ASSESSMENT OF THE NUTRITIONAL STATUS, CARE AND SUPPORT OF PEOPLE LIVING WITH HIV/AIDS IN NSUKKA LOCAL GOVERNMENT AREA, ENUGU STATE

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ABSTRACT

The nutritional status, care and support of people living with HIV/AIDS (PLWHIV/AIDS) in Nsukka L.G.A of Enugu State was studied at Bishop Shanahan Hospital. The hospital is a HIV counseling and testing (HCT) centre. Descriptive and laboratory analysis were adopted for the study. A total of two hundred and forty three respondents only constituted the sample for the study. Questionnaire, anthropometry, biochemical tests and proximate analysis of foods eaten by PLWHIV/AIDS were the instruments for data collection. Method of data analysis for the questionnaire was statistical package for Social Sciences (SPSS), version 15.The body mass index data were categorized using WHO standard to determine the levels of weight. Analysis of variance was used for data from laboratory analysis. The result of the study showed that 36.6% of the subjects were aged between 26-35 years. There were more men (53.37%) than women (46.5%).The highest educational level of the subjects was WASC/SSCE/GCE. About half of the subjects (49.8%) ate food three times daily, while 51.9% affirmed poverty as reason for skipping meals. Most preferred food group of the PLWHIV/AIDS was vegetables (85.2%) taken once a day, 82.8% of subjects took fats and oil twice a day and 40.3% chose vegetables three times a day. Bitter leaf soup was the preferred soup of the subjects. The most observed clinical symptom was fever and by men (23.1%) and women 20.4%.Forty percent of the subjects were on anti retroviral therapy (ART) and within this group, 60% were on combined ART (nevirapine, stavudine and zidovudine). The greatest social support was from the wives (39.5%) and most PLWHIV/AIDS (80%) protected their spouses/sex partners against HIV infection with condom. The mean height, weight, BMI, packed cell volume (PCV) and CD4 count of the men were 1.67 ± 0.01m, 60.76 ± 0.34kg, 23.01 ± 0.5 kg/m2, 29.61 ± 0.16g and 469.23 ± 0.02 cells/ul, respectively. The mean height, weight, BMI, PCV and CD4 count recorded for women were 1.61 ± 0.06m, 59.81 ± 0.1kg, 21.03 ± 0.0kg/m2, 29.01 ± 0.21g and 432.08 ± 0.20 cells/ul respectively. Thirty percent of the women and 21. 6% of the men were underweight while 15.4% of men and 10.5% women were overweight. Education had significant relationship with nutrition knowledge of the PLWHIV/AIDS at P> 0.05.Bitter leaf soup had the highest protein and crude fibre values (5.38 ± 34g, 2.70 ± .10g) among the soups while mixed corn meal had highest protein and fat values (5.00 ± 0.26g, 7.50 ± .46g) among the solid foods. The highest energy value was from garri (983.32kj). There is need to encourage PLWHIV/AIDS to eat more adequate meals especially from locally available foods. Women should be financially empowered to care for PLWHIV/AIDS as they formed their greatest social support in this study.


TABLE OF CONTENTS

Title Page
List of Figures
ABSTRACT

CHAPTER ONE: INTRODUCTION
1.0       Background to the study
1.1       Statement of the problem
1.2       Objective of the study
1.3       Significance of the study

