Prevalence and factors associated with under nutrition among HIV exposed children 6 to 24 months attending antiretroviral therapy clinics in Kampala.

Abstract

Introduction Under nutrition is the leading underlying factor of child mortality and morbidity in Sub-Saharan Africa. There is a critical window of opportunity for improving child nutrition; from pregnancy through the first 24 months of life and deficits acquired at this age are difficult to reverse later in life. The New eMTCT policy states that HIV exposed children (born to HIV infected women) should be breastfed exclusively for six months and continue breastfeeding for at least one year (WHO 2016). However, HIV exposed children attending ART clinics are reportedly breastfed for three to four months and replacement feeding is started early in an effort to reduce transmission of HIV to the children. Early replacement feeding could potentially lead to malnutrition. Objective(s) The aim of this study was to determine the prevalence and the factors associated with under nutrition among HIV exposed children 6 to 24 months attending three ART clinics in Kampala to design strategies aimed at improving their nutrition status. Methodology The study was conducted in three ART clinics from three divisions of Kampala. A cross sectional study design was used. Quantitative methods of data collection were employed. Quantitative data was collected from mothers using structured questionnaires. Anthropometric measurements; weight and length measurements were collected using Seca weighing scales and length boards respectively. Quantitative data from questionnaires was analyzed using STATA 12.0 while anthropometric data was analyzed using ENA for SMART version 2011.

xii

Results Underweight (WAZ) was 10.3%, and was slightly higher among the male children (11.4%) than the female children (9.3%). The prevalence of underweight among children between the ages 12 to 23 months was 15.2%. Stunting was at 23.2% and wasting, 6.2%. Four factors were significantly associated with underweight among exposed children 6 to 24 months at multivariable analysis, they included; caretakers’ income earned, number of children in a household and child HIV status. Caretakers who earned less than 50,000 Uganda shillings were less likely to have under nourished children compared to those who earned 50,000 Uganda shillings and above (APR= 0.408; 95% CI: 0.171 – 0.969). Children residing in households which had five or more children, were more likely to be under nourished compared to those residing in households with a less number of children (APR= 2.818 1.066; 95% CI: 1.233 - 6.437). Children who were HIV positive were less likely to be under nourished compared to those who were negative (APR= 0.293; 95% CI: 0.086 - 0.991). Conclusions and recommendations The overall prevalence of under nutrition among HIV exposed children aged 6 to 24 months attending ART clinics in Kampala district was generally high. Underweight was at 10.3% (20), stunting was 23.2% (45) and wasting at 6.2% (12). There is need to sensitize the community on providing optimal care and support especially among working class caretakers. More so, there is need to design specific nutritional interventions for HIV exposed children giving special attention to caregivers with HIV negative children. There is need for community sensitizarion on Option B+.