Banda Nyirenda, D.

Hâ¿sken, S.M.C.

Sampa, M.

English

Research Papers in Economics

1 
 
Summary
i 
Baseline study: Nutritional status, food security and fish consumption among 
people living with HIV/AIDS in Zambia. 
 
D. Banda Nyirenda, M. Sampa, and S.M.C. Hüsken (2010) 
 
 
Introduction 
 
Availability and intake of nutritious foods is essential for people living with HIV/AIDS to keep 
them  healthy,  active  and  to  prolong  their  lives.  A  stronger,  healthier  body  can  better  resist 
opportunistic infections, while food insecurity and poor nutritional status may hasten progression 
from HIV into AIDS and may undermine adherence and response to Anti Retroviral Treatment 
(ART). Understanding food availability and accessibility, and the nutritional quantity and quality 
of food intake, is imperative in resource limited settings where malnutrition and food insecurity 
are chronic or endemic, as is the case in many parts of Zambia.  
 
Statistics  on  malnutrition  and  stunting  among  children  in  different  parts  of  Zambia  are 
increasingly available. However, knowledge is limited on which and how many nutrients are 
required at various stages of progression of HIV/AIDS to mitigate the disease and the best ways 
to assess malnourishment with regard to macro-nutrients (energy, protein) and micro-nutrients 
(vitamins, minerals) based on people’s food intake. Different foods contain varying quantities of 
the nutrients required for normal health, growth and body repair in sickness. All the required 
nutrients cannot be found in one food type, but some foods can provide a major part of the 
needed nutrients. Fish is such a food that contains high quantity and quality nutrients; it contains 
high biological availability of nutrients such as proteins, fats, vitamins and minerals. 
 
Under the regional programme Fisheries and HIV/AIDS in Africa, the University of Zambia, in 
collaboration with the WorldFish Center, has undertaken a baseline survey of the nutritional 
status and fish consumption of people living with HIV/AIDS in Zambia.  
 
Methods 
 
The lead researcher from the University of Zambia trained a team consisting of four university 
graduates on interactive questionnaire administration and Participatory Rural Appraisal (PRA) 
methods. The research team developed, tested and conducted the baseline questionnaire in four 
target areas; two rural sites and two peri-urban sites. A total of 145 respondents were interviewed 
at  their  respective  health  centres.  All  respondents  signed  an  informed  consent  declaration, 
participation was anonymous and the research team observed strict confidentiality practices. 
 
Data  were  uploaded  into  Excel  format,  after  which  the  lead  researcher  and  biometricians 
analyzed the data using SPSS software. Frequencies and cross tabulations of information from all 
four peri-urban and rural areas targeted were completed and the narrative results per target area 
were analyzed and integrated within the coded data set. The statistical analysis of the coded data 
using SPSS Pearson’s Chi square’s associations of variables showed some trends, some of which 
were not significant and cannot be generalized to a larger population. 2 
 
Study results 
 
a.  Socio-economic profile of respondents 
The  study  found  that  40%  of  the  sample  population  were  female  headed  households,  with 
women being the majority of the 86% of people living on less than 5 million Zambian Kwacha 
(≈ USD 1000) per year. Women were also found to be more heavily dependent on their children 
and more likely to be trapped in the widely acknowledged vicious cycle of food insecurity in a 
context of HIV/AIDS and malnutrition. Education levels of respondents were generally low, with 
half of the respondents having attended grade 1-7 of primary school, while 38% had completed 
grade  8-12,  and  12%  had  never  been  to  school.  The  majority  (80%)  of  the  rural  female 
respondents  claimed  they  had  only  attended  lower  primary  school  (grade  1-4)  and  as  a 
consequence they were often unemployed or working as subsistence farmers. However, yields 
did not last for more than three months per year. While income levels were found to be generally 
low, those living in rural areas had more people with lower income (86% lived on 0-5 million 
Kwacha per year) than those in peri-urban areas (64% in the same income category). 
 
