ABSTRACT
The study evaluated the nutritional status, knowledge, attitude and practices of people living with HIV/AIDS (PLWHA) attending special treatment centre (STC) in National Hospital Abuja. A cross sectional study design was carried out in the STC and a total of two hundred and seventy (270 [150 male and 120 female]) PLWHA were used for the study. The PLWHA attend STC once in 2months and the subjects were grouped into 16 giving 4 groups per week since the centre runs Monday through Thursday weekly and by 2months, there were altogether 32groups. Nine (9) subjects (5 males and 4 females) per group were recruited using simple random sampling by balloting without replacement (Yes/No) to select the number required for the study in each day of visit. A structured questionnaire was used to collect background information, socioeconomic characteristics, knowledge, attitude and practice of nutrition of PLWHA. Anthropometric measurement (weight, height and triceps) and biochemical parameters (haemoglobin and CD4+ count) were carried out. Data collected were analyzed using descriptive statistics, Chi-square and regression analysis. The result revealed that 44.2% of the subjects had tertiary education, 40.2% were civil servants, while 34.8% earned less than N10,000 monthly. Less than half (41.1%) had poor knowledge of nutrition, 29.1% had both fair and good knowledge while very few (0.7%) had an excellent knowledge, however, more than half (52.8%) had a positive attitude of nutrition. 52.7% and 43.1% of PLWHA were asymptomatic and symptomatic, respectively, while most (66.5%) were moderately anaemic and their skinfold status showed that 56.0% were malnourished. Socioeconomic characteristics had a significant (P<0.01) influence on their nutritional status, which revealed that low education and being self-employed had a significant (P<0.01) influence on the CD4+ count of PLWHA. Furthermore, gender (being female) and age (being young) had a significant (P<0.01) influence on their BMI, while only being female significantly (P<0.01) influenced the skinfold thickness of the PLWHA. Self-employment and being female were the strongest (P<0.01) positive predictors of nutrition knowledge, while their attitude of nutrition was significantly (P<0.01) predicted by being female, however, low education and being single had a negative influence on the attitude of the PLWHA towards nutrition. Therefore, good nutrition knowledge with proper education, occupation (good paying job) and high income are important tools which when in place and sustained will promote a healthy people living with HIV, thereby leading to a healthy nation.
TABLE OF CONTENT
COVER PAGE
TITLE PAGE i
DECLARATION ii
CERTIFICATION iii
DEDICATION iv
ACKNOWLEDGEMENTS v
TABLE OF CONTENTS vi
LIST OF TABLES ix
ABSTRACT x
CHAPTER 1:
INTRODUCTION
1.1 Background
of the Study 1
1.2 Statement
of Problem 3
1.3
Objective of the Study 4
1.3.1 The general objective of the study 4
1.3.2 The specific objectives of the study 4
1.4 Significance of the study 4
CHAPTER 2: LITERATURE REVIEW
2.1 History of
HIV/AIDS 6
2.1.1 The history of HIV in Nigeria 7
2.2 Prevalence of HIV/AIDS in Nigeria 8
2.2.1 Pathophysiology and clinical presentation 11
2.3 Nutrition and HIV/AIDS 12
2.3.1 Carbohydrates 12
2.3.2 Fat 13
2.3.3 Protein 14
2.3.4 Micronutrients 14
2.4 Benefits of Nutrition in HIV/AIDS 17
2.4.1 Nutrition improves the immune system 17
2.4.2 Nutrition prevents malnutrition and weight
loss 18
2.4.3 Nutrition and opportunistic infections 20
2.4.4 Nutrition complements the effects of
Anti-retroviral Therapy (ART) 20
2.4.5 Nutrition reduces morbidity and mortality 21
2.4.6 Recommended Daily Allowance (RDA) of
nutrients for PLWHA 21
2.4.7 Effects of poor nutrition in PLWHA 25
2.4.8 Nutritional challenges in PLWHA 226
2.5 Nutrition-related Knowledge, Attitude and
Practice among PLWHA 27
2.6 Nutritional Status 30
