. Dollars</p><p>^fEstimated U.S. Dollars spent on food for the household per day</p><p>*Mean and range based on raw data, p-value based on square root transformation.</p><p>Comparison of participant characteristics according to nutritional status.</p

Comparison of HIV outcomes and associated behaviors according to food security status and nutritional status.

<p>^aSeverely food insecure: HFIAS score = 4; Not severely food insecure: HFIAS score 1–3.</p><p>^bMalnourished = BMI <18.5</p><p>Comparison of HIV outcomes and associated behaviors according to food security status and nutritional status.</p