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Nutritional issues of HIV/AIDS Orphan in Sagamu South West, Nigeria

INTRODUCTION

Two types of retrovirus (HIV 1 and HIV 2) were known to cause AIDS worldwide; predominantly HIV 1.transmission in both could be by sexual contact, transfusion of blood or blood products, contact with sharp objects and vertically from mother to child. However, HIV 2 is transmitted less early and has a longer period between infection and development of AIDS [i]. Worldwide, more than fifty million children under 18 years have been orphaned due to AIDS, more that twelve million of these children leave in sub-Sahara Africa [ii].

The concept of orphan varies from one cultural context to another but refers to children (age 0-14) whose either or both parents have died [iii]. The age of orphan is fairly constant across countries with 15% being 0-4 years old, 35% 5-9 years old and 50% 10-14 years old [iv] .The vulnerability of children to health and social mishaps increase long before the death of their parents or guardians. Children watch their parents deteriorate and eventually die. They are often confronted with loss of family identity, increased malnutrition, reduced education opportunity, exploitative child labour and child abuse, and increased susceptibility to HIV infection [v]

Inconsistent findings in nutritional status of orphan and other children make vulnerable by HIV/AIDS make it difficult to assess if orphaned and other vulnerable children have specific nutritional needs separate from invulnerable children [vi] .Malnutrition and HIV have similar deleterious effect on the immune system [vii] . In both malnutrition and HIV, there is reduced CD4 and CD8 T-lymphocytes [viii], delayed cutaneous sensitivity, reduced bactericidal properties [ix] and impaired serological response after immunizations [x]..HIV/AIDS have a detrimental impact on household food security and nutrition in endemic areas. Household problems start as soon as the first adult become sick which results in a decline or loss in the productive capacity of individuals and households, decline or complete loss of household incomes  [xi].

Concurrently, there is increase in household expenses as a result of increase health care costs [xii] .Household assets are often sold to offset there effects resulting in more poverty and more food insecurity [xiii]. Children might be forced to discontinue their schooling due to household engagements and inability to afford school expenses.

Thus, food assistance can have multiple objectives in supporting food-insecure households and this can enable them to participate in treating or preventing malnutrition [xiv]. Linking participation in food assistance program with nutrition education and skills training can foster self reliance [xv]

 

 

 

MATERIALS AND METHODS

Fifty HIV/AIDS orphaned children whose parents were attending Sagamu Community Centre (a non-governmental organization) were used for the study. The children were all screened for HIV/AIDS and they were all non-reactive (seronegative). The control group comprises of fifty children who were not orphaned, selected randomly amongst the 1,495 people that attended the centre during the period of this study. They were all HIV negative

Structured questionnaire were administered to the parents of the children in the control group as well as guardians of the orphaned children to obtain additional information on their nutritional status. Certain anthropometrics measures were taken to assess the nutritional status; these include height, weight, mid-upper arm circumference, and the head circumference. The BMI was computed in both the orphaned and non-orphaned children.

Five millilitres of blood were aseptically collected from both the subjects and the control group with minimum stasis, using pyrogen-free needles and disposable plastic syringes. Two millilitres of the collected blood was put in an EDTA bottle for the determination of haemoglobin concentration while the remaining three millilitres was dispensed into heparinized bottle for the determination of total protein, albumin, calcium, and phosphate levels.

Serum haemoglobin was determined by standard method [xvi] other parameters were estimated as described  total protein [xvii], albumin [xviii], calcium [xix] and phosphate [xx] in both subject and control groups. The obtained data were analyzed using SPSS version 10.0 chi-square was used to determine differences between the subject and control groups.

 

 

 

 

RESULT

Table 1 shows anthropometric measurements of the subjects and the control. There was no significant difference in the anthropometric measurements the subjects and the control (p>0.05)   Significant difference in the height for age which is a measure of stunted growth was observed between the orphan and control (p<0.05), but no significant difference in weight for age and weight for height. (Table 2).

Table 3 shows mean concentration of haemoglobin, total protein, albumin, calcium phosphate and globulin. Significant difference in mean between the orphan and control (p<0.05) was observed for all parameters

Table 4 shows type of nutrition taken for breakfast, lunch, and dinner in both orphan and control group. 3.8% of orphan did not take breakfast, 77.3% of breakfast meal was carbohydrate while .protein was 18.9%. 82.0% of lunch meal was carbohydrate while .protein was 18.0%, 85.5% of breakfast meal was carbohydrate while .protein was 14.5%

Table 5 reveals Mean body mass index in stratified age groups in subjects and controls There was no significant difference (p > 0.05) between the age groups < 6 years, 7 – 11 and > 12 years of subjects compared to the control groups.