2.6.1 Anthropometric measurement 30
2.6.1.1
Height measurement 31
2.6.1.2
Weight measurement 31
2.6.1.3
Body Mass Index (BMI) 31
2.6.1.4
Waist circumference 32
2.6.2 Biochemical nutritional assessment 33
2.6.2.1
CD4 t-cells 33
2.6.3 Clinical nutritional assessment 35
2.6.4 Dietary nutritional assessment 35
2.6.5 Baseline assessment of nutritional status 35
2.7 Food habit 36
2.7.1 Factors that influence food habit 37
2.7.1.1
Hunger and satiety 37
2.7.1.2
Cultural influences 38
2.7.1.3
Palatability 38
2.7.1.4
Social influences 39
2.7.1.5
Religious influences 39
2.7.1.6
Environmental influences 39
2.7.1.8
Economic and physical determinants of food choice cost and accessibility 40
2.7.1.9 Education
and knowledge 40
2.7.1.10
Meal patterns 41
2.8 Factors that Affect HIV Disease
Progression 41
2.8.1 Age 41
2.8.2 Body Mass Index (BMI) 43
2.8.3 Ethnicity and race 44
2.8.4 Gender 44
2.8.5 Pregnancy 45
2.8.6 Haemoglobin 45
2.8.7 Mode of transmission 45
2.8.8 Psychosocial factors 46
2.8.9 Total Lymphocyte Count (TLC) 46
2.9 The Effects of HIV and AIDS on Different
Systems of the Body 47
2.9.1 Immune system 47
2.9.2 Cardiovascular complications 47
2.9.3 Respiratory system 48
2.9.4 Nervous system 48
2.9.5 Gastrointestinal (GI) system 49
2.9.6 Skin system 49
2.10 Nutritional Management of Opportunistic
Infections in People
Living
with HIV/AIDS 50
2.10.1 Diarrhoea 50
2.10.1.1
Preparing an oral rehydration drink with sugar and salt 52
2.10.1.2
Preparing an oral rehydration drink with powdered cereals 52
2.10.2 Lack of appetite 53
2.10.3.1
How to deal with nausea and vomiting 54
2.10.4.1
How to deal with a sore mouth 55
2.10.5
Other digestive problems 55
2.10.5.1
How to stop constipation 56
2.10.5.2
How to prevent a bloated feeling 56
2.10.5.3
Changes in the taste of foods 57
2.10.5.4 Skin problems 57
2.10.5.5
Cold, cough and influenza 57
2.10.6 Fever 58
2.10.7
Weight loss/ muscle wasting 58
CHAPTER
3: MATERIALS AND METHODS
3.1 Study Design 59
3.2 Area of Study 59
3.3
Population of Study 59
3.4
Sampling and Sampling Techniques 59
3.4. 1 Sample
size determination 59
3.4.2
Sampling procedure 60
3.4.3
Inclusion/exclusion criteria 61
3.5
Preliminary Activities 61
3.5.1
Preliminary visit 61
3.5.2
Validation of questionnaire 61
3.5.3
Pre-testing of questionnaire 61
3.5.4 Training of research
assistants 62
3.5.5 Ethical approval 62
3.5.6 Written/oral informed consent 62
3.6
Data collection 62
3.6.1
Questionnaire administration 62
3.6.2 Anthropometric
measurement 63
3.6.2.1 Weight measurement 63
3.6.2.2 Height measurement 63
3.6.2.3 Body Mass Index (BMI) 63
3.6.2.4 Skin fold measure 64
3.6.3 Determination of Nutrition Knowledge 65
3.6.4 Attitudinal
Questions 65
3.6.5 Dietary Practices 66
3.6.7
Biochemical Assessment 66
3.7
Data Analysis 67
3.8 Statistical
Analysis 67
CHAPTER
4: RESULTS AND DISCUSSION
4.1 Background
Information and Socioeconomic Characteristics of the Respondents 68
4.3
Nutrition Knowledge and Attitude of
the Respondents 86
4.4
Nutrition practices of the respondents 90
4.5
Anthropometric and Biochemical Status of the Respondents 100
4.6
Influence of Socioeconomic Characteristics, Nutrition Knowledge And
Attitude on The Nutritional Status of People Living
With HIV/AIDS 103
CHAPTER 5: CONCLUSION AND RECOMMENDATIONS
5.1
Conclusion 108
5.2.1
Recommendations 108
5.2.2
References 110
LIST OF TABLES
Table 3.1: Body mass index classification 64
Table 3.2: Skin fold measurement 65
Table 4.1:
Background information and socioeconomic characteristics of the respondents 70
Table 4.2a: Food frequency of intake of
root and tuber crops 73
Table 4.2b: Food frequency of intake of
cereal and cereal products 74
Table 4.2c: Food frequency of intake of
legume and leguminous products 76
Table 4.2d: Food frequency of intake of
meat and meat products 78
Table 4.2e: Food frequency of intake of
milk and milk products 79
Table 4.2fi: Food frequency of intake of
