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Boneya DJ, Ahmed AA, Yalew AW. Food insecurity and its severity among adults receiving antiretroviral therapy in health facilities, northcentral Ethiopia: a multi-facility-based cross-sectional study. Front Public Health 2024; 12:1380958. [PMID: 39104892 PMCID: PMC11298467 DOI: 10.3389/fpubh.2024.1380958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024] Open
Abstract
Background Food insecurity plays a crucial role in predicting the spread of HIV due to the adverse effects of coping mechanisms adopted to mitigate it. However, there is a scarcity of context-specific evidence regarding food insecurity among HIV-infected adults. Therefore, this study aimed to assess the context-specific magnitude of food insecurity and associated factors among adults receiving antiretroviral therapy (ART) in health facilities in the North Shewa Zone, Ethiopia, ultimately contributing to the achievement of the 95-95-95 HIV treatment target in the local context. Methods A multi-facility cross-sectional study was conducted among 865 HIV-infected adults receiving ART and being followed up for their treatment. We included health facilities that provide ART, including four hospitals and six health centers. A log-binomial regression model was fitted to identify the association between food insecurity and independent variables. Adjusted prevalence ratios (APRs) with a 95% confidence interval were computed to measure the strength of the association. Results In this study, 290 (33.7, 95% CI: 30.60, 36.91) of the HIV-infected adults studied had food insecurity during their treatment and follow-up, of which 152 (52.41, 95% CI: 46.64, 58.13) and 110 (37.93%, CI: 32.50, 43.68) of them were found to have severe and moderate forms of food insecurity, respectively. We found that being younger (APR = 2.27, 95% CI: 1.12, 4.60), being female (APR = 1.87, 95% CI: 1.03, 3.39), lacking formal education (APR = 10.79, 95% CI: 14.74, 24.58), having lower educational status (APR = 5.99, 95% CI: 2.65, 13.54), being a daily laborer (APR = 6.90, 95% CI: 2.28, 20.85), having low monthly income (APR = 1.89, 95% CI: 1.11, 3.22), advanced WHO clinical stage (APR = 2.34, 95% CI: 1.08, 5.10), and receiving ART for less than 4 years (AOR = 2.28, 95% CI: 1.09, 4.74) were significantly associated with a high proportion of food insecurity among HIV-infected adults. Conclusion The magnitude of food insecurity among HIV-infected adults receiving ART was high, with an extremely high magnitude of severe food insecurity. The finding suggests the need for culture- and context-specific nutritional interventions to address the gender dynamics of food insecurity, attention to the early stage of ART, and the integration of strategies to improve educational status and enhance income-generation activities of HIV-infected adults. This requires an emphasis on the link between food insecurity and HIV in Ethiopia's national food and nutrition policy.
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Affiliation(s)
- Dube Jara Boneya
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Demisse A, Demena M, Ayele BH, Mengistu A. Food insecurity and associated factors among adult HIV patients on anti-retroviral therapy in Dessie referral hospital, South Wollo Zone, North central Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000445. [PMID: 36962524 PMCID: PMC10021340 DOI: 10.1371/journal.pgph.0000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022]
Abstract
Food insecurity has a paramount negative impact on the overall nutritional and health status of people living with the human immune deficiency virus, hence leading to opportunistic infections, rapid disease progression, hospitalizations, poor treatment outcomes, and mortality, both are intertwined and worsen one another through a mixture of nutritional, mental health, and behavioral pathways that heighten vulnerability to, and worsen the severity of, each condition. Nevertheless, little is known about the magnitude of food insecurity and associated factors among adults on antiretroviral therapy in the current study area. This study aims to assess the magnitude of food insecurity and associated factors among Adults on Antiretroviral Treatment in Dessie referral hospital South Wollo Zone, Northcentral Ethiopia. An institution-based cross-sectional study was conducted among 407 selected adults living with Human Immune Virus receiving Anti-Retroviral treatment in Dessie referral hospital. Data was entered into Epi-data version 3.1 and exported to STATA version 16.0 for cleaning and analysis. Bivariable and multivariable binary logistic regression analysis was carried out to identify factors associated with the outcome variable. Odds ratio along with 95% confidence interval was estimated to measure the strength of the association and the level of statistical significance was declared at a p-value less than 0.05. This study revealed that the magnitude of food insecurity was 62.4% (95% CI: 57.6, 44 66.8]. CD4 count <350 [AOR = 3.51, 95% CI: 1.88, 6.52], average monthly household income ≤ 40 USD [AOR = 2.34, 95% CI: 1.42, 3.84], World Health Organization clinical stage III&IV [AOR = 2.85, 95% CI: 1.61, 5.04], not getting any support [AOR = 3.04, 95% CI: 1.45, 6.38] were factors significantly associated with food insecurity. Social protection interventions targeting patients with CD4 <350, monthly income less than 40 USD/month, World Health Organization clinical stage III &IV, and those patients with no support are crucial interventions for food security.