From the data obtained, it was observed that paternal orphan was the commonest (60%), while double orphan was the least (4%), maternal orphan constitute only 36%. The sponsorship of education of the orphans was done mainly by their mothers (50%), while sponsorship by the father and other relatives constitute 26% and 16% respectively.

 

 

 

 

 

 

 

DISCUSSION

Nutritional status in children, are usually assessed by determining their weight, height, head circumference, and mid-upper arm circumference. Values obtained that are below the normal range for individual age group is considered to reflect a malnutrition state. Lack of social support for orphan from family members as a result of stigmatization and discrimination contribute to reduced food availability and hence inadequate dietary intake by orphans

There were no significant differences observed in the anthropometrics between the orphaned and non-orphaned children. However, there were significant differences in their plasma levels of hemoglobin, total protein, albumin, globulin, calcium and inorganic phosphate. These biochemical parameters were significantly lower (p < 0.05) in orphaned children than non-orphaned children. The reduction in the above parameters amongst orphan children is a reflection of the poor nutritional status exhibited by the orphaned children in comparison to non-orphaned children.

Households affected by HIV/AIDS are usually confronted by severe decline in food availability (qualitatively and quantitatively) or food insecurity due to complete loss of the socio-economic contributions of either or both of their parents. The necessary home needs of such orphaned children are catered for by the grandparents or often by the guardians, who also have their immediate family to take care of.

The stunted growth observed in these orphans might contribute to further stigmatization and discrimination by fellow community people. Most times, the orphans with stunted growth are often tagged HIV/AIDS infected individuals, after all both malnutrition and HIV/AIDS have similar presentation. In this situation, a diet rich in protein, energy, micronutrients especially vitamin A is essential to bring about drastic changes in the health and physical appearances of such orphans.

The significantly low globulin level (p < 0.05) in the orphans measures the immune status. It suggests that there are some degrees of immunosuppression in the orphaned children and they are thus vulnerable to multiple infections. The decreased immunity associated with malnutrition lead to increased susceptibility to infections (including HIV infection) which in turn lead to increased nutrient requirements. If these requirements are not adequately met, it may lead to more malnutrition state. As HIV/AIDS prone orphans to malnutrition, malnutrition makes orphan susceptible to HIV/AIDS.

 

 

 

REFERECES

[i] HIV/AIDS care and treatment: In a clinical course for people caring for persons living with HIV/AIDS ,2003;  pp 24.

 

[ii] UNIAIDS: Report on the global AIDS epidemic, chapter 4, the impact of AIDS on people and societies, 2006.

 

[iii] Hunter,S. and Williamson,J.: Children on the brink;Strategies to Support Children Isolated

by HIV/AIDS,Arlindton, Virgina, 2002.

 

[iv] Monasch, J. and Ties Boerma: Orphanhood and child care patterns in sub-Saharan Africa. An analysis of National Surveys from 40 countries. AIDS 18 (suppl. 2); 2004;. Pg 555-565

 

[v] De Wagt, A. and Conndly, M.: Orphan and the impact of HIV/AIDS in sub-Saharan Africa. Food nutrition and agriculture 2005; 34;pg 24-31

 

[vi] Rivers, J, Silverstre,E., Mason,J.: Nutritional and Food Security Status of orphans and vulnerable children, report of  a research supported by UNICEF, IFPRI, and WFP, 2004.

 

[vii] Piwoz, E.G.: Nutrition and HIV/AIDS; evidence, gaps and priority actions, 2004.

 

[viii] Suttajit,M.: Advances in nutrition support for quality of life in HIV/AIDS, Asia Pac. J Clin. Nutr. 2007; 16, suppl., pp318-322,

 

[ix] Beisel,W.R.: Nutrition and immune function; overview. Nutri. 1996; 126, pg 26115-26155

 

[x] Kroon,F.P.,van Dissel,J.T.,de Jong, J.C., and van Forth,R.: Antibody response to influenza,

tetanus, and pneumococcal vaccines in HIV-seropositive individuals in relation to the

 

[xi] Gillespie, S. and Kadayila,S.: HIV/AIDS and food nutrition security, from evidence in action, food policy review no 7, Washington, DC,IFPRI,2005.