fruits and vegetables 81
Table 4.2fii: Food frequency of intake of
fruits and vegetables 82
Table 4.2g: Food frequency of intake of
fats and oil 83
Table 4.2h: Food frequency of intake of
non-alcoholic and alcoholic drinks 85
Table
4.3a: Nutrition knowledge score of the respondents 86
Table 4.ai: Mean
and standard deviation of nutrition
knowledge
questions of the respondents 87
Table 4.3b: Attitude score towards
nutrition of the respondents 88
Table 4.bi: mean
and standard deviation of attitude questions
on
nutrition by the respondents 89
Table 4.4a: Factors that affects choice of
meal of the respondents 91
Table 4.4b:
Factors that prevent eating of healthy foods by the respondents 94
Table 4.4c: Methods of cooking by the
respondents 96
Table 4.4d: nutrition practice of the
respondents 99
Table 4.5: Anthropometric and biochemical status of
the respondents 102
Table
4.6a: Influence of socioeconomic characteristics on nutritional status
of
people living with HIV/AIDS 105
Table
4.6b: influence of socioeconomic characteristics on the nutrition knowledge
and
attitude of people living with HIV/AIDS 107
LIST OF FIGURES
Figure
1: Benefits of nutrition intervention 25
CHAPTER 1
INTRODUCTION
1.1
BACKGROUND OF THE STUDY
Human
immunodeficiency virus (HIV),
also known as retrovirus, is a main cause of acquired immune deficiency
syndrome (AIDS). HIV has a
deleterious impact on the body's natural defenses against infection and disease
(Bijlsma, 2000).
An individual's defense mechanism is
affected by HIV, thereby making way for other parasites (viruses and bacteria)
to further destroy the body's immune system, resulting to oral thrush,
tuberculosis, and/or pneumonia (Bijlsma, 2000). AIDS is mostly present when an
individual starts experiencing some of the opportunistic infections.
According to Bijlsma (2000) the expected
period for HIV to translate into AIDS is relatively dependent on the health and
nutritional status of an infected individual, and this period could be said to
be within 10 years. Some therapeutic measure can be used to prevent and/or manage and cure the opportunistic diseases
in order to treat the symptoms such as cough, itches, fever, diarrhoea, and
breathing and/or swallowing difficulties, associated with the diseases
(Bijlsma, 2000).
In order
to improve the health and nutritional status of persons with HIV and AIDS
(PLWHA), studies have suggested that nutrition knowledge and attitude are
important factors of dietary practices and are, thus, potential target for
appropriate planning of nutrition care programmes. Hence, nutrition education
paved way for nutrition knowledge which invariably influence attitude and
practice towards adequate nutrition (Komwaet
al., 2010; Whaling et al., 2012).
However, De Vriendtet al. (2009) and
McLeod et al. (2011) opined that
socio-demographic characteristics had contributed to poor adoption of adequate
nutrition practices. The World Health Organization (2003) reiterated some of
the changes such as appetite and weight loss, and malnutrition due to HIV,
which will further compromise nutrition status of individuals already infected
with HIV and invariably aggravate the disease impact.
Adequate
nutrition is vital for good health and development. Infection and malnutrition
interaction has been documented, which indicated that irrespective of the
disease progression, nutritional status of an individual has a vital role on
the effect of mortality and/or morbidity (Lawrence and Stuart, 2001). Muthamiaet al. (2014) reported that proper
nutrition knowledge impacts the dietary intake in all income levels, which
impact on nutritional status of all age group. Nutrition knowledge is important
to PLWHA, because it will aid in making right choices in food selection,
preparation and/or food habit and thus influence their dietary practices and
invariably influence their nutritional status.
