Abstract

Nutrition is a vital component in the management of HIV/AIDS, especially considering the fact that this condition which impairs the ability of the immune system to play its role has no cure.

This means providing nutrition education becomes a vital component of nursing management for these patients. This study thus sought to explore nurses’ approach to nutrition education for these patients as well as the nurses’ and patients’ challenges in the process.

The objectives of this study were to find out the nurses’ approach to HIV nutrition education and barriers faced by nurses and HIV patients in the process. Using a qualitative design, 10 nurses and 10 patients were selected purposively to take part in semi-structured interviews. Interviews were tape-recorded, transcribed, and analyzed with the aid of Alas. ti version 5.2.

Three themes and thirteen categories emerged from the data. The main themes included: nurses’ approach to nutrition education, challenges faced by nurses and patients in the education process. The results showed that there were two major approaches to nutritional education; done as a routine activity and when there was a need.

The findings again showed that nurses were responsible for deciding the nutrition topics and content to be taught. The process to teaching was basically deciding the topic and content, using lectures and/or discussions, to transmit the knowledge, use questions and feedback to evaluate patients learning.

Lack of formal teaching guides, inadequate knowledge, insufficient teaching aids, heavy workload etc were all identified challenges nurses faced in the nutritional education process.

Lack of supplementary reading materials, low retainment level and superficial teaching etc were all identified challenges faced by patients in the education process.

Further education opportunities for nurses, availability of teaching guides, provision of supplementary materials etc will help to improve nutritional education. This study can guide nurses, patients and the hospital to work collaboratively in improving nutritional education in treatment centers.

CHAPTER ONE

INTRODUCTION

Nutritional care has recently come to the forefront as a critical component of any comprehensive treatment, care, and support package for people living with HIV/AIDS (PLWHA). This research revolves around this concept with focus on education. In chronic diseases such as HIV, patients are involved in the care. Patients are expected to be involved in self-care management in order to promote health and delay disease progression.

Making proper food choices, the timing of eating and so many other nutritional factors are relevant in self-care management by the patient. We would all agree with the opinion that, a patient cannot make proper decisions about nutrition if he/she is not knowledgeable about what it entails.

Now, health professionals come in to make sure that patients are been taught so that they will acquire this knowledge, skills, and attitudes. However, nurses will be more inclined to educate these patients by virtue of their professions. Nursing is all about care, and caring for someone who is sick also involves teaching this person to make proper health choices.

• BACKGROUND

HIV/AIDS does not discriminate: it has infected and affected people of every race, creed, gender, nationality, ethnicity, age, and income. In the year 2013, about 35.0 million people (ages 15-49) were living with HIV which gave a global prevalence rate of 0.8%⁹⁷. It is distressing to know that out of these 35million persons, 1.5 million persons died of AIDS. HIV is a leading cause of death worldwide and the number one cause of death in Africa⁹⁷.

Despite interventions in place, still there were about 6,000 new infections per day⁹⁸. New cases have been reported in all regions of the world but it is worth noting that almost 70% of these cases located in sub-Saharan Africa⁷¹.

The healthcare systems of countries in Sub-Saharan African therefore face a great threat as a result of HIV/AIDs. For an illustration, some country-specific HIV/AIDS prevalence in 2012 ^[3] includes; South Africa (17.9%), Botswana (23%), Swaziland (26.5%), Senegal (0.5%), Cameroon (5.5%), Nigeria (3.1%), Kenya (6.1%), Uganda (7.2%), Tanzania (5.1%) ⁷¹.

Sub-Saharan Africa, the hardest hit region, has about 71% of people living with HIV but only about 13% of the world’s population⁹⁸. Its national HIV prevalence rate is greater than 1%. In 9 countries, 10% or more of adults are estimated to be HIV-positive⁷¹. It is worth noting that Cameroon is one of the countries in West Africa has a high prevalence.

