Assessment of the Nutritional Status, Care and Support of People Living with Hiv/Aids in Nsukka Local Government Area, Enugu State

ABSTRACT The nutritional status, care and support of people living with HIV/AIDS (PLWHIV/AIDS) in Nsukka L.G.A of Enugu State was studied at Bishop Shanahan Hospital. The hospital is a HIV counseling and testing (HCT) centre. Descriptive and laboratory analysis were adopted for the study. A total of two hundred and forty three respondents only constituted the sample for the study. Questionnaire, anthropometry, biochemical tests and proximate analysis of foods eaten by PLWHIV/AIDS were the instruments for data collection. Method of data analysis for the questionnaire was statistical package for Social Sciences (SPSS), version 15.The body mass index data were categorized using WHO standard to determine the levels of weight. Analysis of variance was used for data from laboratory analysis. The result of the study showed that 36.6% of the subjects were aged between 26-35 years. There were more men (53.37%) than women (46.5%).The highest educational level of the subjects was WASC/SSCE/GCE. About half of the subjects (49.8%) ate food three times daily, while 51.9% affirmed poverty as reason for skipping meals. Most preferred food group of the PLWHIV/AIDS was vegetables (85.2%) taken once a day, 82.8% of subjects took fats and oil twice a day and 40.3% chose vegetables three times a day. Bitter leaf soup was the preferred soup of the subjects. The most observed clinical symptom was fever and by men (23.1%) and women 20.4%.Forty percent of the subjects were on anti retroviral therapy (ART) and within this group, 60% were on combined ART (nevirapine, stavudine and zidovudine). The greatest social support was from the wives (39.5%) and most PLWHIV/AIDS (80%) protected their spouses/sex partners against HIV infection with condom. The mean height, weight, BMI, packed cell volume (PCV) and CD4 count of the men were 1.67 ± 0.01m, 60.76 ± 0.34kg, 23.01 ± 0.5 kg/m2 , 29.61 ± 0.16g and 469.23 ± 0.02 cells/ul, respectively. The mean height, weight, BMI, PCV and CD4 count recorded for women were 1.61 ± 0.06m, 59.81 ± 0.1kg, 21.03 ± 0.0kg/m2 , 29.01 ± 0.21g and 432.08 ± 0.20 cells/ul respectively. Thirty percent of the women and 21. 6% of the men were underweight while 15.4% of men and 10.5% women were overweight. Education had significant relationship with nutrition knowledge of the PLWHIV/AIDS at P> 0.05.Bitter leaf soup had the highest protein and crude fibre values (5.38 ± 34g, 2.70 ± .10g) among the soups while mixed corn meal had highest protein and fat values (5.00 ± 0.26g, 7.50 ± .46g) among the solid foods. The highest energy value was from garri (983.32kj). There is need to encourage PLWHIV/AIDS to eat more adequate meals especially from locally available foods. Women should be financially empowered to care for PLWHIV/AIDS as they formed their greatest social support in this study.

