F ACTORS INFLUENCING THE NUTRITIONAL OUTCOME OF HIV POSITIVE CHILDREN 6-59 MONTHS ON F OOD B Y P RESCRIPTION IN DANDORA, NAIROBI KENYA EDWINA MAKOKHA A90/0307/2008 SUPERVISOR 1:Prof.S.K.Mbugua SUPERVISOR 2: Mrs. A.A. Andago

I NTRODUCTION FBP is a nutrient based intervention that provides fortified blended food and nutritional care at HIV care and treatment facilities in Kenya. The programme’s objective is to provide energy and nutrient-dense food products along with nutrition assessment, counselling and clean, safe water to PLHIV who are malnourished or at risk of malnutrition Study was conducted in Dandora at Lea Toto program -provides support to most of the households of children infected with HIV through provision of medication, nutrition support and social support

RESEARCH PROBLEM Despite the efforts by the government and various NGOs to offer nutrition and food to PLHIA to improve well-being and treatment outcomes, support treatment adherence and protect household integrity and to encourage a productive recovery and sustained adherence through various interventions,there are various factors that interfere with the effectiveness and positive outcomes of such food based interventions. These factors are both external and internal.

JUSTIFICATION Food by prescription aims at improving nutritional status of children living with HIV/AIDS. This is quite a challenge because of various factors e. g socio-economic factors, demographic factors, household food security and morbidity experience that negatively impact on the improvement of nutritional status. This research will assist bring out the real issues beyond the service delivery which when addressed will improve the nutritional outcome and thus nutritional status of the HIV positive children.

AIM To contribute towards improving the nutritional status of HIV positive children who are below five years of age in Kenya

PURPOSE To identify factors affecting the effectiveness of feeding programme related to HIV/AIDS for children to ensure improvement of service delivery aimed at enhancing their nutritional status and their overall health

MAIN OBJECTIVE To assess factors influencing the nutritional outcome of HIV positive children 6-59months on Food by Prescription in Dandora

SPECIFIC OBJECTIVE To determine the socio-economic and demographic factors that affect children who are on FBP To determine adherence to prescribed treatment and feeding regimes To determine the nutritional status of the children at their enrollement to the programme and subsequent visits to the clinic To determine the morbidity experience of the study children.

METHODOLOGY AND TOOLS STUDY SETTING Study was based in Dandora at the Lea Toto program. Dandora is a high density slum with high poverty, unemployment and crime rates and high prevalence of disease especially HIV/AIDS.

STUDY DESIGN The study encompassed a cross- sectional design with a descriptive and analytical component undertaken at Lea Toto program in Dandora Both qualitative and quantitative data was collected The study tools used; semi structured questionnaire and Dietary diversity score

SAMPLE SIZE DETERMINATION Exhaustive sampling was done that generating a population size of 37 clients which met the rule of a minimum size of 30 for valid statistical analysis. This is because only 37 clients were enrolled into the programme at the time of the study.

D ISTRIBUTION BY AGE AND SEX BoysGirlsTotalRatio AGE (mo)no.% % %Boy:girl Total

E DUCATION LEVEL ATTAINED

A VERAGE FAMILY SIZE

P ROPORTION OF CLIENTS COLLECTING FBP/M EDICINES AS SCHEDULED

P ERCENT DISTRIBUTION OF CLIENTS WHO FINISHED THE FEED GIVEN

NUMBER OF FOOD GROUPS CONSUMED

M ORBIDITY EXPERIENCE

CD4 COUNT VS DISEASE FREQUENCY There is a relationship between CD4 count and frequency of disease but the influence is small (r=-0.291)

MUAC MUAC BEFOREMUAC AFTER

W EIGHT FOR HEIGHT Z SCORES Baseline WHZIntervention WHZ

CONCLUSION From the study it was evident that majority of the clients were complying to the specifications of the programme, but a few who did not, was as a result of external and internal factors that influenced their intake of the food supplement given and thus their nutritional status This factors negatively influence the effectiveness of such food based intervention programs.

RECOMMENDATIONS The program should introduce an aspect of economic empowerment into it objectives so as to address the problem of poor economic status at the household level which affects the household food security. The Lea Toto management should stress the appropriate usage of FBP in terms of adherence to FBP guidelines to ensure maximum benefits from the program.

REFERENCES UNAIDS/WHO/UNICEF,2009/2010.Global HIV/AIDS Statistics vol. 6, pg 2 Kenya Demographic Health Survey , pg Child survival and Development Strategy Ministry of Health and Sanitation , pg 1-24 Kenya National Guidelines on Nutrition and HIV/AIDS, 2007, pg 54-64

C ONT. UNAIDS, Report on the global AIDS epidemic, Geneva, 2010.Report on the global AIDS epidemic FANTA 2/USAID, “A Review of Kenya’s Food by prescription Program” 2009

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