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The nutritional well-being of children under five with HIV-positive parents at Bikurungu Health Center III in Rukungiri District

Annibal Muhanguzi

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.

ABSTRACT

Families affected by HIV/AIDS often face food insecurity and malnutrition. In impoverished nations, over a third of infectious disease-related deaths in children under five result from poor nutrition. Household food insecurity and the impact of HIV/AIDS-related illnesses can hinder the growth of young children, leading to increased malnutrition. A study involving 310 mother/infant pairs from various households was conducted using a convenient sampling method. Information was gathered through a structured questionnaire. Analysis revealed that children in households affected by HIV had a significantly higher rate of stunting (height-for-age < –2 SD) compared to those in unaffected households (25.5% vs. 9.1%, p = .002). However, the rates of wasting and underweight did not significantly differ between HIV-affected and unaffected households. Living in households affected by HIV is associated with stunted growth in children under five.

Keywords: HIV/AIDS, Children under 5 years of age, Malnutrition, Stunting

INTRODUCTION

Nutritional status is the condition of the body resulting from the nutrient content of the food consumed in relation to the body’s nutritional needs and from the ability of the body to digest, absorb, and use those nutrients [1]. Technically, normal nutritional status among individuals is achieved when someone is able to consume food in a balanced form and the body utilizes the consumed nutrients normally [2, 3]. According to the United Nations (UN), adequate nutrition is one of the fundamental rights of every human being. It should be provided to everyone especially vulnerable groups like children, pregnant mothers, and the elderly. A well-nourished population repays to society in the form of high productivity, better learning capacity, and low healthcare expenditure. Good nutrition enhances body immunity which offers protection to the body against infectious diseases such as malaria and respiratory infections [4-6]. It also prevents risks of non-communicable diseases like obesity, heart disease, diabetes, cancer, and stroke [7-10]. However, when the nutrients provided in the diet are inadequate or not utilized properly, a state of imbalance results in the body [11]. Globally, poor nutrition is one of the main factors attributed to more than half of child deaths, among children under the age of five years [12]. It causes immunological dysfunction which increases the susceptibility of children under five to infections. According to the World Health Organisation (WHO), poor nutrition can also lead to impaired physical and mental development but also reduced productivity [13, 14]. The impact of malnutrition among countries globally is high, and it manifests itself in many forms: as children who do not grow and develop to their full potential, as people who are skin-and-bone or prone to infection, or as people who carry too much weight [15]. Malnutrition and diet are one of the largest risk factors responsible for the global burden of disease, with malnutrition alone accounting for about 45% of deaths of children under five [16]. In sub-Saharan Africa, the epidemiology of severe malnutrition has increased in children requiring hospitalization composed of those who are HIV-infected or HIV exposed with case-fatality rates reaching as high as 20–50% [17]. Large percentages of HIV-positive children have an episode of severe malnutrition as their first AIDS-defining illness. Undernutrition is an important factor that might predict the disease progression of HIV-infected individuals [18, 19]. It also results in a higher risk of morbidity and mortality in both HIV-infected adults and children [20, 21]. Wasting and weight loss are common features of HIV infection, especially in resource-limited settings. It is known that children with HIV and severe malnutrition invariably have lower nutritional recovery and higher mortality rates than their HIV- negative counterparts [22-24]. In East Africa, a variety of previous studies have reported that the magnitude of undernutrition, accordingly the prevalence of under-weight, wasting, and stunting ranged from 19.4% to 77.1%, 7% to 77.1%, and 13% to 71.8% respectively. This showed pronounced discrepancies among reports of undernutrition across different geographical settings and different time periods.  Moreover, there is no regionally represented pooled data on undernutrition in East Africa [25]. Although the future of human societies relies on healthy children being able to achieve their optimal physical growth and development, this optimum is far from being realized in many parts of the world. Undernutrition and HIV infection are major problems in children worldwide, especially in sub-Saharan Africa [26]. Undernutrition is well recognized as a major risk factor for morbidity and mortality contributing to just over 50% of the 10 million child deaths a year worldwide [27]. Anemia is a common feature of undernutrition [28-30]. Other co-morbidities like malaria, pneumonia, and diarrhea can increase the risk of undernutrition [31-34]. It has been observed that modern communities with higher HIV/AIDS prevalence showed lower child malnutrition and mortality rates, potentially due to the overriding influence of trade and income from wage employment. These communities, which are better off economically and have greater access to essential services, such as water and sanitation, exhibited lower child underweight prevalence. Thus, high HIV/AIDS prevalence and better nutritional outcomes can coexist under better socioeconomic conditions. While this scenario does not suggest that higher HIV/AIDS prevalence is causally associated with better nutritional outcomes, it reinforces the need to control for the underlying socioeconomic conditions in examining the association between HIV/AIDS prevalence and nutritional outcomes [35]. In Uganda, the UNICEF country report on the status of children reported that HIV/AIDS is one of the predominant common factors among parents of malnourished children [36]. However, there is limited cross-country evidence on the coexistence of HIV/AIDS and malnutrition in Uganda. Instead, Nalwoga et al. [27] suggest that a high national or community HIV/AIDS prevalence is not associated with a higher risk of child malnutrition. Previous studies are also restricted to country-level analysis involving household and community-level data, usually the Demographic and Health Surveys (DHS). Similarly, the few studies involving cross-country analysis of HIV/AIDS and malnutrition have employed individual, household, and community-level data [27, 37].  Therefore, this study seeks to assess the nutritional status of children under five years born to HIV- positive parents attending Bikurungu Health Center III in Rukungiri District.

