Undernutrition and associated factors among adults living with Human Immune Deficiency Virus in Dembia District, northwest Ethiopia: an institution based cross-sectional study

Rural-urban disparities in nutritional status among women in Ethiopia based on HIV serostatus: a cross-sectional study using demographic and health survey data

BACKGROUND

Ethiopia is one of the sub-Saharan African countries most affected by the human immunodeficiency virus (HIV) epidemic and also by severe undernutrition, which is particularly prevalent among women. HIV infection, reproductive biology, and their role in society increase the vulnerability of women to malnutrition. Various factors including urbanization could cause differences in the nutritional status of rural and urban residents. In this study, we aimed to assess rural-urban disparities in nutritional status among women of reproductive age based on HIV serostatus in Ethiopia.

METHOD

Data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 were used. Among 15,683 women included in the survey, 8822 non-pregnant women aged 15-49 years, including those who gave birth two months before the DHS survey were included in this study. Multinomial logistic regression was used to determine the relative risk ratios (RRR) for the associations between study variables.

RESULTS

Generally, the prevalence of underweight among women of reproductive age was higher in rural residents (28.9%) than in urban residents (12.3%) in Ethiopia. Being overweight was more prevalent among urban women than rural women, (35.1% vs. 4.8%). About 32% of HIV-positive women were underweight in both rural and urban areas. About 29% of HIV-positive urban women were overweight compared to 3.4% of HIV-positive rural women. Among urban residents, HIV-positive women were about 4 times more likely to be underweight than their HIV-negative counterparts, RRR 3.8 (95% CI: 1.58, 9.26). However, there was no significant difference in nutritional status between HIV-positive and HIV-negative women living in rural areas. Anemic women were more likely to be underweight while, wealthy women were less likely to be underweight in both rural and urban areas. Women aged 25-49 years were generally more likely to be overweight/obese and less likely to be underweight compared to younger women aged [Formula: see text]years.

CONCLUSION

Malnutrition was more prevalent among HIV-positive women living in urban Ethiopia. Targeted nutritional interventions for HIV-positive women of reproductive age living in urban areas could be considered. Furthermore, efforts should be made to improve the nutritional status of women of reproductive age across the country.

Levels of undernutrition and associated factors among adults receiving highly active anti-retroviral therapy in health institutions in Bench Maji Zone, Southwest Ethiopia in 2018

Background

Nutritional issues are common in people with Human Immune Virus (HIV). At some point, almost everyone living with HIV faces challenges in maintaining good nutrition. There is insufficient evidence-based information on undernutrition in adults living with HIV on Highly Active Anti-Retroviral Therapy.

Objective

To assess the magnitude of undernutrition and associated factors among patients receiving Highly Active Anti-Retroviral Therapy in health facilities in the Bench Maji Zone, southwest Ethiopia in 2018.

Methods

A facility-based cross-sectional study design was employed from 1 May to 30 June 2018 on 1,007 study subjects and the participants were selected by using a consecutive sampling technique. Five health facilities were selected through a simple random sampling technique. Data were entered into Epi Data Statistical software version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software version 21.0. Logistic regression analysis was used to identify factors associated with undernutrition in adults receiving ART. Odds ratios with 95 % confidence intervals were used to examine associations between dependent and independent variables.

Result

Of the total 1,007 study subjects, 961 participated in the study. More than half of the participants were female (61.2%), 57.2% were married and 42.9% were in the 30–39 years age group. In this study, the level of undernutrition among patients on antiretroviral therapy was 16%. Age ≥50 [AOR 2.5, 95% CI (1.1–5.6)], being single [AOR 2.2, 95% CI (1.4–3.7)], developing gastrointestinal symptoms [AOR 2.6, 95% CI (1.5–4.4)] and in WHO-defined clinical stages III and IV of HIV/AIDS [AOR 2.8, 95% CI (1.3–6.0)] were found to have a statistically significant association with undernutrition.

