Assessment of nutrition, infection and immune factors in Hiv Sero-positive patients enrolled in the Ampath clinic at Chulaimbo sub-district hospital, Kisumu west district, Kenya
AGATHA, Onyango Christine
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ABSTRACT HIy worsens the nutritional status by increasing the body's requirement for food and also leads to opportunistic infections, which in turn, increase body nutrition requirements. This study was conducted to assess nutrition, infection and immune factors in HIV sero-positive patients at Chulaimbo Sub-district Hospital, Kenya. This is one of the centres for the Academic Model for the Prevention and treatment of HIV and AIDS (AMPATH) program of Moi University covering about 14,339 HIV and AIDS patients. Patients were followed for six months to collect information on selected variables including CD4 cell count, white blood cells and platelet count; to assess food consumption patterns, nutrient status and nutritional status of HIV sero-positive patients; to establish the infection pattern in HIV sero-positive patients; to establish the association of nutrition, infection and immune factors across the mild, moderate and severe categories of immune status; to determine the knowledge, attitude, beliefs and practices of the patients towards dietary management of HIV infection. A longitudinal study design was adopted where the HIV and AIDS patients enrolled at the hospital were followed for six months. Simple random sampling was adopted for the selection of the sample 497 patients for this study. Data was collected between the month of February and July, 2010 using focus group discussion guides, structured interview schedule, nutrient assessment measures, anthropometric measurements and immune status measures. Data analysis was qualitatively carried out using content analysis and quantitatively using descriptive statistics and inferential statistics. Food composition tables were used to compute the nutrient intake of the HIV sero-positive patients. Chi-square was used to establish if there was any relationship in marital status, education level, occupation, WHO staging and categories (mild, Moderate and severe) between sexes. Independent sample t-test was used to establish if there was any significant difference in the means between sexes and age, family size, immune status measures, nutrient intake, nutrient status, those who suffered infection and those who did not suffer infection, and those who had episodes of diarrhoea and those who did not have episodes of diarrhoea. Linear regression was used to determine mean differences of immune factors and nutrient intake, nutrient status indicators, BMI, immune status measures and infections. Findings in this study revealed that majority of the patients in this study were in the third WHO staging (42.3%) with CD4 cell count ranging between 200-499 cell/rnrrr' (50.7%). There were more male patients (32.4%) compared to females (14.0%) with CD4 cell count below 200 cells/mm3. There was inadequate nutrient intake reported in most of the patients although majority (55.3%) had three meals per day. Generally there was inadequate nutrient intake reported among the HIV patients in all the three categories of immune status, except for iron (10.49 ±3.49 mg) in the males and thiamine in both males (1.65 ±O.66 mg) and female (1.72 ±O.69 mg). Malnutrition was observed in 20.3% of 497 HIV sero-positive patients were who had a mean BMI < 18.5kg/m2. Majority of the patients in the severe category (CD4 < 200 cell/rnrrr') had a BMI of less than 18.5kglm2. There was a significant difference in the BMI between the male and female patients (February p = 0.001, April, p = 0.010, May p = 0.011 and July p = 0.015). Majority of the patients (66.4%) who had infections were in the severe category of immune status. Therefore, nutrition assessment of HIV and AIDS patients is important at all stages of the disease in order to identify those with signs of malnutrition. Results of this study will help to educate health workers on the relative value of using various measurements to assess nutritional status of HIV-infected populations for appropriate interventions. The inferences drawn from this study will assist the Government of Kenya and health professionals in designing nutritional support for HIV-infected persons.