CONTEXTUAL ASSESSMENT OF FOOD SYSTEM, SAFETY-NETS AND NUTRITIONAL STATUS OF PEOPLE LIVING WITH HIV/AIDS IN KADUNA CITY, NIGERIA

Abstract

HIV/AIDS status and food system interact in a vicious cycle which influence nutrition at individual and household levels. Safety nets are important mechanisms to promote health and nutrition among People Living with HIV/AIDS (PLWHA), however, these mechanisms are being weakened following dwindling resources among other factors. Understanding the food system and safety net types of PLWHA is important to promoting nutritional status and improved treatment outcomes. This study was designed to assess food system, safety nets and nutritional status of PLWHA in Kaduna city, Nigeria. Descriptive cross-sectional and a mixed-methods approach were used. A total sampling of consenting 532 PLWHA across 14 support groups in Kaduna was conducted. Three key informant interviews and three focus group discussion sessions were conducted among support group leaders and male/female members, respectively using structured guides. Intervieweradministered questionnaire was used to collect information on socio-demographic characteristics, CD4 cell count, safety net types, food system and dietary intake of PLWHA. A 24-hour recall was conducted to assess dietary intake and analysed using adapted Total Diet Assessment software and dietary diversity according to the FAO standard. Body weight and height were assessed to determine the Body Mass Index (BMI) and categorised using WHO standards. Qualitative data were analysed thematically. Quantitative data were analysed using descriptive statistics, and Chi-square tests at α0.05. There was declining involvement of PLWHA in food production following poor productive capacity. Respondents expressed understanding of the link between nutrition and treatment outcomes and identified poor income as a constraint to food access. Respondents’ age was 38.1±9.7 years, 78.0% were females, 44.9% were married, and 40.3% earned <₦5000 monthly. About 20.0%, 25.0% and 55.0% had CD4 cell count (cells/µl) of ≥500, 200-499 and <200, respectively. Safety net types included counselling (39.2%), treatment for opportunistic infections (27.5%), food and nutrition aid (15.7%), prayer (15.7%), and drug aid (1.9%). Majorly produced staple was cereals (93.7%), 40.3% raised livestock/poultry, and 27.4% had vegetable garden. Majority (58.1%) experienced hindrances to market access, 45.2% skipped meals and 59.7% consumed street foods. Rice (71.0%), beans (61.3%) and maize (50.0%); orange (61.3%), banana (25.8%) and watermelon (24.2%); and pumpkin leaves (ugwu) (41.9%) and okro (9.7%) constituted the widely consumed staples, fruits, and leafy vegetables. Intakes of energy, protein, vitamin A, zinc and iron were 1065.1±148.1Kcal, 50.3±42.7g, 10491.5±1510.6mcg, 6.7±6.1mg and 8.9±7.5mg, respectively. Mean dietary diversity was 4.8±1.12, reflecting a poor-quality diet. Prevalence of underweight, overweight and obesity was 5.1%, 28.9% and 12.4%, respectively. Among respondents with normal BMI, 80.0% had received financial empowerment, 64.5% received counselling /psychosocial support and 63.6% had food support. Body Mass Index was significantly associated with age, dietary diversity, income, and intakes of energy, protein and zinc. Access to food among people living with HIV/AIDS is constrained by poor income, reduced productive capacity and limited support mechanism and this reflect in form of poor diet quality, overweight and obesity. Household economic strengthening activities and food and nutrition support are hereby recommended for PLWHA in Nigeria.