KNOWLEDGE, ATTITUDE AND PRACTICE OF NUTRITION OF HIV ADULT PATIENTS ATTENDING UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU-OZALLA, ENUGU

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Appendix V

 

Table 4.8:     Relationship between knowledge, attitude and practices questions 48

Over the last decade, HIV/AIDS has become the world’s largest devastating epidemic, particularly in the developing countries where many governments have declared it an emergency. In 2004; 39.4 million people around the world were living with HIV/AIDS. More than 64.9 million people have been affected since the pandemic began. AIDS Control and Prevention AIDSCAP/FHI (2012). AIDS is a leading cause of death in Sub Sahara African, and fourth leading cause of death worldwide. Globally, 45% of adult living with HIV/AIDS are women. By region this percentage varies considerably with 57% in Sub Sahara Africa, 28% in East Asia and 17.6% million in the pacific NASCOP (2014). Human immune-deficiency Virus (HIV) infection and Acquired Immune Deficiency Syndrome (AIDS) are caused by the Human Immune Deficiency Virus  which  has various stereotypes. Since the isolation of the first confirmed case of the disease in 1981, HIV/AIDS has become a global health problem, with bulk of the disease borne by Sub Sahara Africa. (Report on the Global HIV/AIDS Pandemic, 2009). Many HIV related conditions affect and are affected by the body’s nutritional status Barlett ( 2003). The first two AIDS cases in Nigeria was diagnosed in 1985 and reported in 1986 in Lagos one of which was young female sex worker aged 13 years from one of the West Africa countries (Nasidi and Harry, 2006). Subsequently the government mobilized additional resources and established a national AIDS Control Council to advocate, strengthen and co-ordinate the multi-sectoral response to contain the spread of the HIV and mitigate the impacts of AIDS, Federal Ministry of Health FMOH, (2011). The United Nations reports that everyday 6000 people aged 15-24 years become infected with HIV. Economic, social and cultural factors contribute to the disparity of HIV/AIDS between children and women USAIDS (2003). HIV infection compromises the nutritional status of infected individuals and in turn poor nutritional status can affect the progression of HIV infection. Of all the body’s system, the immune system responds most sensitively to subtle changes in nutritional status. Impaired immunity decreases disease risk, disease state reduces food intake and nutritional status suffers further (Piwiz and Preble, 2000). HIV and nutrition are interrelated and as antiretroviral drug become increasingly available in the poorest parts of the world, critical questions are emerging about how well the drugs work in people if they are short of food, and for those already receiving treatment, side effects such as body fat changes are a daily concern Barlett (2003) and Association of Nutrition Services Agencies (ANSA). Adequate nutrition refers to intake of a diet which meets the specific nutritional needs for the specific individual for that specific period in time. (Association of Nutrition Services Agencies (ANSA). The sole aim of adequate nutrition is to meet the growth and developmental demands of the unique, specific individual’s body. (Walsh et al., 2011). Inadequate nutrition in people with HIV infection may result from many factors including nausea, vomiting and anorexia that may prevent adequate intake of nutrients and medications; diarrheal infections that prevent absorption of nutrients and medications; Oral health conditions that interfere with chewing or tasting food like oral candidiasis in adult patients who present late; systemic illness (including HIV itself) that create a catabolic state; and psychological conditions such as depression that impair adult patients ability to nourish themselves. Steinhart,(2011) and association of Nutrition Services Agencies (ANSA).In addition, financial constraints may limit adult patients access to nutritious food (Walsh et al., 2011). Adequate nutrition helps to maintain and improve the nutritional and immunological status of a person with HIV/AIDS and delay the progression from HIV to AIDS related diseases (Steinhart, 2011). It can therefore improve the quality of life of HIV/AIDS adult patients. Adequate nutrition will complement the effects of antiretroviral therapies and will help to maintain body weight and fitness, as well as improve the performance of the immune system already compromised by the infection (Steinhart 2011). Whereas starving people tend to lose fat first, the weight lost during HIV infection to be in form of lean tissue such as muscle mass. This means there maybe changes in the makeup of the body even if the overall weight stays the same (Evidence lessons and recommendations for action, April 2005 issue and World Health Organization (WHO). African Regional report 2008) one factor behind HIV-related weight loss is increased energy expenditure (European Collaborative Study 2003 and Batterham, 2005). Many studies indicate that people with HIV tend to burn around 10% more calories while resting, compared to those who are unaffected (Evidence lessons and recommendations for action, April 2005 issue and Batterham, 2005). Nutritional control of weight can be effectively used to balance out these body changes in infected adult patients. Current antiretroviral drug treatments control HIV infection and prevent severe wasting. In addition, some antiretroviral drugs have been linked to lipo-dystrophy, as well as lipid abnormalities by raising Low Density Lipoproteins (LDL) cholesterol, lowering High Density Lipoprotein (HDL) cholesterol and raising triglyceride levels in the blood (Batterham, 2005 and Sabin et al., 2008). One study in Malawi found that adult patients with mild malnutrition (a Body Mass Index (BMI) of 17.00-18.49kg/m2) were twice likely to die in the first three months of treatment; and for those with severe malnutrition (BMI less than 16.00kg/m2), the risk was six times greater than those with healthy body weight (BMI ranging between 18.5-24.99kg/m2) (Paton 2006). Since the beginning of the pandemic, over 30 million people have died from AIDS-related causes globally (Banwat 2014 ). In Nigeria, an estimated 4.6% of the populations are living with HIV/AIDS (The United Nations General Assembly Special Session Country Progress report; Nigeria, 2010).

