Dietary Intake, Nutrition Status, Morbidity and Factors Affecting Food Service of Male Prisoners Living with uman Immunodeficiency Virus at Selected Prisons Kenya

Abstract

Dietary intake and consequent nutrition status impacts on HIV either negatively or positively. Within prison settings, barriers exist that limit ability of prisoners to improve and maintain their health. Prisoners are a population recognized as vulnerable and socially excluded and poor nutrition status has been a hindrance to providing adequate treatment to those among them living with HIV. Generally, men's prison population is higher, have more muscle mass and perform hard chores hence making their nutritional requirements greater. The prisons were chosen because they had high HIV rates at 8.2% compared to the general population's 5.9%, The purpose of this cross sectional analytical study (n=113) was to assess factors affecting food service, dietary intake, nutrition and morbidity status of male prisoners living with HIV at selected prisons in Kenya. Purposive sampling procedure was used to select the prisons and study population. Simple random sampling was used to select the subjects for the study whereas proportionate sampling was used to get specific numbers per prison due to variance of number of prisoners living with HIV in the selected prisons. A structured questionnaire was used to collect demographic, 24 hour recall, food frequency and anthropometric data. An observation checklist and Focused Group Discussions was used to collect qualitative data. Anthropometric data were analyzed using World Health Organization classification while 24 hour recall was analyzed for mean nutrient consumption for key nutrients by use of Nutri-survey software. The 7 day recall was analyzed for food frequency. These data were further analyzed using SPSS software. Association between morbidity and nutrition status was analyzed using regression analysis. Pearson Chi-square was used to compare percentages between prisons. Pearson's Product Moment correlation (r) was used to analyze continuous data where P -value <0.05 was considered significant. Descriptive statistics were used to describe and summarize data on respondents', demographic characteristics and morbidity status. Results revealed that 50.4% of the prisoners were between ages 36-53 years. Primary education was attained by 60.2% and Secondary 21.2%. Mean dietary intake for macronutrients was Energy (815±218Kcal.), Protein (56±12g), fat (32±6g), Carbohydrates (322±45g), Fiber (41±23g) and PUFA (8±1g). None of the prisoners attained Recommended Daily Allowances (RDA) for energy, fat and PUFAs. Mean key micronutrient intake was Vitamin A (1195.1±812.7J.1g), ,. Vitamin B6 (1.9±0.9mg), Vitamin C (55.7±18.4mg), Iron (l0.2±2.7mg), Magnesium (488.l±152.3mg) and Zinc (13.9±6.7mg). However, none met the RDA for Sodium, Calcium and Iron. Normal nutrition status per Body Mass Index was 66.4% based on World Health Organization classification. A total of 14.2% of respondents were underweight, 15.9%overweight and 3.5% obese. The most prevalent illnesses were Anemia (20.9%) and Malaria (16.9%). A number of respondents also reported diarrhea (14.1%) and oral thrush (6.8%) which could have had a negative relationship with nutrition status. There was no significant relationship (P<0.05) between the study variables. Consumption of a nutritionally balanced diet in prisons can only be achieved by variety of foods that contain necessary nutrients. Support for therapeutic foods should be at source whenever needed and nutrition officers should be employed to support Nutrition Assessment Counselling and Support at prisons. Prison staff and prisoners should be given nutrition education as an integral part of health promotion and disease prevention. Prisoners' health is important and therefore management should be as stipulated in guidelines without discrimination. The nutrition guidelines for HIV should apply equally to both prisoners and non-imprisoned People Living with HIV.