b.  Availability of fish 
Fish, meat and chicken are the most commonly found animal protein sources in all four study 
sites. Fish, mainly bream and kapenta (small dried fish), was found to be most preferred, most 
consumed and most available to fishing and retailing households. While fish is mainly destined 
for sale, some fish is used for home consumption when unsold or when lacking other animal 
protein or vegetables to accompany the staple food nshima (maize meal). Kapenta was found to 
be  most  affordable  and  easily  divisible  among  household  members.  Especially  in  peri-urban 
areas, consumption of fish (bream or kapenta) depends on purchasing power of the household 
and the study found that poorer households (36% in rural and 22% in peri-urban areas) rarely - 
probably no more than once a month - eat large fish or meat,. In both rural and peri-urban areas, 
respondents indicated not having enough money to buy meat, chicken or whole large fish, as 
they are expensive. This is another reason why kapenta is popular.  
 
c.  Fish consumption and preparation 
The most common staple for lunch and supper was nshima (maize meal) with vegetables, nshima 
with fish, and nshima with beef. Most families (75%) were found to eat together, while in some 
households (15%) the children ate first; in a few households (10%) the father ate first. In both 
rural and peri-urban areas it was found that the prevailing practice was to give every household 
member their food on their own plate, which allows children to get an equitable share and be 
able to finish their meal at their own pace.  
 
The amount and types of fish consumed varied among the respondents in the different target 
areas.  The  majority  of  respondents  claimed  to  prefer  fresh  and  dried  bream,  but  actual 
consumption  depends  on  purchasing  power  of  the  household.  Respondents  had  a  strong 
preference for fresh fish, but could only afford kapenta, which is highly nutritious but not as 
much preferred as large bream. Dried kapenta was often cooked in groundnut sauce in order to 
extend  the  small  amount  of  fish,  or  cooked  for  a  long  time  and  added  to  large  amounts  of 
vegetables such as cabbage, pumpkin leaves, onion and tomato, to make the vegetables taste of 
fish. This indicates respondents’ preference for fish, but the nutritional losses of these types of 
preparation have yet to be determined.  3 
 
 
Kapenta was said to have a bitter taste, so some respondents were found to remove the stomach. 
As a consequence, a lot of nutrients are removed, reducing the potential nutritional benefits. A 
few  respondents  claimed  to  develop  allergic  reactions  to  kapenta,  but  for  the  majority  of 
respondents  it  is  the  default  animal  protein  source  when  income  does  not  allow  for  more 
expensive fish or other animal protein sources. 
 
All respondents reported the same process for cleaning large fresh fish before cooking; fresh fish 
is cleaned by removing gills, intestines, scales, and washed in clean water, the fish is then boiled 
whole or cut in half in a saucepan with water, a little oil, tomato and onion if available. The 
cleaned fresh fish can also be fried in cooking oil and gravy made from fried chopped tomato 
and onion. Preparation of dried fish also appeared to be similar among most respondents. Some 
respondents stated that they rinse the dried fish with warm or cold water, while others first clean 
the dried fish by removing gills and excess scales. The dried fish is then washed in warm water 
and boiled in water as a whole or cut in pieces to fit the pot. Cooking oil, tomato and onion can 
be  added  when  available.  Another  method  of  preparation  includes  washing  the  dried  fish, 
allowing it to soak a little, then rubbing it with salt and roasting it over a charcoal fire, on a grill, 
or frying it in a pan. Dried fish can be boiled with different types of vegetables as extenders. 
Preparation  of  small  fresh  fish  (kapenta)  was  done  in  the  same  manner  by  all  respondents; 
removing scales, gills and intestines, then washing it in cold water, sun-drying it if possible, and 
then pan-frying or boiling and adding pounded groundnuts.  
 
Fish powder supplementation was received by some respondents in the two rural sites through an 
NGO at their health clinic. The fish powder is mixed with pounded groundnuts and added to 
porridge or used it as sauce for nshima. Some added the powder to vegetables, which made it 
taste like dried fish with vegetables. The respondents in the peri-urban sites had never received 
fish  powder  supplementation  from  external  sources,  including  their  respective  clinic.  Some 
elderly respondents recalled that many years ago, the under-five clinic advised them to pound 
dry kapenta and add it to children’s porridge to help prevent malnutrition. The study did not find 
evidence that these practices still exist. 
 
