Effects of nutritional support on growth and development of children receiving Anti-Retroviral Therapy (ART) in selected slums of Nairobi, Kenya

Abstract

Background: Anti-retroviral therapy (ART) in infants and children has been proven effective. For optimal outcomes of ART, other factors such as the nutrition status of the patient, dietary patterns, treatment adherence, economic status and incidence of opportunistic infections are essential for effective therapeutic outcomes.

Objective: To determine the effect of nutritional support on growth and development patterns of HIV-infected children aged 6-59 months, receiving ART in urban resourcepoor setting of Nairobi, Kenya.

Study Design: Quasi experimental study design.

Study Setting: Eight slum areas of Nairobi namely Kibera, Kawangware, Kangemi, Dagoretti, Mukuru, Dandora, Kariobangi and Mwiki

Study Subjects: Two hundred and sixty (260) HIV-infected children (aged 6-59 months) on ART were randomly selected from eight comprehensive care centres (CCCs) and followed for a period of up to six months.

Results: Nutritional support had significant effect on HAZ (P<0.05) and was protective against stuntedness of children (P=0.044; 95% CI, 0.20-0.98). However, the association between nutritional support and weight-for-age (WAZ) (P=0.477) or weight-for-height (WHZ) (P=0.924) were not significant. The WAZ improved for both the experimental and control groups by the end of the study. Additionally, the study showed that nutritional support was not significantly protective of children in experimental study arm from becoming underweight compared to controls (P=0.521; 95% CI, 0.51-3.70). Similarly, food support was not protective of children in experimental group from being wasted compared to controls (P=0.586; 95% CI, 0.54-2.94). The association between nutritional support and motor development was not significant (P=0.091). The CD4 cell counts between the study groups was not statistically different (P=0.087) and neither was disease incidence (P=0.166).

Conclusion: Despite results indicating non-significant differences of four of the five parameters measured, the results show that growth and  development parameters of children in the experimental group had  improved. Given the food insecurity status in the experimental group, growth and development parameters of children improved and may have been worse had support not been provided. In light of this, the study recomends that interventions on nutritional support for HIV-infected chidren in limited resource settings should be implemented to cater for the short term acute shortages. Additionally, the appropiateness of support provided with regard to the formulation and content of food for the 6-59 months age group should always be considered for better outcomes.