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Affiliation(s)
- Amanuel Demisse
- Public Health Expert at South Wollo Zone Guguftu Woreda Health Office, Guguftu, Ethiopia
| | - Melake Demena
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte Ayele
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abrham Mengistu
- Department of Public Health, College of Medicine and Health Science, Wechemo University, Hossana, Ethiopia
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Shakiba M, Salari A, Mahdavi-Roshan M. Food insecurity status and associated factors among rural households in the north of Iran. Nutr Health 2021; 27:301-307. [PMID: 33686880 DOI: 10.1177/0260106021996840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Iran has been experiencing an accelerated change in the nutrition and health of its people, which has led to considerable variations in the country's nutritional status. Little is known about the food insecurity status in the north of Iran. AIM The present study aimed to investigate the food insecurity status and factors associated with it in a rural area in the north of Iran. METHODS This cross-sectional study was conducted among 573 rural households in Guilan Province in the north of Iran. The food insecurity status of the households was measured using the Household Food Insecurity Access Scale. Data on the demographic characteristics of the households and their depression status were collected by interviewing the heads of the households. The socioeconomic status index of the households was constructed using factor analysis, and a multivariate ordinal logistic regression model was used to estimate the adjusted odds ratio of the independent predictors of food insecurity. RESULTS The results indicated that approximately half of the households (50.8%) had experienced mild (43.2%), moderate (6.5%) or severe (1.1%) food insecurity. The multivariate model showed that sex, age, depression status of the head of the household and having a patient with a chronic condition in the household were independently associated with food security status. CONCLUSIONS This study showed that food insecurity was highly prevalent among rural households in the north of Iran. The study concludes that interventions with the aim of reducing the prevalence of food insecurity, depression and chronic diseases in the area can be effective in improving the nutritional status of the households.
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Affiliation(s)
- Maryam Shakiba
- Cardiovascular Diseases Research Centre, Guilan University of Medical Sciences, Iran.,School of Health, Guilan University of Medical Sciences, Iran
| | - Arsalan Salari
- Cardiovascular Diseases Research Centre, Guilan University of Medical Sciences, Iran
| | - Marjan Mahdavi-Roshan
- Cardiovascular Diseases Research Centre, Guilan University of Medical Sciences, Iran.,Department of Community Medicine, Guilan University of Medical Sciences, Iran
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Added socioeconomic burden of non-communicable disease on HIV/AIDS affected households in the Asia Pacific region: A systematic review. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 9:100111. [PMID: 34327436 PMCID: PMC8315338 DOI: 10.1016/j.lanwpc.2021.100111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 01/11/2023]
Abstract
Background HIV/AIDS causes significant socioeconomic burden to affected households and individuals, which is exacerbated by non-communicable diseases (NCDs). The Asia Pacific Region (APR) comprises about 60% of the global population and has been significantly affected by HIV/AIDS with 5.8 million after Sub-Saharan Africa in 2019. We investigated socioeconomic impacts of HIV/AIDS alone and the added burden of NCDs on HIV-affected households (HIV-HHs) and individuals in the APR. Method We searched multiple databases for studies published in English over 30 years on socioeconomic impact of HIV/AIDS alone and HIV/AIDS with NCDs on affected households or individuals in APR. Findings were synthesised across six domains: employment, health-related expenditure, non-health expenditure, strategies for coping with household liabilities, food security, and social protection. Findings HIV-HHs had a significantly higher socioeconomic burden compared to Non-HIV households. Total household expenditure was lower in HIV-HHs but with higher expenditure on health services. HIV-HHs experienced more absenteeism, lower wages, higher unemployment, and higher food insecurity. There is a paucity of evidence on the added burden of NCDs on HIV-HHs with only a single study from Myanmar. Interpretation Understanding the socioeconomic impact of HIV/AIDS with and without NCD is important. The evidence indicates that HIV-HHs in APR suffer from a significantly higher socioeconomic burden than Non-HIV-HHs. However, evidence on the additional burden of NCDs remains scarce and more studies are needed to understand the joint socioeconomic impact of HIV/AIDS and NCDs on affected households. Funding Deakin University School of Health and Social Development grant and Career Continuity grant.