The study found a trend that more respondents prefer to consume processed, mostly dried, fish 
(72%) compared to fresh fish (28%). Respondents from the rural site next to the river were no 
exception, although one would assume these people to have more access to fresh fish. Most 
respondents (93%) in all four target communities, when asked what fish they preferred, indicated 
they preferred large rather than small fish. 
 
Conclusions and recommendations 
 
Although further research and stronger data sets are needed, the authors draw some tentative 
conclusions. The main point is the importance of having reliable access to food for health and 
survival.  Households  without  regular  income  were  found  to  be  more  vulnerable  to  food 
insecurity,  and  faced  poor  health  and  disease  as  a  consequence,  especially  female  headed 
households. Fish is the most preferred source of protein, with kapenta (small dried fish) being 
the  most  commonly  consumed  animal  protein,  although  not  consumed  in  large  quantities. 
However, access to fish depends on availability of cash and most people living with HIV/AIDS 4 
 
are too poor to even  afford frequent consumption of the accessible,  cheaper kapenta. While 
kapenta is easy to share and extend with vegetables, real quantitative intake seemed to be low 
due to intra household sharing of food. Further research is required to confirm actual intake of 
protein and other foods per household member. 
 
Nshima is the major staple for all respondents, who interpreted “being food secure” with eating 
this  traditional  Zambian  maize  meal  2  to  3  times  per  day.  The  study  confirmed  that  rural 
households were much poorer than peri-urban households, based on comparison of occupation, 
income and individual household asset ownership. For most respondents, low income combined 
with low asset ownership contributes to a vicious cycle of chronic hunger and food insecurity. A 
variety of nutrition information is provided, but a disparity in nutrition information and education 
between the rural and the peri-urban target areas was noted. Information provided included the 
importance of good nutrition and examples of what people living with HIV/AIDS should eat or 
avoid consuming. However, due to regular or permanent lack of food at household level, most 
respondents cannot practice the well intended training and information on nutrition which they 
have received at their respective health centres. 
 
The data gathered has provided an insight into the often desperate food insecurity and poverty 
faced by rural and peri-urban households where one or more household members are living with 
HIV/AIDS. Based on study findings and analysis, key recommendations include: 
 
 
 
 
 
 
 
 
 
 
 
           
          For further information on this study, please contact: 
 
          Saskia M.C. Hüsken 
          Regional Advisor Fisheries, Health and HIV/AIDS 
          The WorldFish Center 
          4186 Addis Ababa Road, Longacres, Lusaka 
          S.Husken@cgiar.org 
 
 
                                                       
i The full report: Banda Nyirenda, B., Sampa, M. and Hüsken, S.M.C. (2010). Baseline study: Nutritional status, 
food security and fish consumption of people living with HIV/AIDS in Zambia was produced under the Regional 
Programme Fisheries and HIV/AIDS in Africa: Investing in Sustainable Solutions and can be obtained from 
www.worldfishcenter.org/wfcms/SF0959SID or from the WorldFish Center office in Lusaka. 
￿  Increased funding for studies on fish and food consumption among people 
living with HIV/AIDS in Zambia;  
￿  Studies on the effects of fish on Anti Retroviral Therapy (ART);  
￿  Studies on the effectiveness of sustainable income generating activities on 
the food and nutritional status of people living with HIV/AIDS, including 
small scale aquaculture;  
￿  Baseline  information  on  nutritional  and  food  security  status  and  fish 
consumption  of  HIV/AIDS  infected  and  affected  fishing  communities  in 
Zambia. 

Baseline study: nutritional status, food security and fish consumption among people living with HIV/AIDS in Zambia: summary

http://www.worldfishcenter.org/resource_centre/WF_2767.pdf

Baseline study: nutritional status, food security and fish consumption among people living with HIV/AIDS in Zambia: summary

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