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Title: Diet and nutritional assessment of people living with HIV/AIDS in Nepal (Kathmandu Valley and Terai Highway)
Author: Upreti, Dilip
ISNI:       0000 0004 5361 3353
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 2014
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Background Nutrition and food security are important for maintaining a strong immune system and good general heath of People Living with HIV/AIDS (PLHA). The main aim of this study was to survey the nutritional status, habitual diet, dietary knowledge and demographic characteristics of PLHA in Nepal. A second aim of this study was to explore the voices of PLHA and policy level people on the current and possible future nutrition intervention programmes for PLHA in Nepal. Methods Using mixed methods (quantitative and qualitative) research techniques, 601 (M: 314 and F: 287) HIV positive people from the Kathmandu valley and Terai highway regions of Nepal were recruited and completed the study. All participants completed an interviewer administered questionnaire. This questionnaire includes an assessment of habitual food intake using a newly developed and validated 45-item semi-quantitative food frequency questionnaire. The validity of the FFQ was previously assessed against the 24-h multiple pass dietary recall in a sub-sample of the study population. Socio-economic and demographic information, dietary/nutritional knowledge, height, weight, waist circumferences and skinfold thickness were also collected. Finally, reported food intake was converted into energy and selected nutrient intakes (fat, protein, carbohydrate, iron, vitamin A and vitamin C) by linking with a newly compiled nutrient database of 116 food items for Nepal. Nutritional knowledge and perceptions of the current Nepalese nutritional supplementation and possible alternative interventions were explored using qualitative techniques. Four focus group discussions (FDG) and 11 in-depth interviews were carried out with PLHA and key local stakeholders respectively. Results The newly designed semi-quantitative FFQ can retrospectively assess the group mean intake for energy, protein, fat, carbohydrate, iron, carotene and vitamin C as there was no significant difference for reported intakes (all p > 0.2), but mean fat intake was significantly lower when determined by the FFQ than the 24-h recall (p < 0.001). The average age of participants was 33.8±6.4 years (mean ±SD) and 29% were classified as underweight (BMI < 18.5kg/m2). The study population typically ate a plant-based diet and intake of animal products was low, the energy intake of men and women was 1960±195 and 1880±261 kcal/d mean (±SD) respectively. Fat, protein and carbohydrate contributed 12%, 10% and 79% to total energy intake respectively. Iron and vitamin A intakes also tended to be lower than recommended, whereas vitamin C intake was satisfactory. Most participants (82%) believed that PLHA need a special diet but less than half of those reported changing their diet after diagnosis. A major reason for this was restricted income: 46% of participants reported being unable to afford sufficient food for the whole year, and 57% of those reported borrowing food for more than four months a year. Participants from FGD and in-depth interviews were not satisfied with the daily food and nutrient intake by HIV positive people. The Nepalese government currently provides a nutritional supplement for PLHA mainly for those who are on anti-retroviral treatment (ART). However, this was not satisfactory with the majority of volunteers reporting suffering negative health effects, including diarrhoea and vomiting, after consuming the supplement. Similarly, poor quality packaging, storage, delivery and lack of nutritional expertise and education were frequently reported problems for the proper implementation of the existing supplement. The participants suggested a nutrition intervention, based on a locally produced supplement, combined with dietary education and were highly motivated to support the development, implementation and evaluation of a new intervention. Conclusion Food and nutrient intakes by PLHA in Nepal were not adequate and did not meet dietary recommendations. Overall, the quality of the current nutritional supplement is poor and not suitable for ensuring maintenance of PLHA health. A nutrition intervention trial based on locally produced fortified mixed grain flour was favoured by PLHA and key stake holders. However, further research is needed to improve the nutritional status of PLHA in Nepal. Therefore, the evidence identified by this study could be used to inform the design of a new intervention. However, further research is recommended to clarify the issues.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: HIV-positive persons ; AIDS (Disease) ; HIV infections