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Pakravan-Charvadeh MR, Mohammadi-Nasrabadi F, Gholamrezai S, Vatanparast H, Flora C, Nabavi-Pelesaraei A. The short-term effects of COVID-19 outbreak on dietary diversity and food security status of Iranian households (A case study in Tehran province). JOURNAL OF CLEANER PRODUCTION 2021; 281:124537. [PMID: 33052173 PMCID: PMC7537655 DOI: 10.1016/j.jclepro.2020.124537] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/23/2020] [Accepted: 10/04/2020] [Indexed: 05/21/2023]
Abstract
Currently, the COVID-19 outbreak is spreading fast in 185 countries and has engaged most people around the world. COVID-19 imposes severe and tragic consequences on people's health due to the high rate of spread and potentially fatal impacts. In this study, the association of socio-economic factors with food security and dietary diversity is assessed before and during the COVID-19 pandemic. Data from 299 respondents were collected by an online standard questionnaire. Household Dietary Diversity Score (HDDS) and Household Food Insecurity Access Scale (HFIAS) were calculated. A multinomial regression model was applied to determine factors associated with HDDS and HFIAS before and during COVID-19 outbreak. Food security of Iranian households improved during the initial COVID-19 pandemic period (P < 0.001). Households reduced consumption of some food groups during the COVID-19 pandemic compared to the pre-COVID-19 period. Key socio-economic factors associated with food insecurity during the COVID-19 pandemic included personal savings, household income, employment status of head of household, and nutrition knowledge of head of household. During the COVID-19 outbreak, household size, head of household's occupation, personal savings, and number of male children were significantly associated with dietary diversity. Distributing free food baskets to poor households, extending e-marketing, providing nutrition consultations, and organizing donations to support infected households may increase household dietary diversity and improve food security status during a pandemic such as COVID-19. Vulnerable populations in countries experiencing food insecurity, such as Iran, should be supported - not just by providing medical care and personal protective equipment, but also with flexible safety nets and food-based intervention programs to respond to population needs.
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Affiliation(s)
| | - Fatemeh Mohammadi-Nasrabadi
- Research Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Gholamrezai
- Department of Agricultural Economics and Rural Development, Faculty of Agriculture, Lorestan University, Khorramabad, Iran
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cornelia Flora
- Distinguished Professor, Department of Sociology, Iowa State University, USA
| | - Ashkan Nabavi-Pelesaraei
- Department of Agricultural Machinery Engineering, Faculty of Agricultural Engineering and Technology, University of Tehran, Karaj, Iran
- Head of Process Engineering & Systems Improvement, Management of Fruit and Vegetables Organizations, Tehran Municipality, Tehran, Iran
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Nigusso FT, Mavhandu-Mudzusi AH. High magnitude of food insecurity and malnutrition among people living with HIV/AIDS in Ethiopia: A call for integration of food and nutrition security with HIV treatment and care Programme. Nutr Health 2020; 27:141-150. [PMID: 33172349 DOI: 10.1177/0260106020971855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food insecurity and malnutrition has been reported to have a strong connection with human immunodeficiency viruses (HIV); this is more pervasive in Sub-Saharan Africa including Ethiopia. In this study, we examined the predictors of food insecurity and factors associated with malnutrition among people living with HIV (PLHIV) in Benishangul Gumuz Regional State, Ethiopia. METHODS We conducted a cross-sectional study at outpatient antiretroviral therapy (ART) clinics. Data were collected using participant interview, anthropometry, and participants' chart review. Interviews were carried out with 390 PLHIVs who were on antiretroviral treatment follow-up. Four robust multivariate linear regression models were used to identify predictors of food insecurity and factors associated with malnutrition. RESULTS The prevalence of food insecurity and malnutrition among PLHIV were found to be 76% and 60%, respectively. The predictors of food insecurity were: urban residence; household dependency; average monthly income below 53.19 USD; poor asset possession; CD4 count below 350 cell/μL; and recurrent episodes of opportunistic infections (OIs). Correspondingly, malnutrition among PLHIV was found strongly associated with: female gender; urban residence; income below 53.19 USD; poor asset possession; duration of less than one year on ART; and recurrent episodes of OIs. CONCLUSION The study findings suggest that the higher prevalence of food insecurity and malnutrition among PLHIV underscore: the need for economic and livelihood intervention; addressing contextual factors including the gender dimensions; adoption of nutrition-specific and sensitive interventions; and integration of food and nutrition security with HIV treatment and care programmes.