Johansen
(2007) is of the opinion that nutrition is key among others such as medical
approach, in the management of PLWHA, however, there are challenges they face
such as maintence of proper nutrition, effect of high lively antiretroviral
therapy (HAART) and viral infection. Riddler (2003) reported that HAART could
affect individual's absorption and utilization of nutrients, could also cause
fatigue, nausea and abnormal appetite.
The
nutritional desires of PLWHA are high, in order to boost their immune system to
combat opportunistic infections that is not prevalence in healthy individuals
(Riddler, 2003; Johansen, 2007). Appropriate medication and right nutrition,
conversely, are critical for maintaining good health and improving the lives of
PLWHA (Thomson, 2010).
There is little or no information on PLWHA
dietary knowledge, attitudes, or behaviors. The aim of this study was to assess
the nutrition knowledge, attitudes, and behaviors of PLWHA who visited the
special treatment centre (STC), an outpatient clinic at National Hospital Abuja.
1.2 STATEMENT OF PROBLEM
Despite
growing understanding about the human immunodeficiency virus, the rate of death
and other diseases caused by HIV/AIDS in developing nations remain unacceptably
high (HIV). The viral infection amounts to global public health emergency and
is most predominant in areas where undernutrition exists. Millions of people
remained chronically malnourished globally and populations already endangered
by food and nutrition insecurity and/or diet low in both quality and quantity
are most hit by HIV epidemics.
In
Nigeria, there is little or no information on the influence of nutrition
knowledge, practices and attitude on the health and nutritional status of
PLWHA. However, significant impact has been observed in the medical management
and support for PLWHA attending STC in National Hospital Abuja since
antiretroviral therapy (ART) became accessible, however, there is still big gap
to bridge in the knowledge, practices and attitude of nutrition of PLWHA and
this may have greatly affected their nutrition and health outcome. This aspect
of management in HIV infection is a cause for concern.
There is
also limited nutrition education and counseling given to PLWHA, which has
contributed to poor dietary choices and/or practices in disease management and
treatment. Furthermore, PLWHA may be unaware of the significance of nutrition
to maintaining good health, and that nutrition counseling, support and care are
integral to comprehensive management of PLWHA. However, there is room for
improvement in nutrition knowledge, practices and attitude, which is essential
in HIV/AIDS care process. Thus, there is need for the present study to be
carried out.
1.3OBJECTIVE
OF THE STUDY
1.3.1 The general objective of the study
The general objective of the study was to evaluate the nutritional
status, knowledge, attitude and practices of people living with HIV/AIDS
(PLWHA) attending outpatient clinic in National Hospital Abuja.
1.3.2 The specific objectives
of the study
The specific objectives were to:
1. assess the socio-economic characteristics of PLWHA;
2. determine the nutrition knowledge of PLWHA;
3. determine the attitude of PLWHA;
4. assess their practices using food frequency questionnaire;
5. determine the nutrition status of PLWHA using anthropometric (weight,
height and skinfold measurement) and biochemical measurements and;
6. determine the influence of socioeconomic characteristics on the
nutritional status, knowledge, and attitude of nutrition on PLWHA.
1.4 SIGNIFICANCE OF THE STUDY
The result
of this study will suggest nutrition education and intervention programmes to
be carried out and the outcome could serve as a guide for Clinical
Nutritionists, Dietitians and other health-care professionals in the management
of PLWHA and thus, help improve the nutritional and health status of PLWHA, also
significantly reduce morbidity and mortality.
The
study's findings will further stimulate policy formulations on support and care
process for PLWHA by the Nigerian Ministry of Health, the National AIDS Control
Programme (NACP), and other HIV/AIDS-related NGOs. This will then lead to
creating public awareness towards nutrition education and intervention for
PLWHA.
The study will further enrich knowledge base and findings
will be made open for other researchers and/or young researchers alike to
leverage on the study and also replicate/further study in other locations.
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