The Interrelationship between Food Security, Nutrition, and HIV: Findings from Ongoing Fieldwork

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Published on July 10, 2009

Author: glcrsp

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The Interrelationship between Food Security, Nutrition, and HIV: Findings from Ongoing Fieldwork. Presented by Grace Ettyang (Moi University) at the GL-CRSP End of Program Conference on June 17, 2009, Naivasha, Kenya.

The Interrelationship Between Food Security, Nutrition and HIV/AIDS Findings From Ongoing Field Work G. Ettyang, J. Ernst, , C. Neumann, W. Nyandiko, A. Siika, and C. Yiannoutsos,

Session Outline  Food Security and HIV/AIDS  Under-nutrition and HIV/AIDS  Challenges to food assistance interventions  The HNP Approach  Preliminary findings  Concluding Remarks

Food Security and HIV/AIDS

Elements of Food Security Food security Access Availability Access Utilization

Limitations to Food Security in the context of HIV/AIDS  Food Availability  Production failures related to labor constraints  Gender inequality in land tenure  Loss of productive assets needed to sustain household food production.  Food Access  Affected households and infected individuals are too ill or overburdened to earn money to buy food  Due to stigma HH may have limited access to community net works and markets.

Limitations to Food Access in the context of HIV/AIDS  Affected households and infected individuals are too ill or overburdened to earn money to buy food  Due to stigma HH may have limited access to  community net works  markets  trade associations.

Insecure Food Access and Undernutrition Source. Adapted from UNICEF

Coping Strategies  HIV infection itself undermines food security and nutrition by reducing work capacity and productivity and jeopardizing house hold livelihoods leading to ;  Eating less  Substituting less nutritious foods  Selling assets  Using savings and investments to pay for basic needs and medical care .

Under-nutrition and HIV/AIDS

The vicious cycle of Under-nutrition and HIV . Poor Nutrition resulting in weight loss, muscle wasting, weakness, nutrient deficiencies Impaired immune system Increased Nutritional Poor ability to fight HIV needs, Reduced food intake HIV and other infections, Increased oxidative and increased loss of stress nutrients Increased vulnerability to infections e.g. Enteric infections, flu, TB hence Increased HIV replication, Hastened disease progression Increased morbidity Source: Adapted from FANTA 2003

Affects of HIV/AIDS on Nutrition  Decrease in the amount of food consumed  Mouth and throat sores  Side effects from Medication  Household food insecurity and poverty  Impaired nutrient absorption  HIV infection of intestinal cells  Frequent diarrhea and vomiting  Opportunistic infections

Affects of HIV/AIDS on Nutrition  Changes in metabolism  Increase in energy (10-15%) requirements  Infection increases demand for and utilization of antioxidant vitamins (E, C, beta-carotene) and minerals (zinc, selenium, iron)  Insufficient antioxidants from increased utilization causes oxidative stress  Increases HIV replication  Leads to higher viral loads

Effects of Nutrition on HIV/AIDS  Weight loss associated with HIV infection, disease progression, and mortality.  Poor absorption of fats that affects use of fat- soluble vitamins such as A and E  Some nutrient deficiencies (vitamins A, B12, and E, selenium and zinc) associated with HIV transmission, disease progression and mortality.

Challenges to Food Assistance Interventions

Food Assistance and Disease Progression  Given when PLHIV are already undernourished ( BMI < 18.5) and with a compromised immune status (CD4+ count falls < 200 cells per cubic millimeter).  CD4+ count takes only about a year to decline from 350 to < 200  Risk of death increased by 69% when the initiation for therapy is delayed until the CD4+ count drops to <350 cells per cubic millimeter.  Dearth of evidence on when food assistance may be initiated for the asymptomatic patient.

Importance of early Food Assistance Efforts  At prevention stage  Access to food may reduce adoption of livelihood strategies that increase susceptibility to HIV infection.  At HIV asymptomatic  Food assistance efforts to strengthen livelihoods and meet nutrient needs can promote positive living for PLHIV.