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Affiliation(s)
- Fikadu Tadesse Nigusso
- Department of Health Studies, 108197University of South Africa, Pretoria, South Africa.,Programme Section, United Nations World Food Programme, Addis Ababa, Ethiopia
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Elevated highly sensitive C-reactive protein and d-dimer levels are associated with food insecurity among people living with HIV in Pune, India. Public Health Nutr 2019; 22:2022-2029. [PMID: 30827288 DOI: 10.1017/s136898001900020x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the prevalence and determinants of food insecurity among people living with HIV (PLWH) in Pune, India and its association with biomarkers known to confer increased risks of morbidity and mortality in this population. DESIGN Cross-sectional analysis assessing food insecurity using the standardized Household Food Insecurity Access Scale. Participants were dichotomized into two groups: food insecure and food secure. Logistic regression models were used to assess associations between socio-economic, demographic, clinical, biochemical factors and food insecurity. SETTING Antiretroviral therapy (ART) centre of Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals (BJGMC-SGH), Pune, a large publicly funded tertiary and teaching hospital in western India.ParticpantsAdult (≥18 years) PLWH attending the ART centre between September 2015 and May 2016 who had received ART for either ≤7d (ART-naïve) or ≥1 year (ART-experienced). RESULTS Food insecurity was reported by 40 % of 483 participants. Independent risk factors (adjusted OR; 95 % CI) included monthly family income <INR 5000 (~70 USD; 13·2; CI 5·4, 32·2) and consuming ≥4 non-vegetarian meals per week (4·7; 1·9, 11·9). High-sensitivity C-reactive protein (hs-CRP) ≥0·33 mg/dl (1·6; 1·04, 2·6) and d-dimer levels 0·19-0·31 µg/ml (1·6; 1·01, 2·6) and ≥0·32 µg/ml (1·9; 1·2, 3·2) were also associated with food insecurity. CONCLUSIONS More than a third of the study participants were food insecure. Furthermore, higher hs-CRP and d-dimer levels were associated with food insecurity. Prospective studies are required to understand the relationship between food insecurity, hs-CRP and d-dimer better.
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Boneya DJ, Ahmed AA, Yalew AW. The effect of gender on food insecurity among HIV-infected people receiving anti-retroviral therapy: A systematic review and meta-analysis. PLoS One 2019; 14:e0209903. [PMID: 30615692 PMCID: PMC6322826 DOI: 10.1371/journal.pone.0209903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-infected adults receiving anti-retroviral therapy have a high prevalence of food insecurity in both high- and low-income settings., Women bear an inequitable burden of food insecurity due to lack of control over resources and over household food allocation decision-making. The few studies conducted on the association between food insecurity and gender among HIV-infected adults have inconclusive findings. Therefore, the objective of this systematic review and meta-analysis was to estimate the pooled effect of gender on food insecurity among HIV-infected adults receiving antiretroviral therapy. METHOD We conducted an electronic, web-based search using PubMed, CINAHL, PopLine, MedNar, Embase, Cochrane library, the JBI Library, the Web of Science and Google Scholar. We included studies which reported the association between food insecurity and gender among HIV-infected adults receiving antiretroviral therapy whose age was greater than 18 years. The analysis was conducted using STATA 14 software. A random effects model was used to estimate the pooled effect a 95% confidence interval(CI). Forest plots were used to visualize the presence of heterogeneity. Funnel plots and Egger's and Begg's tests were used to check for publication bias. RESULTS A total of 776 studies were identified of which seventeen studies were included in the meta-analysis, with a total of 5827 HIV infected adults receiving antiretroviral therapy. We found that the gender of HIV-infected adults receiving anti-retroviral therapy had statistically significant effects on food insecurity. The pooled odds of developing food insecurity among female HIV infected adults receiving anti-retroviral therapy was 53% higher than male HIV infected adults (OR: 1.53, 95% CI: 1.29, 1.83). Our analysis indicate the findings of studies conducted in the high-income countries showed weakest associations between gender and food insecurity than those conducted in low- and middle-income countries. CONCLUSION Our systematic review and meta-analysis showed statistically significant effect of gender on food insecurity among HIV-infected adults receiving anti-retroviral therapy in which odds of food insecurity was higher among female HIV infected adults compared to male HIV-infected adults. These findings suggest that the need to include within food and nutrition interventions for HIV-infected adults receiving antiretroviral treatment, culture- and context-specific gender-based policies to address the sex/gender related vulnerability to food insecurity.
