Dietary practices and nutrition status of HIV-infected patients on ARVs at AMREF clinic Kibera-Nairobi
HIV and AIDS is a major health challenge to many nations globally. The scourge has scaled down social and economic progress in many countries and more so in the sub-Saharan Africa where its impact has further been compounded by escalating poverty levels and food insecurity. Studies from developed countries have shown that good nutrition with proper drug use improves longevity and productivity of life of those infected. Little is known about how HIV-infected persons faced with chronic malnutrition and regular food shortages from a developing nation like Kenya adjust their dietary practices to attain good nutrition with use of ARVs. The study sought to find out if HIV-infected patients on ARVs from resource-limited settings were able to practice good nutrition that would enable them to achieve optimal nutritional status and ensure proper drug use. Assessments were done on nutritional status, dietary practices, dietary management of common illnesses affecting food intake and ARV use with food recommendations. A descriptive case study design was used on one hundred and twenty systematically sampled HIV-infected patients registered for ARVs at AMREF Clinic of Kibera slums. Data were collected by, anthropometric measurements, bio-chemical analysis (serum total protein, albumin levels, cholesterol and haemoglobin), semi-structured questionnaire and secondary data. Statistical package of social sciences (SPSS) and Nutri-survey computer packages were used to analyze data. The patients ate one meal per day with their diets consisting of more carbohydrate foods. Quality protein foods were scarce in the diet just like fruits and indigenous vegetables. Dietary intake of vital micro-nutrients such as zinc, selenium, magnesium, calcium, iron, vitamins E, C, Bit, B2, folic acid and 136 were inadequate for >70% of the patients. While only 6.7% of the respondents were underweight (BMI<18.5), there were 9.2% of them who were overweight (BMI> 25kg/m2) and majority (84.2%) were normal (BMI 18.5-25k g/m2) though serum albumin test results showed (mean 3.34_+0.06g/dl) that 60.8% of the respondent were protein deficient, thus, malnourished. Dietary protein intakes were also low (33.10+2.23gm) for 44.2% of the respondents. The BMI was not related to dietary nutrient intakes and neither was it related to serum albumin and to CD4 cell counts (p>0.05). It appeared that there was no significant difference in BMI at different categories of CD4 cell count (p>0.05) suggesting that the level of immunity did not affect weight gain with ARV as has been found in many studies from developed countries. There was a significant relation ship between serum albumin and dietary intakes of all the nutrients (p<0.05) and the strength of the relationships was weak (r<0.5). Dietary food intakes were hindered by lack of appetite, coughs, heart-burn, dental problems, constipation and bloatedness. Patients seemed well informed on how to manage their nutrition problems but a few were practicing nutritionally risky measures such as licking ash, stopping to eat for a while, use of lemons or chewing medicine, that needed nutritional interventions. Malnutrition was evident among 60.8% of the cases as identified by serum albumin tests. Therefore, improving the respondents' access to quality food is a necessity. Nutritional projects for Kibera community need to be more focused on improving micro-nutrients and protein consumption as their intakes were inadequate in the diets assessed. Since majority (68%) of the patients only 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.