Although HIV prevalence is much lower in other African countries, the enormous size of Nigeria’s population makes this prevalence to be a large number. The HIV pandemic has also significantly compromised the food security of affected households and communities, reducing the availability of productive labor, diverting income, depleting savings and productive assets and impending intergenerational knowledge transfer (Human Development Reports (2007/2008). Based on the backdrop, there is need therefore to examine the knowledge, attitude and practices of nutrition on the nutritional status of HIV/AIDS adult out-patients attending UNTH in Ituku Ozalla, Enugu.

AIDS has become a tragedy of devastating proportions in Nigeria. The lives of infected individuals, their families and communities, the communities they work for, and the country as a whole have been affected by the HIV/AIDS epidemic (NASCOP. 2014). HIV/AIDS and nutrition are intimately linked. HIV weakens the immune system thus compromising the body’s ability to fight infections. As a result, due to repeated periods of prolonged illness, they reduce their appetite and interfere with the body’s absorption of nutrients. Infections also increase the body’s need for essential nutrients, (FAO, 2003). Although  good  nutrition is important for better health and quality of life of adults living with HIV.

However, there is little evidence that is adequately addressed in counseling and care of HIV/AIDS adult living with HIV. Nutrition education at early stage gives the person a chance to build up healthy eating habits and to take action to improve food security in the home, particularly with regard to cultivation, storage and cooking of food. A person receiving treatment for the injections and combination therapy for HIV needs good nutrition to influence the effect of drugs taken (FAO, 2002). Hence the study sought to assess the knowledge, attitude and dietary practices HIV/AIDS adult out patients.

The general objectives of the study is to assess the knowledge, attitude and practices of nutrition of general adults living with HIV/AIDS attending UNTH in Ituku/Ozalla, Enugu.

The specific objectives of this study are to;

Practically, the findings of this study will be of immense benefit to the hospitals, parents, HIV patients, students and researchers. The findings of the study will provide a guide for the parents and relations of adults living with HIV adequate plans to provide food with adequate nutrition which will complement and improve the performance of the immune system already compromised by the infection.

The findings in changes in knowledge, attitude, and practices of nutritional patterns of adults living with HIV attending UNTH will help in planning short term nutrition intervention programmes at the center.

This information will also help nutrition counselors to identify appropriate and possible nutrition actions at the centre, in the implementation of best nutrition actions. Hence advice is a necessary adjustments in dietary practices of clients at an early stage.

The findings on nutrition related side effects will help care providers to identify the side effects common to the first few months of treatment and manage them at an early stage.