CONCLUSION

Stunting among children under five was more common in households with HIV infection. This was most likely brought on by ongoing malnutrition. However, there were no variations in the levels of underweight and wasting in children from affected and unaffected households that were serviced at Bikurungu Health Center III.

Recommendations

Future longitudinal studies that can monitor the development of kids living in households with HIV are advised. Since confounding variables including seasonality, household affluence, and the number of children living there were not taken into account, the study’s findings may have been skewed, thus recommending future studies accounting for these confounders.

REFERENCES

  1. (2019). Analyzing the conditions that affect nutritional status. 2019. http://www.fao.org/3/i3261e/i3261e03.pdf.
  2. (2020). Nutritional Status Research. OMICS International. 2020.
  3. Alum, E. U., Aja, W., Ugwu, O. P. C., Obeagu, E. I., Okon, M. B. Assessment of vitamin composition of ethanol leaf and seed extracts of Datura stramonium. Avicenna J Med Biochem. 2023; 11(1):92-97. doi:10.34172/ajmb.2023.2421.
  4. Eze, E. D., Barasa, A., Adams, M. D., Rabiu, K. M., Ayikobua, E. T., Ezekiel, I., & Okpanachi, A. O. Assessing factors contributing to the prevalence of protein–energy malnutrition among children under five years of age attending Kigoma District Hospital, Tanzania. Journal of Food and Nutrition Sciences, 2018; 6(5), 123-128.
  5. Mada, S. B., Bawa, K. D., Saliu, M. A., Garba, A., Abarshi, M. M., Muhammad, A., & Garba, I. Evidence of Malnutrition and its Associated Factors among Under-five Children in Danko-Wasagu Kebbi State, North-western Nigeria. Nigerian Journal of Basic and Applied Sciences, 2020; 28(1), 56-65.
  6. Alum, E. U., Oyika, M. T., Ugwu, O. P. C., Aja, P. M., Obeagu, E. I., Egwu, C. O., & Okon, M. B. Comparative analysis of mineral constituents of ethanol leaf and seed extracts of Datura stramonium. IDOSR Journal of Applied Sciences,2023; 8(1):143-151. https://doi.org/10.59298/IDOSR/2023/12.1.7906.
  7. Uti, D. E., Ibiam U. A., Omang, W. A., Udeozor, P. A., Umoru, G. U., Nwadum, S. K., Bawa, I., Alum, E. U., Mordi, J. C., Okoro, E. O., Obeten, U. N., Onwe, E. N., Zakari, S., Opotu, O. R., & Aja, P. M. Buchholzia coriacea Leaves Attenuated Dyslipidemia and Oxidative Stress in Hyperlipidemic Rats and Its Potential Targets In Silico.  Pharmaceutical Fronts. 2023; 05(03): e141-e152.
    DOI: 10.1055/s-0043-1772607.
  8. Ugwu, O. P.C., Alum, E. U., Okon, M. B., Aja, P. M., Obeagu, E. I., & Onyeneke, E. C. Ethanol root extract and fractions of Sphenocentrum jollyanum abrogate hyperglycemia and low body weight in Streptozotocin-induced diabetic Wistar albino Rats, RPS Pharmacy and Pharmacology Reports, 2023; 2,1-6. https://doi.org/10.1093/rpsppr/rqad010
  9. Alum, E. U., Umoru, G. U., Uti, D. E., Aja, P. M., Ugwu, O. P., Orji, O. U., Nwali, B. U., Ezeani, N., Edwin, N., & Orinya, F. O. Hepato-protective effect of Ethanol Leaf Extract of Datura stramonium in Alloxan-induced Diabetic Albino Rats. Journal of Chemical Society of Nigeria. 2022a; 47 (3): 1165–1176. https://doi.org/10.46602/jcsn.v47i5.819.