 

[xii] Alban, A. and Anderson, N.B.: Putting it together; AIDS and the millennium development goals, 2005

 

[xiii]  Barnett,A. and Rugalema,G.: HIV/AIDS, International Food Policy Research Institute,2020 focus no 05, brief no 09, Washington, DC, IFPRI,2001.

 

[xiv] Grant, F.: Nutrition interventions for PLWHAs and the use of Ready-to-use Therapeutic Foods, presentation at the FANTA project, academy for Educational Development, Washington, DC, 2006.

[xv] Greenaway, K. Greenblott,K.,Hagens,K.: Targeted Food Assistance in the context of HIV/AIDS, Gauteny, South Africa; consortium for southern Africa Food Security Emergency(C-SAFE) learning centre,2004.

 

[xvi]  Kayira,K., Greenaway, K., Greenblott, K: Food for assents; adopting programming to an HIV/AIDS context, Gauteny, South Africa; consortium for southern Africa Food Security Emergency(C-SAFE) learning centre,2004.

 

[xvii] Dacie JV & Lewis SM  Practical Haematology, p 10. London.

ChurchillLivingstone  (1984

 

[xviii]  Gornall AG, Bardwill CJ, David M.M: Determination of serum proteins by

means of the biuret reaction. J Biol Chem 1949; 177: 751-756.

 

[xix] Doumas B.T., Watson W.A and Biggs H.G: Albumin standards and the measurement of serum albumin with bromcresol green. Clin. Chim. Acta 1971; 31: 87.

 

[xx] Stern J. and Lewis W.H.P: The colorimetric estimation of calcium in serum with o-cresolphthalein Complexone. Clin. Chim. Acta 1957; 2: 576

 

[xxi] Fiske C. H. and SubbaRow Y:. The colorimetric determination of phosphorus. J.Biol.Chem. 1925; 66: 375

INTRODUCTION

Two types of retrovirus (HIV 1 and HIV 2) were known to cause AIDS worldwide; predominantly HIV 1.transmission in both could be by sexual contact, transfusion of blood or blood products, contact with sharp objects and vertically from mother to child. However, HIV 2 is transmitted less early and has a longer period between infection and development of AIDS [i]. Worldwide, more than fifty million children under 18 years have been orphaned due to AIDS, more that twelve million of these children leave in sub-Sahara Africa [ii].

The concept of orphan varies from one cultural context to another but refers to children (age 0-14) whose either or both parents have died [iii]. The age of orphan is fairly constant across countries with 15% being 0-4 years old, 35% 5-9 years old and 50% 10-14 years old [iv] .The vulnerability of children to health and social mishaps increase long before the death of their parents or guardians. Children watch their parents deteriorate and eventually die. They are often confronted with loss of family identity, increased malnutrition, reduced education opportunity, exploitative child labour and child abuse, and increased susceptibility to HIV infection [v]

Inconsistent findings in nutritional status of orphan and other children make vulnerable by HIV/AIDS make it difficult to assess if orphaned and other vulnerable children have specific nutritional needs separate from invulnerable children [vi] .Malnutrition and HIV have similar deleterious effect on the immune system [vii] . In both malnutrition and HIV, there is reduced CD4 and CD8 T-lymphocytes [viii], delayed cutaneous sensitivity, reduced bactericidal properties [ix] and impaired serological response after immunizations [x]..HIV/AIDS have a detrimental impact on household food security and nutrition in endemic areas. Household problems start as soon as the first adult become sick which results in a decline or loss in the productive capacity of individuals and households, decline or complete loss of household incomes  [xi].

Concurrently, there is increase in household expenses as a result of increase health care costs [xii] .Household assets are often sold to offset there effects resulting in more poverty and more food insecurity [xiii]. Children might be forced to discontinue their schooling due to household engagements and inability to afford school expenses.

