Nutrition status of HIV+ children in Botswana

• Published in: Health education (Bradford, West Yorkshire, England) West Yorkshire, England), 2015-08, Vol.115 (5), p.495-514
• Main Authors: Nnyepi, Maria, Bennink, Maurice R, Jackson-Malete, Jose, Venkatesh, Sumathi, Malete, Leapetswe, Mokgatlhe, Lucky, Lyoka, Philemon, Anabwani, Gabriel M, Makhanda, Jerry, Weatherspoon, Lorraine J
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome (AIDS); Adolescents; Age; Age Differences; AIDS; Antiretroviral therapy; Attrition (Research Studies); Blood; Body Composition; Body fat; Body Height; Body mass index; Body Weight; Botswana; Child Health; Children; Colleges & universities; Communicable Diseases; Comparative Analysis; Control Groups; Cultural Influences; Developing Nations; Dietary supplements; Dietetics; Disease; Drug Therapy; Eligibility; Energy; Experimental Groups; Food; Foreign Countries; Health & social care; Health education; Hemoglobin; HIV; Human Body; Human immunodeficiency virus; Immune response; Infections; Intervention; Malnutrition; Mortality; Narcotics; Nutrients; Nutrition; Nutritional status; Older children; Physicians; Physiology; Pretests Posttests; Program Effectiveness; Randomized Controlled Trials; Research Assistants; Sample Size; Severity; Sorghum; Statistical Analysis; Teenagers; Underweight
• ISSN: 0965-4283; 1758-714X
• DOI: 10.1108/HE-04-2014-0052

Purpose – Identifying and addressing poor nutritional status in school-aged children is often not prioritized relative to HIV/AIDS treatment. The purpose of this paper is to elucidate the benefits of integrating nutrition (assessment and culturally acceptable food supplement intervention) in the treatment strategy for this target group. Design/methodology/approach – The authors conducted a randomized, double blind pre-/post-intervention trial with 201 HIV-positive children (six to 15 years) in Botswana. Eligibility included CD4 cell counts < 700/mm3 (a marker for the severity of HIV infection), documented treatment with antiretroviral (ARV) drugs, and no reported evidence of taking supplemental food products with one or more added nutrients in the six-month period prior to the study. The intervention (12 months) consisted of two food supplements for ethical reason, one with a higher protein content, bean (bean-sorghum based) group (n=97) and a cereal (sorghum) group (n=104) both of which contained added energy- and micro- nutrients. Anthropometric and biochemical nutritional status indicators (stunting, wasting, underweight, skinfolds for fat and muscle protein reserves, and hemoglobin levels) were compared within and between the bean and the cereal groups pre- and post-intervention separately for children six to nine years and ten to 15 years. Findings – Older children (ten to 15 years) fared worse overall compared to those who were younger (six to nine years) children in anthropometric and protein status indicators both at baseline and post-intervention. Among children six to nine years, the mid arm circumference and blood hemoglobin levels improved significantly in both the bean and cereal groups (p < 0.01 and p < 0.05, respectively). Although the BMI for age z-score and the triceps skinfold decreased significantly in the bean group, the post-intervention subscapular skinfold (fat stores) was significantly higher for the bean group compared to the cereal group (p < 0.05). Among children ten to 15 years, both the bean and the cereal groups also showed improvement in mid arm circumference (p < 0.001), but only those in the bean group showed improvement in hemoglobin (p < 0.01) post-intervention. Originality/value – Similar significant nutritional status findings and trends were found for both food interventions and age within group pre- vs post-comparisons, except hemoglobin in the older children. Post-intervention hemoglobin levels for the type food supp