CHAPTER TWO: LITERATURE REVIEW
2.0       Concept of HIV and AIDS
2.1       Replication of HIV
2.2       Immune system
2.3       Mechanism of CD4 cell death
2.4       CD4 T-cell count
2.5       Incidence of HIV/AIDS
2.6       Modes of transmission
2.6.1    Sexual transmission
2.7       Factors that make women so vulnerable to HIV infection
            a. Transmission through infected blood
            b. Mother-to-child transmission (MTCT)
2.8       Methods of risk reduction
2.9       Clinical manifestations
2.10     Diagnosis
2.11     Relationship between HIV/AIDS and other sexually
            transmitted diseases
2.12     HIV counseling and testing (HCT) as an entry point to
            prevent, care and support services
2.13     Care and support of PLWHIV/AIDS
2.14     Management
2.15     Anti-retroviral therapy
2.16     The effects of medication on nutrition
2.17     Material and financial support
2.17.1  Care for caregivers
2.17.2  Support groups
2.1 7.3 Health information
2.17.4  Tip for positive living
2.17.5  Nutrition care
2.18     Impact of HIV/AIDS on nutrition
2.18.1  Nutrition and the care package for people living with AIDS
2.18.2  Guide to daily food choices
2.18.3  Infant feeding options
2.18.4  Dietary practices of HIV/AIDS related symptoms
2.18.5  Advantages of dietary management
2.18.6  Symptoms associated with HIV in adult

CHAPTER THREE: MATERIALS AND METHODS
3.0       Research design
3.1       Area of study
3.2       Sample population
3.3       Sample size and sample size calculation
3.4       Sampling technique
3.5       Ethical consideration
3.6       Instruments for data collection
3.6.1    Questionnaire
3.6.2    24-hour dietary recall
3.7.3    Anthropometric measurement
3.7.3.1 Weight determination
3.7.3.3 Height measurement
3.7.3.4 Body mass index
3.7.4    Clinical observation
3.7.5    Biochemical tests
3.7.5.1 CD4 cell count
3.7.5.2 Haematocrit (packed cell volume or pcv)
3.7.5    Analytical procedure
3.7.6    Food sample collection for analysis
3.7.6.1 Determination of moisture
3.7.6.2 Determination of protein
3.7.6.3 Determination of fat
3.7.6.4 Determination of crude fibre
3.7.6.6 Determination of ash
3.7.6.7 Determination of carbohydrate
3.7.6.8 Determination of iron, calcium and zinc
3.8       Data analysis

CHAPTER FOUR:  RESULTS
4.0       Background of the subject
4.1       Age, gender of the subject
4.2       Education, occupation and income levels of the subject
4.3       Nutrition knowledge of the subject
4.4       Health characteristics of PLWHIV/AIDS
4.5       Food consumption pattern of PLWHIV/AIDS
4.7       Proximate composition of commonly consumed mixed dishes by PLWHIV/AIDS
4.8       Anthropometric and biochemical variables of the subjects
4.9       Management experience

CHAPTER FIVE: DISCUSSION
5.1       Characteristics of the subjects
5.2       Nutritional knowledge of the PLWHIV/AIDS
5.3       Health characteristics of the PLWHIV/AIDS
5.4       Food consumption pattern of the subjects
5.5       Proximate compositions of dishes commonly consumed by the Subjects
5.6       Anthropometric indices of the subjects
5.7       Biochemical parameters of the PLWHIV/AIDS
5.8       Health status and management of PLWHIV/AIDS
5.9       Conclusions
5.10     Recommendations
REFERENCES
APPENDICES


CHAPTER ONE

INTRODUCTION

1.0 Background to the study.

Human Immuno Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has become the greatest tragedy in many countries of the world. HIV/AIDS is the fourth biggest cause of death after heart disease, stroke, and acute respiratory disease (Bollinger and Stover, 1999). It is the greatest tragedy in many countries of the world. HIV/AIDS has defied all boundaries, infecting persons of all categories in its progression through the human society. This most dreaded, most feared and still most talked about disease is still a challenge to scientists until recently. HIV/AIDS is a public health and development crisis which affects not only the lives of individuals but also socio economic development of countries around the world. The millennium summit in 2000 laid the foundation for acknowledging that HIV/AIDS as a global crisis requiring global action.