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Affiliation(s)
- Dube Jara Boneya
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali Ahmed
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku Yalew
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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König Walles J, Balcha TT, Winqvist N, Björkman P. Growth pattern in Ethiopian infants - the impact of exposure to maternal HIV infection in relation to socio-economic factors. Glob Health Action 2018; 10:1296726. [PMID: 28470110 PMCID: PMC5496093 DOI: 10.1080/16549716.2017.1296726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Infants exposed to maternal HIV infection who remain HIV-uninfected (HIV-exposed/uninfected; HIV-EU) may be at increased risk of growth retardation, which could be due both to directly HIV-related effects and to socio-economic factors overrepresented among HIV-positive women. Objective: To investigate growth development at 9–12 months of age in HIV-EU infants participating in prevention of mother-to-child transmission (PMTCT) care compared to HIV unexposed (HIV-U) infants in relation to socio-economic conditions. Methods: Anthropometric and socio-economic data were collected retrospectively from PMTCT registers (for HIV-EU infants), with HIV-U controls recruited at measles vaccination at public health facilities in Ethiopia. Growth was compared with regard to HIV exposure and socio-economic variables in multivariate regression analysis. Results: The following growth measurements were found for 302 HIV-EU and 358 HIV-U infants at 9–12 months of age, respectively: mean weight-for-age z-score (WAZ) 0.04 and −0.21, p < 0.001 (proportion underweight 5.7% and 6.7%, p = 0.60); median length-for-age z-score (LAZ) −0.92 and −0.91, p = 0.53 (proportion stunted 25.1% and 20.5%, p = 0.17). In multivariate analysis, lower WAZ was associated with male sex (p = 0.021), lower maternal education (p < 0.001), presence of siblings (p < 0.01) and HIV-U (p < 0.01). Underweight was associated with male sex (p = 0.017) and absence of maternal education (p = 0.019). Lower LAZ was associated with male sex (p < 0.001), presence of siblings (p < 0.001) and poor maternal education (p < 0.01), while stunting was associated with male sex (p < 0.001), presence of siblings (p < 0.001), few rooms in the home (p < 0.01), access to running water (p = 0.026) and low level of maternal education (p = 0.014). Conclusions: At 9–12 months of age, HIV-EU infants had non-inferior growth and higher mean WAZ than HIV-U controls. Poor growth development was associated with socio-economic factors. This suggests health benefits from PMTCT participation for infant growth. Similar interventions could be considered for Ethiopian infants, irrespective of HIV exposure, with a particular focus on children with poor socio-economic status.
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Affiliation(s)
- John König Walles
- a Department of Translational Medicine, Section for Infectious Diseases , Lund University , Malmö , Sweden.,b Department of Infectious Diseases , Central Hospital , Kristianstad , Sweden
| | - Taye Tolera Balcha
- a Department of Translational Medicine, Section for Infectious Diseases , Lund University , Malmö , Sweden.,c Armauer Hansen Research Institute , Addis Ababa , Ethiopia
| | - Niclas Winqvist
- a Department of Translational Medicine, Section for Infectious Diseases , Lund University , Malmö , Sweden.,d Skåne Regional Office for Infectious Disease Control and Prevention , Malmö , Sweden
| | - Per Björkman
- a Department of Translational Medicine, Section for Infectious Diseases , Lund University , Malmö , Sweden
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