Abstract

Background: Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS. Thus, proper nutrition is critical to minimize susceptibility to opportunistic infections which worsen HIV/AIDS progression and equally minimize non-acquired Immunodeficiency syndrome(AIDS) related mortality in HIV-infected persons.

Aim: This study aimed at determining the prevalence and determinants of malnutrition amongst HIV-infected adults on ART at the BRH.

Method: After getting all necessary authorizations, questionnaires were used in assessing nutritional characteristics of the participants. In addition, anthropometric measurements such as weight, height and mid-upper arm circumference were taken. Viral load information was also gotten. This data was then analyzed using the SPSS software.

Results: This study reported a high burden of malnutrition with a prevalence of 53.1%, with overweight and obesity being more prevalent as compared to underweight. A good number of these participants were also food insecure. Sex and marital status were found to be statistically significant with malnutrition at p values of p=0.000 and p=0.002 respectively.

Conclusion: Overweight and obesity are becoming more prevalent in HIV-infected persons as compared to wasting syndrome which was initially the problem.

CHAPTER ONE

INTRODUCTION

1.1 Background

There is increasing interest globally about malnutrition which directly affects one in three people living in the world and refers to undernutrition, overnutrition [1] and obesity which leads to diet non-communicable diseases such as; Diabetes, cardiovascular diseases, stroke and cancers. Malnutrition is the most important risk factor for the burden of disease in developing countries thus, the risk of death in these diseases is directly correlated with the degree of malnutrition [2]. For example; malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS [3].

In 2020, there were 37.7 million people living with HIV worldwide of which 36.0 million were adults [4]. Sub-Saharan Africa suffers from a high burden of malnutrition affecting 23.2% of its population and in 2015 constituted 69% of the estimated people living with HIV globally [1]. Although mortality amongst PLWHIV has decreased since the introduction of ART, mortality rates however remain higher in this population as compared to the general uninfected population. This difference is due to vulnerability to opportunistic infections that can be amplified by undernutrion, and equally non-AIDS related comorbidities like; Diabetes and cardiovascular diseases which could be fueled by overnutrition and ART [5].

The role of malnutrition in HIV disease and poor clinical outcomes is significant and likely under-reported and very few studies have examined the impact of macronutrient supplementation  and or nutritional counselling and exercise programs on limiting mortality and improving survival in adults in resource-constrained settings.

In certain African countries such as Ethiopia, malnutrition amongst people living with HIV and enrolled on ART has been a major challenge to accomplish the full impact of intervention. The prevalence of malnutrition amongst HIV-infected adults in Ethiopia ranges from 12.3% to 55.6% [6]. Other countries such as Tanzania, Zimbabwe and Senegal discovered a prevalence of 19% [7], 10% [8] and 19% [9] respectively.

In Cameroon, the expansion of ART availability has revolutionalized the treatment of HIV-infected persons and led to a decline in HIV transmission. However, adequate nutrition is necessary to manage opportunistic infections, maintain the immune system, prevent development of non-AIDS related mortality in PLWHIV and optimize response to medical treatment [10].

A study conducted in the Center region of Cameroon showed a high burden of malnutrition in HIV-infected adults receiving ART. It recorded a prevalence of 8.5% undernutrition, 11% obesity and 35.4% overnutrition. Pertinent risk factors were the quality of food consumed, other socio-demographic and socio-economic factors. In a similar study conducted in the East Region of Cameroon, a prevalence of malnutrition of 11.6% was recorded [11].

1.2 Problem Statement

Malnutrition in HIV-infected persons leads to mortality through nutrient insufficiencies which weaken the immune system and decrease its ability to fight opportunistic infections, and even nutrient excesses which lead to non-AIDS related mortality from diet non-communicable diseases such as; diabetes, heart disease, high blood pressure, stroke and cancers. Despite these findings, very few studies have examined the rate of malnutrition in these persons and promoted the act of macronutrient supplementation, nutritional counselling and exercise programs in limiting mortality rates amongst this population. Thus, there is a need to determine and identify the prevalence and determinants of malnutrition in this population.

 1.3 Rationale

There has been an increasing prevalence recorded from the few studies on malnutrition in HIV-infected adults in Africa and Cameroon inclusive, this is negatively affecting survival rates within this population. However, no recent published study has provided information on this subject in the BRH. Thus, this study aims at determining the prevalence and determinants of malnutrition in HIV-infected adults on ART at BRH in order to propose better ways of eradicating malnutrition and improving survival rates amongst this population.

1.4 Research Questions

1. What is the prevalence of malnutrition amongst HIV-infected adults on ART at the Buea Regional Hospital?
2. What are the nutritional and other health characteristics of HIV-infected adults on ART at BRH?
3. What are the risk factors of malnutrition amongst HIV-infected adults on ART at BRH?

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