Conclusion

Significant numbers of people on highly active antiretroviral therapy in the study area were undernourished. This demonstrated that HIV/AIDs and its treatment directly or indirectly impacted the nutritional status of the patients, who need a critical follow-up from health workers. Age, marital status, progressing to WHO-defined clinical stage of disease, and development of gastrointestinal symptoms were identified as factors that contribute to undernutrition among patients on highly active antiretroviral therapy. The health care workers and experts working at the ART clinic should focus on patient counseling regarding the early prevention, detection, and treatment of opportunistic infections. Early health-seeking behaviors before the AIDs stage and critical follow-up are the first actions to identify undernutrition.

Time to Nutritional Recovery and Its Predictors Among Undernourished Adult Patients Living with Human Immune Deficiency Virus Attending Anti-Retroviral Therapy at Public Health Facilities in Southwest Ethiopia. A Multicenter Study

Background

Infection with the human immunodeficiency virus is one of the factors that contribute to malnutrition. Several initiatives have been launched in Ethiopia to improve HIV patients’ nutritional status and achieve early recovery when malnourished patients are found. Despite these efforts, adult HIV patients’ malnutrition recovery remains poor.

Objective

The objective of this study was to assess the time to recovery from undernutrition and associated factors among adult HIV patients on ART at public health facilities in Ilu Aba Bor zone, Southwest Ethiopia, 2021.

Methods

An institution-based retrospective cohort study of 374 adult HIV patients with undernutrition receiving ART at public health institutions in Southwest Ethiopia was conducted. Data were extracted from the patient’s record and entered into Epi-Data version 3.1 before being exported to STATA version 14. The Kaplan–Meier method was used to estimate the time to recovery, and the difference in survival time between predictor variables was tested using the Log rank test. Weibull regression models, both bivariable and multivariable, were fitted. A p-value of 0.05 was declared statistically significant.

Results

The recovery rate was 67.7% and the median recovery time was 65 days (95% CI = 61.6–68.4) and 145 days (95% CI = 130.7–159) for MAM and SAM, respectively. Marital status (Married) (AHR = 0.61; CI = (0.43,0.86)), ART status (pre ART) AHR = 0.492; CI = (0.305,0.793), CD4 (200-350c/m3, AHR = 2.116;CI = (1.447,3.21), type of malnutrition (AHR = 0.22; CI= (0.156,0.307)), ART adherence level (AHR = 3.33, CI = (1.997,5.56)) WHO clinical staging (AHR = 0.685, CI = (0.485,0.948)), sex (male), (AHR = 0.678; CI = (0.509,0.901)) and age (35–54), (AHR = 1.86; CI = (1.408,2.47)) were predictors of recovery time.

Conclusion

Compared to previous studies, the recovery rate was high. SAM, advanced clinical stage, sex, and marital status were all negatively associated with nutritional recovery time, whereas ART adherence, CD4 count, and age were predictors. As a result, a therapeutic feeding program should focus on factors that slow recovery time.

Prevalence of Food Insecurity and Its Associated Factors among Adult People with Human Immunodeficiency Virus in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Food insecurity is the shortage of both the quantity and quality of food and a negative impact on the overall nutritional and health status of people with human immunodeficiency virus (HIV). Ethiopia is intensely affected by food insecurity which is about 87.4% of adult people living with human immuno deficiency virus (HIV) are still facing shortage to have access to safe, sufficient, and nutritious food for themselves and their family. However, there is no concrete scientific evidence established at the national level in Ethiopia. Hence, this review gave special emphasis on adult people with human immunodeficiency virus (HIV) to estimate the pooled prevalence of food insecurity and its associated factor at the national level in Ethiopia.

METHODS

Studies were retrieved from selected electronic data bases, including PubMed/Medlin, Cochrane library, Sciences Direct, Google, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled prevalence of food insecurity and its associated factors at 95% confidence interval with odds ratio (OR) using statistical R-software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias was checked using the funnel symmetry test, and heterogeneity was checked using forest plot and inverse variance square (I 2). The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search.

