Nutrition and health status of HIV-infected adults on ARVs at AMREF clinic Kibera Urban Slum, Kenya

The health of people living with HIV and AIDS (PLWHA) is nutritionally challenged in many nations of the world. The scourge has reduced socio-economic progress globally and more so in sub-Saharan Africa (SSA) where its impact has been compounded by poverty and food insecurity. Good nutrition with proper drug use improves the quality of life for those infected but it is not known how PLWHA exposed to chronic malnutrition and food shortages from developing nations adjust their nutrition with use of Anti-Retro-viral Drugs (ARVs). This study assessed nutritional status, dietary practices, and dietary management of common illnesses that hinder daily food intake by the patients and use of ARVs with food recommendations provided by the health care givers. A descriptive case study design was used to sample 120 HIV-infected patients using systematic sampling procedure. These patients sought health care from an urban slum, Kibera AMREF clinic. Data were collected by anthropometric measurements, bio-chemical analysis, semi-structured questionnaire and secondary data. The Statistical Package for Social Sciences (SPSS) and the Nutri-Survey software packages were used to analyze data. Dietary intakes of micro-nutrients were inadequate for >70% of the patients when compared to the Recommended Daily Requirements. When Body Mass Indices (BMI) were used, only 6.7% of the respondents were underweight (BMI<18.5kg/m2) and 9.2% were overweight (BMI> 25kg/m2), serum albumin test results (mean 3.34+0.06g/dl) showed 60.8% of the respondents were protein deficient and this was confirmed by low dietary protein intakes. The BMI was not related to dietary nutrient intakes, serum albumin and CD4 cell counts (p>0.05). It appeared that there was no significant difference in BMI readings at different categories of CD4 cell count (p>0.05) suggesting that the level of immunity did not affect weight gain with ARV as observed in many studies from developed countries. Malnutrition was, therefore, evident among the 60.8% of the cases as identified by serum albumin tests and food intake was not adequate (68%) for the patients as they ate once a day due to lack of food. National food and nutrition policy should incorporate food security boosting guidelines for the poor people infected with HIV and using ARVs.Keywords: Diet, Nutrition, HIV/AIDs, Serum albumin, CD4 cell count

The effect of dose on the antimalarial efficacy of artemether-lumefantrine: a systematic review and pooled analysis of individual patient data

Background: Artemether-lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malaria-endemic settings. Methods: We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites. Findings: We included 61 studies done between January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97·6% (95% CI 97·4-97·9) at day 28 and 96·0% (95·6-96·5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0·92, 95% CI 0·86-0·99 for every 1 mg/kg increase in daily artemether dose; p=0·024), but not on day 2 (p=0·69) or day 3 (0·087). In Asia, children weighing 10-15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91·7%, 95% CI 86·5-96·9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1-3 years (PCR-adjusted efficacy 94·3%, 95% CI 92·3-96·3). A higher artemether dose was associated with a lower gametocyte presence within 14 days of treatment (adjusted OR 0·92, 95% CI 0·85-0·99; p=0·037 for every 1 mg/kg increase in total artemether dose). Interpretation: The recommended dose of artemether-lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups. Funding: Bill and Melinda Gates Foundation

The availability of processed fruit products and their contents of vitamins A and C in Nairobi, Kenya

In Kenya, among children of less than five years, 84% have vitamin A deficiency, 73.4% have iron deficiency, and 51% have zinc deficiency. Among women, 39% have vitamin A deficiency, while among pregnant women, 60% have iron deficiency. Among adult males, 16% have iron deficiency. Improving vitamin A status of children in developing countries reduces child death rates by 20-50%. The WHO recommends per capita consumption of 200 g of fruit on average daily to supply vitamins. Consumption of fruit is low because of lack of awareness on benefits of fruit, poverty and post-harvest losses due to lack of skills for processing and storage. The objectives of this research were to survey household consumption of foods especially processed fruit products in Nairobi, and analyze nutritional quality of processed fruit products. Three estates representing different income groups were selected for the study. Household monthly low, middle, and high incomes were, respectively KES ≤14000, KES 14001 to 56000 and KES >56000; (KES 69 = US$1). A random sample of 130 households per estate was interviewed using 24 hour recall for seven days to assess consumption of processed fruit products. Laboratory analyses were carried out on contents of vitamin A and C. Results showed that all income groups did not consume recommended amounts of fruit products. Those who consumed processed fruit products consisted of 4.5% low income, 33% middle income and 62.5% high income households. Per capita annual consumption by the low income averaged 2.9 L fruit soft drinks, by the middle income was 5.9 L fruit soft drinks and 0.51 kg fruit preserve, and by high income group were 12 L fruit soft drinks and 0.95 kg fruit preserve. Per capita average consumption per annum was 7 L fruit soft drinks and 0.5 kg fruit preserve. Laboratory analysis of processed fruit products showed that they had good content of vitamin C and some vitamin A. However, vitamins are not included in national standards for these products. Quality failure involved one fruit-flavoured drink because it was labelled with fruit pictorial. It is recommended that public education be carried out on use of fruit products for nutrition, poverty reduction and health. Processors should apply quality standards, nutritional labelling and controlled pricing to improve consumption of fruit products. Results of this study shall be useful to processors, consumers, nutritionists, government agencies and UN organizations for promoting production, processing, and consumption of fruit products by Kenyans. Keywords: Processed fruit products, consumption, quality. AJFAND Vol. 9 (1) 2009: pp. 566-57

Hygiene practices in urban restaurants and challenges to implementing food safety and Hazard Analysis Critical Control Points programmes in Thika town, Kenya

Objectives: To determine the microbial load in food, examination of safety measures and possibility of implementing an Hazard Analysis Critical Control Points (HACCP) system.Design: The target population for this study consisted of restaurants owners in Thika Municipality (n=30). Simple random samples of restaurants were selected on a systematic sampling method of microbial analysis in cooked, non-cooked, raw food and water sanitation in the selected restaurants.Subjects: Two hundred and ninety eight restaurants within Thika Municipality were selected. Of these, 30 were sampled for microbiological testing.Results: From the study, 221 (74%) of the restaurants were ready to eat establishments where food was prepared early enough to hold and only 77 (26%) of the total restaurants, customers made an order of food they wanted. 118 (63%) of the restaurant operators/staff had knowledge on quality control on food safety measures, 24 (8%) of the restaurants applied these knowledge while 256 (86%) of the restaurants staff showed that food contains ingredients that were hazard if poorly handled. 238 (80%) of the resultants used weighing and sorting of food materials, 45 (15%) used preservation methods and the rest used dry foods as critical control points on food safety measures.Conclusions: The study showed that there was need for implementation of Hazard Analysis Critical Control Points (HACCP) system to enhance food  safety. Knowledge of HACCP was very low with 89 (30%) of the restaurants applying some of quality measures to the food production process systems. There was contamination with Coliforms, Escherichia coli and Staphylococcus aureus microbial though at very low level. The means of Coliforms, Escherichia coli and Staphylococcus aureas microbial in sampled food were 9.7 × 103CFU/gm, 8.2 × l03CFU/gm and 5.4 × l03 CFU/gm respectively with Coliforms taking the highest mean