Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study.
Children
Cohort
HIV
Malnutrition
Nutritional support
West Africa
Journal
BMC nutrition
ISSN: 2055-0928
Titre abrégé: BMC Nutr
Pays: England
ID NLM: 101672434
Informations de publication
Date de publication:
14 Dec 2021
14 Dec 2021
Historique:
received:
11
12
2020
accepted:
22
11
2021
entrez:
14
12
2021
pubmed:
15
12
2021
medline:
15
12
2021
Statut:
epublish
Résumé
Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d'Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d'Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. PACTR202001816232398 , June 01, 2020, retrospectively registered.
Sections du résumé
BACKGROUND
BACKGROUND
Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa.
METHODS
METHODS
In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d'Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention.
RESULTS
RESULTS
Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d'Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767).
CONCLUSIONS
CONCLUSIONS
This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV.
TRIAL REGISTRATION
BACKGROUND
PACTR202001816232398 , June 01, 2020, retrospectively registered.
Identifiants
pubmed: 34903301
doi: 10.1186/s40795-021-00486-4
pii: 10.1186/s40795-021-00486-4
pmc: PMC8670202
doi:
Types de publication
Journal Article
Langues
eng
Pagination
83Subventions
Organisme : NIAID NIH HHS
ID : U01 AI069919
Pays : United States
Investigateurs
Marcel Djimon Zannou
(MD)
Armel Poda
(A)
Fred Stephen Sarfo
(FS)
Eugene Messou
(E)
Henri Chenal
(H)
Kla Albert Minga
(KA)
Emmanuel Bissagnene
(E)
Aristophane Tanon
(A)
Moussa Seydi
(M)
Akessiwe Akouda Patassi
(AA)
Sikiratou Adouni Koumakpai-Adeothy
(SA)
Lorna Awo Renner
(LA)
Sylvie Marie N'Gbeche
(SM)
Clarisse Amani Bosse
(CA)
Kouadio Kouakou
(K)
Madeleine Amorissani Folquet
(MA)
François Tanoh Eboua
(FT)
Fatoumata Dicko
(F)
Elom Takassi
(E)
François Dabis
(F)
Renaud Becquet
(R)
Charlotte Bernard
(C)
Shino Chassagne Arikawa
(SC)
Antoine Jaquet
(A)
Karen Malateste
(K)
Elodie Rabourdin
(E)
Thierry Tiendrebeogo
(T)
Désiré Dahourou
(D)
Sophie Desmonde
(S)
Julie Jesson
(J)
Valeriane Leroy
(V)
Didier Koumavi Ekouevi
(DK)
Jean-Claude Azani
(JC)
Patrick Coffie
(P)
Abdoulaye Cissé
(A)
Guy Gnepa
(G)
Apollinaire Horo
(A)
Christian Kouadio
(C)
Boris Tchounga
(B)
Informations de copyright
© 2021. The Author(s).
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