RESULT

A total of 650 articles were identified through the initial search of which 20 studies were included in the final review yielding a total sample size of 7,797 adult people with human immunodeficiency virus (HIV). The pooled prevalence of food insecurity was 52% (95% CI, 40%, 63%). Cluster of differentiation 4 (CD4) count < 350 cell/mm3 [AOR = 1.29 (95% CI, 1.08, 1.54)], develop opportunistic infection [AOR = 4.09 (95% CI, 2.47, 6.78)], rural residence [AOR = 1.59 (95% CI, 1.09, 2.34)], and World Health Organization (WHO) clinical stages III and IV [AOR = 1.98 (95% CI, 1.23, 3.19)] was among the significantly associated factors.

CONCLUSION

In this review, there was a high prevalence of food insecurity among adult people with human immunodeficiency virus. Therefore, the responsible stockholders should strengthen the system and procedure for early diagnosis of opportunistic infection, under nutrition, screening of underlying problems.

Underweight and Its Predictors Among Patients on Anti Retroviral Therapy at Selected Health Facilities of Addis Ababa, Ethiopia, 2020

Objective

The study aimed at assessing the prevalence of underweight and its predictors in patients on ART, in health facilities of Addis Ababa, Ethiopia, 2020.

Methods

A multi-center-based cross-sectional study was conducted among 319 patients on ART selected on the basis of stratified sampling method in Addis Ababa from July 01 to August 30, 2020. An interviewer-administered structured questionnaire was used for collection of the data, after which informed consent was obtained from all the included participants. Descriptive statistics for the summarization of the data was used. Binary (Bivariate and multivariate) logistics regression was applied for the identification of predictors of underweight and its strength of association with their respective 95% confidence intervals and less than 5% p-values as statistically significant association.

Findings

The prevalence of underweight among patients on ART was 19.1% (95% CI: 15.0-23.9%), while more than one-tenth (14.4%) of the participants were overweight (95% CI: 10.8-18.8%). A higher level of Educational level, being married, widowed, divorced, a lower family size and poor ART drug adherence level were statistically significantly associated with an increased risk of underweight among patients on ART in the study settings (p<0.05).

Conclusion

Educational level, marital status, family size, and adherence status of the participants were identified predictors of underweight among patients on ART. The lower the educational level, lower family size, being either married, divorced, or widowed, having had of poor ART drug adherence level of the participants, the higher their risk of sustaining underweight. Concerned bodies were suggested to work over the identified determinants of underweight among patients on ART in the study settings.

Assessment of Prevalence of Malnutrition and Its Associated Factors among AIDS Patients from Asella, Oromia, Ethiopia

Sub-Saharan Africa remains to be the most heavily affected region by malnutrition, accounting for 23.8% share of the global burden. Undernutrition weakens the immune system, increases the susceptibility to infections, and may worsen the impact on various kinds of diseases. Our aim was to assess undernutrition and its associated factors among AIDS-infected adult patients from Asella, Oromia Region, Ethiopia. An institutional-based cross-sectional study design was employed from June to July 2018. A total number of 519 patients were selected for the proposed work. Data was entered into EpiData, checked, coded, and analyzed using SPSS version 21 software. Descriptive statistics were used to assess the prevalence of undernutrition among patients. Bivariate and multivariate regressions were used to determine the relationship between undernutrition and its associated factors among the study participants. The results of our study showed that the overall prevalence of undernutrition was 18.3%; out of which 12.7% were mildly and 5.6% were moderately to severely undernourished, respectively. Monthly income (AOR: 3.589, 95% CI (1.469-8.768)), whole grain feeding (AOR: 2.979, 95% CI (1.252-7.088)), opportunistic infections in the last six months (AOR: 3.683, 95% CI (3.075-4.411)), clinical stage (AOR: 2.998, 95% CI (1.269-7.083)), and insufficient quality of food (AOR: 3.149, 95% CI (1.339-7.406)) were found to be significantly associated with undernutrition in this study. Therefore, HIV treatment facility should be supported with nutritional assessment, supplementation, counseling, care, and support to patients that may possibly alleviate this predicament.