Cameroon is no exception to the rule, and interestingly enough may even be the “birthplace of AIDS,” as researchers reported in 2006 that its southeastern rainforests may have even been where the virus first jumped from chimpanzees to humans^94. Cameroon is in the midst of a generalized HIV epidemic with an overall prevalence of 5.5%²⁶.

The AIDS crisis in Cameroon in 2006 was ranked 144 out of 177 countries on the United Nations Development Program’s Human Development Index ⁹⁷.

In the country, hyper- endemicity exist among the military (11.2%); pregnant women in urban areas of the Southwest (12.3%); men who have sex with men (MSM) (24% in Douala and 44% in Yaoundé); and female commercial sex workers (CSW) (36%)²⁶. There is also a marked disparity in HIV rates between women and men especially in youth aged 15-24, among whom females are more than twice as likely to be infected as males. Data on incidence indicates 51,315 new HIV infections per year ²⁶

Prevention, voluntary testing, and counseling centers have been integrated into all national, regional, and district hospitals in 10 regions²⁶.

The government of Cameroon is committed to promoting universal access to treatment through the creation of 28 approved treatment centers and 112 district management units across the country (representing coverage of 56.2%) and by reducing the costs of testing, treatment and laboratory follow-up through subsidies²⁶.

Among the 10 regions in Cameroon, the southwest is the fourth leading region with a high prevalence of about 8% of the adult population living with HIV. In response to this, there are 11 Health Districts having at least an HIV/AIDS management unit representing district coverage of 65%.

These HIV/AIDS management units comprise 2 approved treatment centers (CTA) and 12 HIV/AIDS management units (UPEC) ⁸⁹.

HIV patients face many health challenges. One of such health challenges is maintaining adequate nutrition, as demonstrated by many studies. For example, in one study carried out by Siddiqui et al¹⁹, almost every 1in 10 managed care patients with HIV/AIDS have evidence of HIV-associated weight loss.

Another study carried out in Iran also showed a prevalence of 70% of PLWHIV with anemia¹². It has been shown that nutritional problems can occur in HIV patients in three ways: the disease itself, its treatment, and/or from other social factors⁹.

Nutritional disorders just as in other disease conditions, can have devastating consequences in PLWHIV^{[13][85][87][88][86]}which may involve both clinical and social problems⁸¹. Hence, nutritional support has been identified as a major priority for PLWHIV⁸⁰.

Nurses play a major role in providing nutritional support to PLWHIV. The scope of nutritional care they provide may include nutritional assessment and interventions, counseling, nutrition education, and provision of food²¹. Just as in any chronic condition, one can consider nutrition education as the backbone to nutrition support to PLWHIV.

1.2 PROBLEM STATEMENT

Good nutrition in HIV increases resistance to infection, slows disease progression, improves energy, and makes ARVs work better⁸⁰. From the above importance of nutrition in HIV/AIDS, proper nutritional education is an essential component of nursing care.

Nutrition education needs to be planned, delivered in a systematic manner, evaluated for understanding and implementation⁷⁶. Cameroon’s ministry of public health opened HIV treatment centers across the country where nurses and other health professionals provide focused care.

By virtue of their proximity to, and duration of interaction with the patients, nurses play a key role in the health education process. It is their approach to this that determines whether patients learn and implement proper nutritional habits necessary for their condition.

It was therefore important to study the nutritional education process and barriers to effective teaching and learning in our HIV treatment centers so as to provide recommendations for enhancement and improvements.

1.3 JUSTIFICATION

Studying the nutritional education process would provide information on the strengths or areas of weakness of the process. Nurses and other care providers can now use this to consolidate the positive aspects of nutritional education and to make improvements in the areas where necessary. This research finding may also raise the need for further research.

1.4 RESEARCH GOAL

The goal of this research was to explore the nurse-led nutritional education process.

1.5 RESEARCH QUESTIONS

A research question is a statement of the specific query the researcher wants to answer⁹⁵.

1. How do nurses in HIV treatment centers provide nutritional education?
2. What are nurses’ challenges in the nutritional education process at treatment centers?
3. What are patients’ challenges in the nutritional education process at treatment centers?