  10. Aja, P. M., Nwuguru, M. E., Okorie, U. C., Alum, E. U., & Offor, C. E. Effect of Decoction Extract of Whitfieldia lateritia on Lipid Profiles in Hypercholesterolemic Albino Rats. Global Veterinaria. 2015; 14(3): 448-452. DOI: 10.5829/idosi.gv.2015.14.03.93130.
  11. International Food Policy Research Institute. (2015). The Global Nutrition Report 2015. The Global Nutrition Report, 201.
  12. (2019). Centers for Disease Control and Prevention, Pregnancy & Breastfeeding: Information about Coronavirus Disease. https://www.cdc.gov/corona-%0Avirus/2019- ncov/need-extra-precautions/pregnancy- breastfeeding.html?%0ACDC_AA_refVal=https%3A%2F%Error! Hyperlink reference not valid. us%2F2019-ncov%0A%2Fprepare%2Fpregnancy-breastfeeding.html
  13. Nutrition and Universal health coverage. World Health Organization, (WHO/NMH/NHD/19.24), 2019.
  14. Joshua, Z. P., Abarshi, M. M., Sani, I., Owolabi, O. A., David, M. A., Mada, S. B., & Muhammad, A. Impact of carrot-ginger blend on micronutrient status and CD4+ cell-counts of HIV-positive-patients on antiretroviral therapy in Kaduna, Nigeria. Human Nutrition & Metabolism, 2021;26, 200133.
  15. Kumbakulu, P. K., Ndeezi, G., Egesa, W. I., Nakalema, G., Odoch, S., Kambele, R. L., & Nduwimana, M. Prevalence, feeding practices, and factors associated with undernutrition among HIV-exposed uninfected children aged 6 to 18 months in Bushenyi district, western Uganda: A cross-sectional study. Research Square. 2022;1-22. DOI: https://doi.org/10.21203/rs.3.rs-2079841/v1.
  16. UNICEF, WHO, & World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. Geneva: WHO, 2020; 24(2), 1–16.
  17. Byron, E., Gillespie, S., & Nangami, M. Integrating nutrition security with treatment of people living with HIV: lessons from Kenya. Food and Nutrition Bulletin. 2018; 29(2), 87–97. https://doi.org/oi.org/10.1177/ 156482650802900202.
  18. Alum, E. U., Ugwu, O. P. C., Obeagu, E. I., Aja, P. M., Okon, M. B., & Uti, D. E. Reducing HIV Infection Rate in Women: A Catalyst to reducing HIV Infection pervasiveness in Africa. International Journal of Innovative and Applied Research. 2023; 11(10):01-06. DOI: 10.58538/IJIAR/2048. http://dx.doi.org/10.58538/IJIAR/2048
  19. Alum, E. U., Obeagu, E. I., Ugwu, O. P. C., Samson, A. O., Adepoju, A. O., & Amusa, M. O. Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift. Medicine 2023; 102:41(e35673). http://dx.doi.org/10.1097/MD.0000000000035673. PMID: 37832059.
  20. Obeagu, E. I., Nwosu, D. C., Ugwu, O. P. C., & Alum, E. U. Adverse Drug Reactions in HIV/AIDS Patients on Highly Active Antiretro Viral Therapy: A Review of Prevalence. Newport International Journal of Scientific and Experimental Sciences (NIJSES). 2023; 4(1):43-47. https://doi.org/10.59298/NIJSES/2023/10.6.1000
  21. Alum, E. U., Obeagu, E. I., Ugwu, O. P.C., Aja, P. M., & Okon, M. B. HIV Infection and Cardiovascular diseases: The obnoxious Duos. Newport International Journal of Research in Medical Sciences (NIJRMS), 2023; 3(2): 95-99. https://nijournals.org/wp-content/uploads/2023/07/NIJRMS-3-295-99-2023.pdf.
  22. Obeagu, E.I., Alum, E.U., & Obeagu, G.U. Factors Associated with Prevalence of HIV Among Youths: A Review of Africa Perspective. Madonna University Journal of Medicine and Health Sciences, 2023; 3(1): 13-18. https://madonnauniversity.edu.ng/journals/index.php/medicine