Undernutrition and associated factors among adult HIV/AIDS patients receiving antiretroviral therapy in eastern zone of Tigray, Northern Ethiopia: a cross-sectional study

Background

Undernutrition and HIV/AIDS are highly prevalent in sub-Saharan Africa, Ethiopia inclusive as linked in a vicious cycle. Thus, several studies have documented that undernutrition among HIV/AIDS patients increases the risk of mortality, decrease survival rates, affect the overall clinical outcome and quality of life.Despite this fact, information about the burden of undernutrition and associated factors among adults receiving antiretroviral therapy is lacking in the particular study area. Hence, this study aimed to examine the prevalence of undernutrition and associated factors among adult HIV/AIADS patients receiving antiretroviral therapy patients in Eastern Zone of Tigray, Northern Ethiopia.

Methods

A cross-sectional research design was adopted in data collection while systematic sampling technique was employed to sample and select the study subjects. A structured questionnaire was used to collect information from 394 study subjects through face to face method.Also, data on demographics, laboratory and anthropometric variables were collected from each selected patients sampled.The data collected were entered and analyzed using SPSS version 22.. Bivariate and multivariable logistic regression analysis with 95% confidence interval were used to find factors associated with undernutrition. The adjusted odds ratio was calculated to show the strength of the association. Variables with p-value of < 0.05 were considered statically significant.

Results

The mean age of the respondents was 41 (± 10). Out of 394 study respondents, about 42.9% of them were undernourished (95% CI: 37.8-47.7).Respondents who had CD4+ count less than 200 cells/μl (AOR = 1.84; 95% CI: 1-3.36), being advanced clinical staging (AOR = 3.6; 95% CI: 2.11-6.18), and not taking co-trimoxazole preventive therapy (AOR = 2.38; 95% CI: 1.21-4.6) were independently associated with undernutrition.

Conclusion

The result of this study indicated that the prevalence of undernutrition was high.Respondents with advanced clinical stage of CD4+ count less than 200 cells/ul and those that were not taking co-trimoxazole preventive therapy was found to be positively associated with undernutrition.Therefore, the implementation of nutritional programs is very crucial to improve the nutritional status of HIV/AIDS patients in the particular study.

Undernutrition among Ethiopian adults living with HIV: a meta-analysis

Background

Malnutrition and human immunodeficiency virus (HIV) are interlaced in a vicious cycle and worsened in low and middle-income countries. In Ethiopia, even though individuals are dually affected by both malnutrition and HIV, there is no a nationwide study showing the proportion of malnutrition among HIV-positive adults. Consequently, this review addressed the pooled burden of undernutrition among HIV-positive adults in Ethiopia.

Methods

We searched for potentially relevant studies through manual and electronic searches. An electronic search was carried out using the database of PubMed, Google Scholar, and Google for gray literature and reference lists of previous studies. A standardized data extraction checklist was used to extract the data from each original study. STATA Version 13 statistical software was used for our analysis. Descriptive summaries were presented in tables, and the quantitative result was presented in a forest plot. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I² test. Finally, a random-effects meta-analysis model was computed to estimate the pooled proportion of undernutrition among HIV-positive adults.

Results

After reviewing 418 studies, 15 studies met the inclusion criteria and were included in the meta-analysis. Findings from 15 studies revealed that the pooled percentage of undernutrition among HIV-positive adults in Ethiopia was 26% (95% CI: 22, 30%). The highest percentage of undernutrition (46.8%) was reported from Jimma University specialized hospital, whereas the lowest proportion of undernutrition (12.3%) was reported from Dilla Hospital. The subgroup analyses of this study also indicated that the percentage of undernourishment among HIV-positive adults is slightly higher in the Northern and Central parts of Ethiopia (27.5%) as compared to the Southern parts of Ethiopia (25%).

Conclusion

This study noted that undernutrition among HIV-positive adults in Ethiopia was quite common. This study also revealed that undernutrition is more common among HIV-positive adults with advanced disease stage, anemia, diarrhea, CD4 count less than 200 cells/mm³, and living in rural areas. Based on our findings, we suggested that all HIV-positive adults should be assessed for nutritional status at the time of ART commencement.