The HNP Approach

Project Background  The GL-CRSP through USAID and in partnership with AMPATH is funding a food intervention project that is being implemented in a rural community in Western Kenya.  The food intervention project has improvement of house hold food security through an increased intake of animal source foods as one of its core objective  Expected outcomes include changes in  immune and nutritional status  HIV viral load  Work productivity  quality of life  mortality

Project Background  Study design and target population  A randomized food intervention study  HIV+ drug naïve rural Kenyan women enrolled in the Turbo AMPATH clinic.  The food intervention  Typical biscuit recipe modified to incorporate an animal source protein

Project Background  Food intervention approximate nutrient content per 100 grams:  Energy 460 kcals  Protein 23.2gm  Iron 2.65mg  Zinc 2.56mg  Selenium 0.02mg  Vitamin B12 1.88µg

Project Background  Food intervention properties  Ready to use with hardly and preparation requirements  Palatability and digestibility taken into account  There is no need for fortification  Well accepted by both children and adults

Project Background  Key project incentives  safe water filters  bed nets  dairy goats  Education and training  animal husbandry ( goat)  Nutritional care and support

Very Preliminary Findings

The food intervention  Intra household distribution and intervention sharing has been avoided by ensuring observed consumption of the biscuit.  Data collection is on going on perceived  acceptability  quality  satisfaction

Data collection methods  30 HIV+ drug naïve classified as WHO Stage 1 or 2 with a CD4 count > 250.  A cross-sectional survey used to collect base line demographic and socioeconomic data.  Proxy measures of household food access and nutrient intake.  Dietary Diversity Score (HDDS)  Months of Inadequate Household Food Provisioning (MIHFP)  The 24 hr food recall questionnaire  Medical records source of information on CD4 count status.

Household Characteristics  Land ownership  No land 39% (12)  No cultivated land 27% (9)  < 2 acres cultivated 61%(20)  Income  < 285US $/per year 71%(22)  Source of income  Casual work 42% (13)  Self employed 26% (5)  Farm labour 16% (5)

Extent of HH food access  Household Dietary Diversity Score (HDDS)  High prevalence of low food diversity in diets  Mean (± SD) score 6.10 ± 1.9  Months of Inadequate Household Food Provisioning (MIHFP)  Mean (± SD) score 5.17± 1.4

Extent of HH food access  Months of Inadequate Household Food Provisioning (MIHFP)  Worry due to inadequate food 37% (11)  No resource to get preferred food 43% (13)  A limited variety of foods eaten 63%(19)  Eating small meals 33%(10)  Eating fewer meals 37%(11)

Adequacy of Nutrient Intake  Mean (± SD) nutrient intake based on 24hr recall  Energy 1413 kcals ± (149)  Protein 67.5 g ± (11.3)  Vitamin A 318 µg ± (71.1)  Folic acid 79.5 µg ± 11.1  Vitamin B1 12.1 mg ± (10.6)  Vitamin B2 1.0 mg ± (0.13)  Zinc 4.3 mg ± (0.59)  Iron 28.2 mg ± (4.8)

Adequacy of Nutrient Intake  Percent consuming < the RDA  Energy 74%  Protein 43%  Vitamin A 77%  Folic acid 87%  Vitamin B1 43%  Vitamin B2 73%  Zinc 100%  Iron 40%

Health and Immune Status  Mean (± SD) baseline CD4+ 361 ± (22)  After 3 months before food intervention  On drugs 13% (4)  Dead 3% (1)  > CD4+ 30% ( 9)

Concluding Remarks

Anticipated outcomes  Our aim is to delay the decline in nutritional status and initiation of ART.  Contribute to development and implementation of consistence evidence based strategies in nutritional support and care.  Promote positive living for PLHIV by improve their immune function, quality of life and productivity.  Contribute to enhancement of nutritional assessment  Foster collaboration with new partners

Our most dramatic outcome At approximately 4 yrs unable to stand or play After 4 weeks of food intervention

Acknowledgement . This research was made possible through support provided to the Global Livestock Collaborative Research Support Program by the United States Agency for International Development under terms of Grant No. PCE-G-00-98-00036-00 and by contributions of Moi University USAID-Academic Model Providing Access to Healthcare (AMPATH) Program.

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