TABLE OF CONTENTS

Title Page -- -- -- -- -- -- -- -- i

Certification -- -- -- -- -- -- -- ii

Dedication -- -- -- -- -- -- -- -- iii

Acknowledgements -- -- -- -- -- -- iv

List of Figures -- -- -- -- -- -- -- ix

ABSTRACT -- -- -- -- -- -- -- -- x

CHAPTER ONE: INTRODUCTION

1.0 Background to the study -- -- -- -- -- 1

1.1 Statement of the problem -- -- -- -- -- 2

1.2 Objective of the study -- -- -- -- -- 3

1.3 Significance of the study -- -- -- -- -- 3

CHAPTER TWO: LITERATURE REVIEW

2.0 Concept of HIV and AIDS -- -- -- -- 4

2.1 Replication of HIV -- -- -- -- 4

2.2 Immune system -- -- -- -- -- 5

2.3 Mechanism of CD4 cell death -- -- -- 5

2.4 CD4 T-cell count -- -- -- -- -- -- 6

2.5 Incidence of HIV/AIDS -- -- -- -- -- 6

2.6 Modes of transmission -- -- -- -- -- 10

2.6.1 Sexual transmission -- -- -- -- 10

2.7 Factors that make women so vulnerable to HIV infection 10

 a. Transmission through infected blood -- -- -- 12

 b. Mother-to-child transmission (MTCT) -- -- 12

2.8 Methods of risk reduction -- -- -- -- 13

2.9 Clinical manifestations -- -- -- -- -- 14

2.10 Diagnosis -- -- -- -- -- -- -- 18

2.11 Relationship between HIV/AIDS and other sexually

 transmitted diseases -- -- -- -- -- -- 19

2.12 HIV counseling and testing (HCT) as an entry point to

 prevent, care and support services -- -- -- 19

2.13 Care and support of PLWHIV/AIDS -- -- -- 20

2.14 Management 21

2.15 Anti-retroviral therapy -- -- -- -- -- 21

2.16 The effects of medication on nutrition -- -- -- 23

2.17 Material and financial support -- -- -- -- 24

2.17.1 Care for caregivers -- -- -- -- -- 26

2.17.2 Support groups -- -- -- -- -- -- 27

2.1 7.3 Health information -- -- -- -- -- 27

2.17.4 Tip for positive living -- -- -- -- -- 27

2.17.5 Nutrition care -- -- -- -- -- -- 30

2.18 Impact of HIV/AIDS on nutrition-- -- -- -- 30

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2.18.1 Nutrition and the care package for people living with AIDS -- 34

2.18.2 Guide to daily food choices -- -- -- -- -- 36

2.18.3 Infant feeding options -- -- -- -- -- -- 36

2.18.4 Dietary practices of HIV/AIDS related symptoms -- -- 37

2.18.5 Advantages of dietary management -- -- -- -- 37

2.18.6 Symptoms associated with HIV in adult -- -- -- 38

CHAPTER THREE: MATERIALS AND METHODS

3.0 Research design -- -- -- -- -- -- -- 41

3.1 Area of study -- -- -- -- -- -- -- 41

3.2 Sample population -- -- -- -- -- -- -- 42

3.3 Sample size and sample size calculation -- -- -- 42

3.4 Sampling technique -- -- -- -- -- -- 43

3.5 Ethical consideration -- -- -- -- -- -- 43

3.6 Instruments for data collection -- -- -- -- -- 43

3.6.1 Questionnaire -- -- -- -- -- -- -- 43

3.6.2 24-hour dietary recall -- -- -- -- -- -- 43

3.7.3 Anthropometric measurement -- -- -- -- -- 44

3.7.3.1 Weight determination -- -- -- -- -- -- 44

3.7.3.3 Height measurement -- -- -- -- -- -- 44

3.7.3.4 Body mass index -- -- -- -- -- -- -- 44

 3.7.4 Clinical observation -- -- -- -- -- -- 45

 3.7.5 Biochemical tests -- -- -- -- -- -- -- 45

3.7.5.1 CD4 cell count -- -- -- -- -- -- -- 45

3.7.5.2 Haematocrit (packed cell volume or pcv) -- -- -- 45

3.7.5 Analytical procedure -- -- -- -- -- -- 46

3.7.6 Food sample collection for analysis -- -- -- -- 46

3.7.6.1 Determination of moisture -- -- -- -- -- 46

3.7.6.2 Determination of protein -- -- -- -- -- -- 47

3.7.6.3 Determination of fat -- -- -- -- -- -- 47

3.7.6.4 Determination of crude fibre- -- -- -- -- -- 48

3.7.6.6 Determination of ash -- -- -- -- -- -- 48

3.7.6.7 Determination of carbohydrate -- -- -- -- -- 48

3.7.6.8 Determination of iron, calcium and zinc -- -- -- 49

3.8 Data analysis -- -- -- -- -- -- -- 49

CHAPTER FOUR: RESULTS

4.0 Background of the subject -- -- -- -- -- 50

4.1 Age, gender of the subject -- -- -- -- -- 50

4.2 Education, occupation and income levels of the subject -- 51

4.3 Nutrition knowledge of the subject - -- -- -- -- 51

4.4 Health characteristics of PLWHIV/AIDS -- -- -- 55

4.5 Food consumption pattern of PLWHIV/AIDS -- -- -- 56

4.7 Proximate composition of commonly consumed mixed dishes by

PLWHIV/AIDS -- -- -- -- -- -- -- 63

4.8 Anthropometric and biochemical variables of the subjects -- 67

4.9 Management experience -- -- -- -- -- -- 68

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CHAPTER FIVE: DISCUSSION5.1 Characteristics of the subjects -- -- -- -- -- 70

5.2 Nutritional knowledge of the PLWHIV/AIDS -- -- -- 71

5.3 Health characteristics of the PLWHIV/AIDS -- -- -- 72

5.4 Food consumption pattern of the subjects -- -- -- 72

5.5 Proximate compositions of dishes commonly consumed by the

 Subjects -- -- -- -- -- -- -- -- 74

 5.6 Anthropometric indices of the subjects -- -- -- -- 74

 5.7 Biochemical parameters of the PLWHIV/AIDS -- -- 75

5.8 Health status and management of PLWHIV/AIDS -- -- 76

 5.9 Conclusions -- -- -- -- -- -- -- 77

5.10 Recommendations -- -- -- -- -- -- 77

REFERENCES -- -- -- -- -- -- -- -- 78

APPENDICES -- -- -- -- -- -- -- -- 82