Reducing Undernutrition through Counseling on Diversified Food Intake among Adult People Living with HIV on HAART, Northern Ethiopia

Background

HIV/AIDS and malnutrition are interrelated and exacerbate one another in a vicious cycle. As HIV infection progresses it causes catabolic state and increases susceptibility to other infections, leading to progressive aggravation of undernutrition. However, data are lacking in Ethiopia on determinants of undernutrition among people living with HIV on antiretroviral therapy. Therefore, this study aimed to assess determinants of undernutrition among adult HIV/AIDS patients in Northern Ethiopia.

Method

Facility-based unmatched case-control study was conducted among 324 randomly selected people living with HIV on antiretroviral therapy (ART). A structured and pretested interviewer questionnaire was used to collect data, while digital Seca weight and Seca measuring rod were used to measure weight and height, respectively. Logistic regression was used to identify independent factors of undernutrition, and p value <0.05 was declared for statistical significance. All statistical analyses were performed using SPSS 21™.

Result

This study revealed that people of younger age and those on ART (AOR = 0.29 (95% CI: 0.10, 0.84)) had low risk of being undernourished. However, average individual monthly income (AOR = 2.61 (95% CI: 1.48, 4.61)), not receiving nutritional counseling during visits (AOR = 2.5 (95% CI: 1.52–3.89)), and low diet diversity (AOR = 10.55 (95% CI: 4.17, 26.73)) had higher odds of undernutrition among people living with HIV/AIDS.

Conclusion

Age of patients, average monthly income, nutritional counseling during visits, and diet diversity were the independent factors of undernutrition. Counseling on well-timed and sufficient consumption of nutritious foods, economic strengthening, and livelihood activities is important. Future longitudinal study is necessary to elucidate the problem of undernutrition among people living with HIV/AIDS.

Prevalence Of Undernutrition And Associated Factors Among Adults Receiving First-Line Antiretroviral Treatment In Public Health Facilities Of Arba Minch Town, Southern Ethiopia

Introduction

Access to antiretroviral drugs for all infected persons in need is a global health priority. The primary goals of initiating antiretroviral drugs are to suppress human immunodeficiency virus viral replication and to restore immune function. However, adequate nutrition is necessary to manage opportunistic infections and to maintain the immune system. Therefore, this study aimed to determine the recent prevalence of undernutrition and associated factors among HIV patients receiving first-line antiretroviral therapy in public health facilities of Arba Minch town, Gamo zone, Southern Ethiopia.

Methods

Institution-based cross-sectional study was used among 333 adult patients receiving first-line antiretroviral therapy at public health facilities of Arba Minch town. A simple random sampling technique was used to select the study subjects. Data were collected through interviewer-administered questionnaires. Binary and multivariable logistic regression analyses were used to identify factors associated with undernutrition. A p-value <0.05 with a 95% confidence level was used to declare statistical significance.

Results

The overall prevalence of undernutrition among adult patients receiving first-line antiretroviral therapy is 23.72% (95% CI: 19.13–28.27%). Current substance use (AOR=1.83, 95% CI:1.09–3.08), duration on antiretroviral therapy (AOR=1.87, 95% CI:1.06–3.30), not taking cotrimoxazole preventive therapy (AOR=2.09, 95% CI:1.15–3.82), advanced WHO clinical stages (AOR=5.1, 95% CI: 2.9–7.7), CD4 count less than 350 cell/mm³ (AOR=1.83, 95% CI: 1.09–3.05) and active tuberculosis (AOR=1.89, 95% CI: 1.02–3.53) were factors significantly associated with undernutrition among respondents who were enrolled on first-line antiretroviral therapy.

Conclusion

This study shows that the prevalence of undernutrition was high among adult patients on first-line antiretroviral therapy. Therefore, this finding shows the need to implement nutrition programs to improve the nutritional status of adults living with HIV in the study area. The interventions should emphasise those patients who use the substance, who are in advanced WHO clinical stage and have active tuberculosis. Besides, emphasis should be given for patients to undertake cotrimoxazole preventive therapy and to regularly follow their CD4 count.

Undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in the Arba Minch area, southern Ethiopia

Background: Undernutrition constitutes an important threat to the success of HIV programs in sub-Saharan Africa, and failure to effectively address it may jeopardize the benefits gained so far in the fight against HIV. The aim of the study was to assess undernutrition and associated factors among HIV-positive adult patients enrolled in antiretroviral therapy (ART) clinics in Arba Minch area, south Ethiopia.

Methods: A facility-based cross-sectional study was conducted in 2017. There were 351 adult individual study participants who were enrolled in ART clinics in Arba Minch area public health facilities. Variables with P-value less than 0.25 on binary logistic regression analysis were entered into a multivariate logistic regression model to outline the independent predictors of undernutrition. CI of 95% was used to assess precision of the study.

Results: Out of all the participants, 18.23% (95% CI: 14.52–22.65) were undernourished. The prevalence of undernutrition was significantly lower among those consuming food from five or more food groups per day (AOR: 0.33; 95% CI: 0.16–0.71) and undergoing ART for more than a year (AOR: 0.24; 95% CI: 0.08–0.73). On the contrary, the prevalence was significantly higher among those who were currently smoking tobacco (AOR: 6.67; 95% CI: 1.45–30.76). In addition, those with WHO clinical stage 3 had a significantly higher prevalence of undernutrition compared to those with WHO clinical stage 1 (AOR: 311; 95% CI: 1.47–6.60).

Conclusion: The prevalence of undernutrition was high among adults with HIV/AIDS enrolled in ART clinics in the study area. The prevalence of undernutrition was lower among those who consumed diverse food groups and had been receiving ART for longer (more than a year). On the contrary, the prevalence of undernutrition was higher among those who consumed tobacco and with higher WHO clinical stage. Therefore, efforts should be made to enhance the dietary diversity of these individuals.

Food Insecurity, Nutritional Status, and Factors Associated with Malnutrition among People Living with HIV/AIDS Attending Antiretroviral Therapy at Public Health Facilities in West Shewa Zone, Central Ethiopia

BACKGROUND

In resource limited settings, HIV/AIDS patients lack access to sufficient nutritious foods, which poses challenges to the success of antiretroviral therapy. HIV/AIDS and malnutrition are still major public health problems in Ethiopia. Though measuring nutritional status is an essential part of ART program, little evidence exists on food insecurity and nutritional status of HIV/AIDS patients in Ethiopia. Hence, the study aimed to determine food insecurity and nutritional status and contextual determinants of malnutrition among HIV/AIDS patients in West Shewa Zone, Ethiopia.

METHODS

Institution-based cross-sectional study was conducted among HIV/ADIS patients who have been attending antiretroviral therapy at public health facilities in West Shewa Zone from April to May 2016, Ethiopia. The sample size was 512 and study participants were selected from each facilities using systematic random sampling method. Data were collected using pretested questionnaire by trained data collectors. Data were entered to Epi-Info 3.5.1 for Windows and analyzed using SPSS version 22. Logistic regression analyses were conducted to determine independent factors associated with malnutrition.

RESULTS

Prevalence of malnutrition was 23.6% (95% CI: 19.7%-27.4%) and prevalence of household food insecurity was 35.2% (95% CI: 31.1%-39.0%). Factors significantly associated with malnutrition among HIV/AIDS patients were unemployment (AOR = 3.4; 95% CI: 1.8-5.3), WHO clinical stages III/IV (AOR = 3.3; 95% CI: 1.8-6.5), CD4 count less than 350 cells/μl (AOR = 2.0; 95% CI: 1.8-4.2), tuberculosis (AOR = 2.3; 95% CI: 1.3-4.9), duration on antiretroviral therapy (AOR = 1.8; 95% CI: 1.2-2.9), and household food insecurity (AOR = 5.3; 95% CI: 2.5-8.3).

CONCLUSIONS

The findings revealed high prevalence of malnutrition and household food insecurity among HIV/AIDS patients attended ART. The negative interactive effects of undernutrition, inadequate food consumption, and HIV infection demand effective cross-sectorial integrated programs and effective management of opportunistic infections like tuberculosis.