  23. Teklemariam, Z., Mitiku, H., & Mesfin, F. Prevalence of anemia and nutritional status among HIV-positive children receiving antiretroviral therapy in Harar, eastern Ethiopa. HIV/AIDS (Auckland, NZ), 2019; 7:191.
  24. Obeagu, E.I., Obeagu, G.U., & Ugwu, O. P.C. Stigma Associated With HIV/AIDS: A Review. Newport International Journal of Public Health and Pharmacy (NIJPP).2023; 3(2):64-67.
  25. Abate, B. B., Aragie, T. G., & Tesfaw, G. The magnitude of underweight, wasting and stunting among HIV positive children in East Africa: A systematic review and meta-analysis. PLoS ONE. 2020;15(9 September), 1–22. https://doi.org/10.1371/journal.pone.0238403.
  26. Alum, E. U., Ugwu, O. P.C., Obeagu, E. I., & Okon, M. B. Curtailing HIV/AIDS Spread: Impact of Religious Leaders. Newport International Journal of Research in Medical Sciences (NIJRMS), 2023; 3(2): 28-31. https://nijournals.org/wp-content/uploads/2023/06/NIJRMS-32-28-31-2023-rm.pdf
  27. Nalwoga, A., Maher, D., Todd, J., Karabarinde, A., Biraro, S., & Grosskurth, H. Nutritional status of children living in a community with high HIV prevalence in rural Uganda: A cross-sectional population-based survey. Tropical Medicine and International Health. 2019; 15(4), 414–422. https://doi.org/10.1111/j.1365-3156.2010.02476.x.
  28. Obeagu, E. I., Nimo, O. M., Bunu, U. M., Ugwu, O. P.C., & Alum, E.U. Anaemia in children under five years: African perspectives. Int. J. Curr. Res. Biol. Med., 2023; (1): 1-7. http://dx.doi.org/10.22192/ijcrbm.2023.08.01.001.
  29. Obeagu, E. I., Bot, Y. S., Obeagu, G. U., Alum, E. U., & Ugwu, O. P. C. Anaemia and risk factors in lactating mothers: a concern in Africa. International Journal of Innovative and Applied Research, 2023;11(2): 15-17. http://dx.doi.org/10.58538/IJIAR/2012.
  30. Alum, E. U., Ugwu, O. P. C., Aja, P. M., Obeagu, E. I., Inya, J. E., Onyeije, P. E., Agu, E., & Awuchi, C. G. Restorative effects of ethanolic leaf extract of Datura stramonium against methotrexate-induced hematological impairments, Cogent Food & Agriculture, 2023;9:1, DOI: 1080/23311932.2023.2258774. https://doi.org/10.1080/23311932.2023.2258774
  31. Egwu, C. O., Aloke, C., Chukwu, J., Agwu, A., Alum, E., Tsamesidis, I, Aja, P. M., Offor, C. E., & Obasi, N. A. A world free of malaria: It is time for Africa to actively champion and take leadership of elimination and eradication strategies. Afri Health Sci. 2022; 22(4). 627-640. doi: 10.4314/ahs.v22i4.68. PMID: 37092107; PMCID: PMC10117514.
  32. Asogwa, F. C., Okoye, C.O.B., Ugwu, O. P. C., Edwin, N., Alum, E. U., & Egwu, C. O. Phytochemistry and Antimicrobial Assay of Jatropha curcas Extracts on Some Clinically Isolated Bacteria – A Comparative Analysis. European Journal of Applied Sciences, 2015; 7(1): 12-16. DOI: 10.5829/idosi.ejas.2015.7.1.1125.
  33. Alum, E. U., Uti, D. E., Agah, V. M., Orji, O. U., Ezeani, N. N., Ugwu, O. P., Bawa, I., Omang, W. A., & Itodo, M. O. Physico-chemical and Bacteriological Analysis of Water used for Drinking and other Domestic Purposes in Amaozara Ozizza, Afikpo North, Ebonyi State, Nigeria. Nigerian Journal of Biochemistry and Molecular Biology, 2023; 37(1), 1-8. https://doi.org/10.2659/njbmb.2023.151.