The first reported case of HIV/AIDS was in 1980 which involved a young girl of 13 years at Lagos University Teaching Hospital. The subsequent trend in the rapid spread of HIV/AIDS led to Nigeria joining the international organization in the fight against HIV/AIDS. In 1998, the then health minister in Nigeria – Prof. Adeyenyi - launched the sexually transmitted infections programme and World AIDS Day. As part of that launch, he announced that 2.5 million people were HIV positive. More awareness of the reality of HIV/AIDS leads to creation of NACA in to coordinate the national response on HIV/AIDS in Nigeria. The co-ordination also lead to the formation of HIV/AIDS Emergency plan (HEAP) and NACA, (2005) stated that Nigeria has a truly comprehensive strategy for fighting AIDS to finish or at least for reducing its incidence and prevalence by 2.5% by 2007. The Obasanjo administration hosted the special Africa summit of HIV/AIDS. Tuberculosis and other related infection. The heads of member countries at that summit gave their pledge to allocate more funds to fight HIV/AIDS pandemic. Another key result of that summit was the decision of Nigeria government to start subsidized anti-retroviral therapy at a time no other government in Africa was doing so (NACA, 2005).


Pivot, (2001) stated that unlike other disaster situations, where concerted action may be required for a short time, commitment to HIV/AIDS programmes will require a well-articulated multidisciplinary approach. This approach will surely lead to prolonged and better quality of life for the infected persons. At present, AIDS programmes are being starved of funds worldwide and if the trends continue, millions of people may die for basically lack of adequate care. Most people living with HIV/AIDS (PLWHIV/AIDS) die more because of stigma, malnutrition and poor health than the disease itself. Kaloeba, (2005) also considers stigma to be more Lethal than virus. Stigma and discrimination against PLWHA compound the negative effects of HIV/AIDS and make management more challenging. The people feel unhappy, tend to be violent and quarrelsome, feel defected and rejected, fear associating with other people and even being harassed by family members (Action Aid, 2005).

Food remains number one natural ‘drug’ for the healthy and the sick. People living with HIV/AIDS are no exception and their needs remain our task. There has been commitment to fight this pandemic. This must include the natural ammunition which is “food.” This will affirm that the approach and attitude towards HIV/AIDS intervention is complete. Good nutrition means eating foods that supply the body with all the nutrients. The relationship between HIV/AIDS and poor nutrition is cyclical (UNICEF, 2001).Matemiola, (2004) opined that the people living with HIV/AIDS have need for nutritional care because their body metabolism operates at a higher rate, demanding higher inputs. HIV is known to destroy various vital cells in the body, which are important in the maintenance of immunity. The body reacts by increased production of such cells in an attempt to diminish their rate of attrition. These results to increased metabolic rate and an increased demand for substrates that is required for the cellular activities (Dlamin, 2001). For proper care, there is need to get information on the PLWHIV/AIDS’s nutritional status and how far they are cared for. The thrust of this study is to determine the nutritional status, care and support of people living with HIV/AIDS in Nsukka LGA. The need for the victims to embark on higher intake of food including that of macro and micronutrients can never be overemphasized.

1.1        Statement of the problem.
One of the very important adjuncts to management of infected person is the maintenance of an adequate nutrition and exercise which promotes healthy living and balanced growth (Matemiola, 2004). UNICEF, (2001) observed that good nutrition means different things at various stages of HIV infection. Adequate nutrition prolongs life expectancy with corresponding reduction in early demise of men and women due to resultant stigma, malnutrition and poor care of their victims.

Assessment of nutritional status, care and support have not been studied and integrated into the Nsukka LGA AIDS programme despite the incidence at 3.1% among adults in Nigeria (UNICEF, 2008). The need to carry out a study of this kind in order to know how to help PLWHIV/AIDS better can never be overemphasized. Only a health facility in the L.G.A offered comprehensive HIV/AIDS care service programme (counseling, patient education, adherence support, monitoring and management of toxicities (Onodingene, 2007). This study is of special interest to me because my continued care for PLWHIV/AIDS has constantly revealed that food is the greatest challenge to them....

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