Thus, food assistance can have multiple objectives in supporting food-insecure households and this can enable them to participate in treating or preventing malnutrition [xiv]. Linking participation in food assistance program with nutrition education and skills training can foster self reliance [xv]

 

 

 

MATERIALS AND METHODS

Fifty HIV/AIDS orphaned children whose parents were attending Sagamu Community Centre (a non-governmental organization) were used for the study. The children were all screened for HIV/AIDS and they were all non-reactive (seronegative). The control group comprises of fifty children who were not orphaned, selected randomly amongst the 1,495 people that attended the centre during the period of this study. They were all HIV negative

Structured questionnaire were administered to the parents of the children in the control group as well as guardians of the orphaned children to obtain additional information on their nutritional status. Certain anthropometrics measures were taken to assess the nutritional status; these include height, weight, mid-upper arm circumference, and the head circumference. The BMI was computed in both the orphaned and non-orphaned children.

Five millilitres of blood were aseptically collected from both the subjects and the control group with minimum stasis, using pyrogen-free needles and disposable plastic syringes. Two millilitres of the collected blood was put in an EDTA bottle for the determination of haemoglobin concentration while the remaining three millilitres was dispensed into heparinized bottle for the determination of total protein, albumin, calcium, and phosphate levels.

Serum haemoglobin was determined by standard method [xvi] other parameters were estimated as described  total protein [xvii], albumin [xviii], calcium [xix] and phosphate [xx] in both subject and control groups. The obtained data were analyzed using SPSS version 10.0 chi-square was used to determine differences between the subject and control groups.

 

 

 

 

RESULT

Table 1 shows anthropometric measurements of the subjects and the control. There was no significant difference in the anthropometric measurements the subjects and the control (p>0.05)   Significant difference in the height for age which is a measure of stunted growth was observed between the orphan and control (p<0.05), but no significant difference in weight for age and weight for height. (Table 2).

Table 3 shows mean concentration of haemoglobin, total protein, albumin, calcium phosphate and globulin. Significant difference in mean between the orphan and control (p<0.05) was observed for all parameters

Table 4 shows type of nutrition taken for breakfast, lunch, and dinner in both orphan and control group. 3.8% of orphan did not take breakfast, 77.3% of breakfast meal was carbohydrate while .protein was 18.9%. 82.0% of lunch meal was carbohydrate while .protein was 18.0%, 85.5% of breakfast meal was carbohydrate while .protein was 14.5%

Table 5 reveals Mean body mass index in stratified age groups in subjects and controls There was no significant difference (p > 0.05) between the age groups < 6 years, 7 – 11 and > 12 years of subjects compared to the control groups.

From the data obtained, it was observed that paternal orphan was the commonest (60%), while double orphan was the least (4%), maternal orphan constitute only 36%. The sponsorship of education of the orphans was done mainly by their mothers (50%), while sponsorship by the father and other relatives constitute 26% and 16% respectively.

 

 

 

 

 

 

 

DISCUSSION

Nutritional status in children, are usually assessed by determining their weight, height, head circumference, and mid-upper arm circumference. Values obtained that are below the normal range for individual age group is considered to reflect a malnutrition state. Lack of social support for orphan from family members as a result of stigmatization and discrimination contribute to reduced food availability and hence inadequate dietary intake by orphans

There were no significant differences observed in the anthropometrics between the orphaned and non-orphaned children. However, there were significant differences in their plasma levels of hemoglobin, total protein, albumin, globulin, calcium and inorganic phosphate. These biochemical parameters were significantly lower (p < 0.05) in orphaned children than non-orphaned children. The reduction in the above parameters amongst orphan children is a reflection of the poor nutritional status exhibited by the orphaned children in comparison to non-orphaned children.

Households affected by HIV/AIDS are usually confronted by severe decline in food availability (qualitatively and quantitatively) or food insecurity due to complete loss of the socio-economic contributions of either or both of their parents. The necessary home needs of such orphaned children are catered for by the grandparents or often by the guardians, who also have their immediate family to take care of.

The stunted growth observed in these orphans might contribute to further stigmatization and discrimination by fellow community people. Most times, the orphans with stunted growth are often tagged HIV/AIDS infected individuals, after all both malnutrition and HIV/AIDS have similar presentation. In this situation, a diet rich in protein, energy, micronutrients especially vitamin A is essential to bring about drastic changes in the health and physical appearances of such orphans.

The significantly low globulin level (p < 0.05) in the orphans measures the immune status. It suggests that there are some degrees of immunosuppression in the orphaned children and they are thus vulnerable to multiple infections. The decreased immunity associated with malnutrition lead to increased susceptibility to infections (including HIV infection) which in turn lead to increased nutrient requirements. If these requirements are not adequately met, it may lead to more malnutrition state. As HIV/AIDS prone orphans to malnutrition, malnutrition makes orphan susceptible to HIV/AIDS.

