1. South Western Uganda, November 2015
Malnutrition Among HIV-Positive Pregnant and Lactating Women Enrolled in Family Support Groups in Ntungamo District
South Western Uganda, November 2015
Esther J. Naluguza, MPH. Nutrition Advisor, USAID RHITES-SW

2. Outline Introduction Objective Methods Results
Conclusion and Recommendations
Acknowledgements
Disclaimer: This work was done as part of my MPH project. This presentation is not made on behalf of the Elizabeth Glaser Pediatric AIDS Foundation

3. Introduction
HIV progressively weakens the immune system, leading to malnutrition and thus rapid progression of HIV to AIDS.
Nutrition care plays a critical role in comprehensive care, support and treatment of people living with HIV.
When an HIV-positive woman becomes pregnant, nutritional is an important area of her health and that of her baby; nutrition counselling is needed.
Compared to routine prenatal nutritional assessment and intervention, pregnant HIV-positive women have increased needs to promote a healthy outcome.
The Uganda MOH policy requires assessment of nutrition status in all HIV-positive clients.

4. Objective
To establish the levels of malnutrition and associated factors among pregnant and lactating women living with HIV in Ntungamo District so as to generate information for the district health team, Ministry of Health, and implementing partners to innovatively and effectively prevent and reduce malnutrition among these women.

5. Methods
This facility-based, cross sectional study used simple random sampling at four health facilities with family support groups (FSGs) in Ntungamo District, from which 381 HIV-positive pregnant and lactating mothers were selected for participation.
Malnutrition was assessed using Mid-Upper Arm Circumference (MUAC).
Malnutrition was defined as the state of being under nourished, with a MUAC reading of less than 22cm.

6. Methods (cont.)
A structured interviewer administered a questionnaire to collect data on demographic factors such as marital status, occupation, education levels, and number of children under five years of age living in the household among pregnant among pregnant and lactating mothers.
Logistic regression analyses in STATA version 12.0 was done to establish factors associated with malnutrition.
A 95% confidence interval was used to determine statistical significance.

7. Results
Seven percent (27/381, [95% CI: 4.51 – 9.67]) of HIV-positive pregnant and lactating women were moderately or acutely malnourished.
Nutrition assessment, counselling and support, especially ready to use therapeutic foods (RUTF) & iron and folic acid supplements, was a standard nutrition package that over 90% of the mothers in this study received at their respective health facilities.
Living in a household with ≥5 people (AOR 1.6, 95% CI ), and ability to identify a malnourished person (AOR 2.3, 95% CI ) were not significantly associated with malnutrition in this study.

8. Results (cont.)
Malnutrition among HIV-positive pregnant and lactating mothers was associated with receiving care at a level four health center compared to other facility levels (AOR 0.2, 95% CI ), P<0.003
Mothers who had attained secondary education and above compared to those who had attained primary education and below were more likely to be malnourished(AOR 0.2, 95% CI ), p<0.018.
Knowledge of nutrition services (AOR 2.3, 95% CI ) provided at facility was not independently associated with malnutrition. This is in-line with findings in related studies that knowledge in itself does not influence behavior like seeking nutrition care (Black et al., 2008).

9. Conclusion and Recommendations
Prevalence of malnutrition in HIV-positive pregnant and lactating mothers in Ntungamo District is low (7%) compared to the national levels (9.2%)
Routine nutritional assessment for HIV-positive pregnant women should be strengthened especially within level three health centers where it is suboptimal compared to level four centers and hospitals.
A public health perspective may argue that knowledge could empower clients to seek health and nutrition care.
A comparative study is recommended to compare the nutrition status of HIV-positive pregnant and lactating mothers enrolled in FSGs with those not enrolled.

10. Acknowledgements Elizabeth Glaser Pediatric AIDS Foundation
International Health Sciences University
Ntungamo District Local Government

11. Thank you!