  34. Asogwa, F. C., Ugwu, O. P.C., Alum, E. U., Egwu, C. O., & Edwin, N. Hygienic and Sanitary Assessment of Street Food Vendors in Selected Towns of Enugu North District of Nigeria. American-Eurasian Journal of Scientific Research, 2015; 10 (1): 22-26.DOI: 10.5829/idosi.aejsr.2015.10.1.1145.
  35. Gameli, A. HIV/AIDS and child malnutrition in eastern and southern Africa. Afr Dev Rev. 2021; 33, 79–90.
  36. UNICEF Uganda Annual Report 2019.
  37. (2017). Uganda Demographic and Health Survey 2016. In Uganda Demographic and Health Survey 2016 (Issue 6).
  38. Wiegand, H., & Kish, L., Survey Sampling. John Wiley & Sons, Inc., New York, London 1965, IX + 643 S., 31 Abb., 56 Tab., Preis 83 s. Biometrische Zeitschrift. 10, 88–89 (1968). https://doi.org/10.1002/bimj.19680100122
  39. Bain, L. E., Awah, P. K., Geraldine, N., Kindong, N. P., Sigal, Y., Bernard, N., & Tanjeko, A. T. Malnutrition in Sub – Saharan Africa: Burden, causes and prospects. Pan African Medical Journal. 2013; 15, 1–9. https://doi.org/10.11604/pamj.2013.15.120.2535.
  40. Galgamuwa, L. S., Iddawela, D., Dharmaratne, S. D., & Galgamuwa, G. L. S. Nutritional status and correlated socio-economic factors among preschool and school children in plantation communities, Sri Lanka. BMC Public Health. 2017; 17(1), 1–11. https://doi.org/10.1186/s12889-017-4311-y.
  41. De Onis, M., Borghi, E., Arimond, M., Webb, P., Croft, T., Saha, K., De-Regil, L. M., Thuita, F., Heidkamp, R., Krasevec, J., Hayashi, C., & Flores-Ayala, R. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutrition. 2019; 22(1), 175–179. https://doi.org/10.1017/S1368980018002434.
  42. Biondi, D., Kipp, W., Jhangri, G. S., Alibhai, A., Rubaale, T., & Saunders, L. D. Risk factors and trends in childhood stunting in a district in Western Uganda. Journal of Tropical Pediatrics. 2011; 57(1), 24–33. https://doi.org/10.1093/tropej/fmq043.
  43. Okechukwu, A. Burden of HIV Infection in Children with Severe Acute Malnutrition at the University of Abuja Teaching Hospital Gwagwalada, Nigeria. Journal of HIV for Clinical and Scientific Research. 2015; 2, 055–061. https://doi.org/10.17352/2455-3786.000015.
  44. Muchina, E, & Waithaka, P. M. Relashonship between breastfeeding practice and nutritional status of children aged 0-24 months in Nairobi, Kenya. Afr J Food Agric Nutr Dev. 2020; 10(4), 1684–5374.
  45. Olwedo, M. A., Mworozi, E., Bachou, H., & Orach, C. G. Factors associated with malnutrition among children in internally displaced person’s camps, northern Uganda. African Health Sciences. 2008; 8(4), 244–252.
  46. Patty, S. R., & Nugroho, F. Malnutrition of children under- five in fisherman’s family in banten village, coastal area of serang district. Proceeding International Conference On Social Sciences, Indonesia; November, 5–6.
  47. Ubesie, A. C., Ibeziako, N. S., Ndiokwelu, C. I., Uzoka, C. M., & Nwafor, C. A. Under- five Protein Energy Malnutrition Admitted at the University of in Nigeria Teaching Hospital, Enugu: A 10 year retrospective review. Nutrition Journal. 2012; 11(1), 1–7. https://doi.org/10.1186/1475-2891-11-43.

 CITE AS: Annibal Muhanguzi (2023). The nutritional well-being of children under five with HIV-positive parents at Bikurungu Health Center III in Rukungiri District. IAA Journal of Applied Sciences 10(2):23-35. https://doi.org/10.59298/IAAJAS/2023/3.2.1100 

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