 

 

 

REFERECES

[i] HIV/AIDS care and treatment: In a clinical course for people caring for persons living with HIV/AIDS ,2003;  pp 24.

 

[ii] UNIAIDS: Report on the global AIDS epidemic, chapter 4, the impact of AIDS on people and societies, 2006.

 

[iii] Hunter,S. and Williamson,J.: Children on the brink;Strategies to Support Children Isolated

by HIV/AIDS,Arlindton, Virgina, 2002.

 

[iv] Monasch, J. and Ties Boerma: Orphanhood and child care patterns in sub-Saharan Africa. An analysis of National Surveys from 40 countries. AIDS 18 (suppl. 2); 2004;. Pg 555-565

 

[v] De Wagt, A. and Conndly, M.: Orphan and the impact of HIV/AIDS in sub-Saharan Africa. Food nutrition and agriculture 2005; 34;pg 24-31

 

[vi] Rivers, J, Silverstre,E., Mason,J.: Nutritional and Food Security Status of orphans and vulnerable children, report of  a research supported by UNICEF, IFPRI, and WFP, 2004.

 

[vii] Piwoz, E.G.: Nutrition and HIV/AIDS; evidence, gaps and priority actions, 2004.

 

[viii] Suttajit,M.: Advances in nutrition support for quality of life in HIV/AIDS, Asia Pac. J Clin. Nutr. 2007; 16, suppl., pp318-322,

 

[ix] Beisel,W.R.: Nutrition and immune function; overview. Nutri. 1996; 126, pg 26115-26155

 

[x] Kroon,F.P.,van Dissel,J.T.,de Jong, J.C., and van Forth,R.: Antibody response to influenza,

tetanus, and pneumococcal vaccines in HIV-seropositive individuals in relation to the

 

[xi] Gillespie, S. and Kadayila,S.: HIV/AIDS and food nutrition security, from evidence in action, food policy review no 7, Washington, DC,IFPRI,2005.

 

[xii] Alban, A. and Anderson, N.B.: Putting it together; AIDS and the millennium development goals, 2005

 

[xiii]  Barnett,A. and Rugalema,G.: HIV/AIDS, International Food Policy Research Institute,2020 focus no 05, brief no 09, Washington, DC, IFPRI,2001.

 

[xiv] Grant, F.: Nutrition interventions for PLWHAs and the use of Ready-to-use Therapeutic Foods, presentation at the FANTA project, academy for Educational Development, Washington, DC, 2006.

[xv] Greenaway, K. Greenblott,K.,Hagens,K.: Targeted Food Assistance in the context of HIV/AIDS, Gauteny, South Africa; consortium for southern Africa Food Security Emergency(C-SAFE) learning centre,2004.

 

[xvi]  Kayira,K., Greenaway, K., Greenblott, K: Food for assents; adopting programming to an HIV/AIDS context, Gauteny, South Africa; consortium for southern Africa Food Security Emergency(C-SAFE) learning centre,2004.

 

[xvii] Dacie JV & Lewis SM  Practical Haematology, p 10. London.

ChurchillLivingstone  (1984

 

[xviii]  Gornall AG, Bardwill CJ, David M.M: Determination of serum proteins by

means of the biuret reaction. J Biol Chem 1949; 177: 751-756.

 

[xix] Doumas B.T., Watson W.A and Biggs H.G: Albumin standards and the measurement of serum albumin with bromcresol green. Clin. Chim. Acta 1971; 31: 87.

 

[xx] Stern J. and Lewis W.H.P: The colorimetric estimation of calcium in serum with o-cresolphthalein Complexone. Clin. Chim. Acta 1957; 2: 576

 

[xxi] Fiske C. H. and SubbaRow Y:. The colorimetric determination of phosphorus. J.Biol.Chem. 1925; 66: 375

About the Author

Ogundahunsi  O. A., 1 Adenuga  A.O.,2 Odewabi A.O., 2*, Olooto  W.E1.,  Jeminusi  A.O3.

1.Department of Chemical Pathology, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ogun State; 2.Department of Chemical Pathology Olabisi Onabanjo University Teaching Hospital, Ogun State; 3. Department of Community Health Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Ogun State

*Author to whom correspondence should be addressed.

E-mail: aoodewabi@yahoo.co.uk

P.O.Box 1092,

Sagamu.

08058861972

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