Knowledge, Attitude And Practice Of Adequate Diet Among People Living With HIV In Ekiti State

Project and Seminar Material for Public Health

Knowledge, Attitude And Practice Of Adequate Diet Among People Living With HIV In Ekiti State

Abstract

Nutrition plays a critical role in promoting the health of People Living with HIV/AIDS (PLWHA). Nutritional problems strongly predict illness or death among PLWHA. However, the knowledge, attitude and practices relating to adequate diet by this group of people have not been adequately explored in Nigeria. This study was therefore carried out to determine the knowledge, attitude and practice of adequate diet among people living with HIV who were attending Antiretroviral Therapy (ART) clinics in Ekiti State, Nigeria. The study was cross-sectional in design. A total of 350 respondents were selected from two ART clinics using systematic random sampling technique. A semi-structured questionnaire consisting of information on socio-economic characteristics, a 58-point knowledge scale [classified as poor (score < 29 points), fairly good (score 29 – 34 points), good (score 35– 40 points) and very good (score ≥41)], Likert scale for attitude and a 22-point nutritional practice scale [classified as adequate (≥50%) and inadequate (<50%)] was used for data collection. Weight, height and Body Mass Index (BMI) of the respondents were also measured. Nutritional status of the respondents was defined as underweight (BMI <18.5kg/m2), normal weight (BMI=18.5–24.5kg/m2), overweight (BMI=25.0– 29.9kg/m2) and obese (BMI ≥30.0kg/m2). Data were analysed using, descriptive statistics, t-test and Chi-square test. Mean age of respondents was 35.7 ± 11.4 years and majorities (70.9%) were Yoruba. The females (68.3%) were more than males (31.7%). Only 17.4% of respondents had no formal education while 19.4%, 27.1%, 16.9% and 36.1% had primary, secondary, post- secondary and tertiary education respectively. Majority of the respondents (76.0%) earned less than N10,000.00 per month. All the respondents were aware that adequate nutrition is crucial for their health and survival. The mean nutritional knowledge score of the respondents was 43.0 ± 4.6. There was no significant difference in the mean nutritional knowledge scores between male (42.4 ± 4.7) and female (43.2 ± 4.5). Majority (86.5%) agreed that malnutrition accelerates the progression from HIV to AIDS. More than half (63.7%) agreed that PLWHs need better nutrition than those without HIV. Many of the respondents (64.0%) had normal weight, and a significant difference was observed in the prevalence of underweight, overweight and obesity between the female (6.6%, 13.4% and 9.7%) and male (1.7%, 3.1% and 1.4%) respondents respectively (p<0.05). There was a significant relationship between nutritional status and education, occupation, monthly income and housing facility of the respondents. In other hand, there was no significant relationship observed between the nutritional status and either the nutritional knowledge or practices of the respondents. People Living with HIV/AIDS had very good nutritional knowledge and positive attitudes, but adequate nutrition was only practised by about half of them. There is need to sustain awareness of and support for them to improve the practice of adequate nutrition which is crucial for their health and wellbeing.

Table of Content

  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One

Introduction

1.1 Background of the Study

Human immunodeficiency virus (HIV) the causative agent of the Acquired Immuno Deficiency Syndrome (AIDS) is a Ribo nucleotide androgen (RNA) virus in the family of Retroviridae and subfamily Lentiviridae. Two types of HIV (HIV-1 and HIV-2) have been recognised with many subtypes particularly for HIV-1. AIDS is defined as a syndrome of immune dysregulation, dysfunction and deficiency. It is also defined as all situations involving immuno suppression as measured by absolute CD4 lymphocytes count for CD4/CD8 ratio (Onwuliri, Emejulu, Braig and Agyo, 2004). The final stage of the disease condition caused by HIV is AIDS. AIDS represents the advanced stage of HIV infection during which the HIV–infected individual’s immune system is unable to fight off the opportunistic infections. The immune system is a collection of cells and organs that work together to defend the body from germs or pathogens, which may cause illnesses (FMOH, 2003a; Park, 2002). HIV is found in most human body fluids including blood, semen, vaginal fluids and breast milk. HIV can be transmitted through the following ways: unprotected sexual activity; contact with infected or contaminated blood or blood products; use of contaminated skin piercing instruments or equipment; and from infected mother to her child. The HIV is not transmitted by kissing, hugging, shaking of hands, mosquito or insect bites, coughing and sneezing, sharing of toilets or washing facilities, sharing of utensils or consuming food and drink handled by someone who has HIV and social contact in workplaces (Kidd and Clay, 2003; Park, 2002). HIV and AIDS remain the greatest health challenges of this age (UNAIDS, 2002). It has been stated that the AIDS phenomenon is nothing short of war on humanity. The heavy toll on human lives, large scale devastation and the emasculation of the human spirit occasioned by the scourge, attest to this (Akwa Ibom State SACA, 2005). Therefore, the HIV/AIDS epidemic is a global public health crisis which constitutes one of the most serious challenges to the human race particularly in terms of its adverse effects on man‟s social and economic development. It devastates the lives of individuals, families and communities. Epidemic of HIV/AIDS is affecting all levels of the society including both the young and the old. Anyone can be affected by HIV and AIDS and all are vulnerable to it. The prevalence of the disease condition cuts across both developed and developing countries (Ogundipe, 2007).

HIV and AIDS have caused more than 20 million deaths globally, with 83% (16 million) of these deaths occurring in sub Saharan Africa; 80% of children orphaned by AIDS live in this region and women make up more than 50% of the People Living with HIV and AIDS (PLWH). It has been said that in sub-Saharan Africa, AIDS affects women disproportionately (Harries, Simeon, and Edwin., 2005), although no group of people is speared. HIV also affects dietary status of all groups of people. Dietary status is defined as the measure of adequacy of nutrient intake of an individual or a population in relation to his or their health (Horwitz, 1983), which is strongly predictive of survival and functional status among people living with HIV/AIDS. Dietary problems may occur at any stage of disease and can contribute to impaired immune response, accelerate disease progression, increase the frequency and severity of opportunistic infections, and impede the effectiveness of medications (HRSA Care Action, 2004). HIV and AIDS therefore have direct impact on the nutrition of people living with HIV and AIDS, and for nutritionally vulnerable members in HIV and AIDS–affected households. For instance, people living with HIV face a vicious cycle in which repeated episodes of illness caused by HIV lead to malnutrition. Malnutrition in turn further accelerates the onset of AIDS. HIV damages a person’s immune system, and the repeated illness that ensues reduces appetite; moreover, nutrients are lost from vomiting and diarrhoea, and the use of certain medications. Infections also interfere with the body’s ability to absorb and use nutrients, which are needed to fight off HIV. This has serious consequences for the poor, who are more likely to be malnourished even before they become infected (Administrative Committee on Coordination, Sub-committee on Nutrition –ACC/SCN, 2001; Haddad & Gillespie, 2001; Piwoz & Preble, 2000; Egal & Valstar, 1999). Therefore to live a healthier life, all people, whether HIV-infected or not, need to be fast in nutritional knowledge, positive attitude to nutrition and adequate nutritional practices in order to meet their daily energy, protein and micronutrient requirements. So for a healthy person, good food and nutritional practice may help to make him or her strong for a long time and for an infected or a sick person, the right practice of food and nutrition may help him or her to get well (Serena Rajabium, 2001).

Knowledge is a range of information acquired by someone or a person that enhances such person‟s understanding of a subject; while attitudes reflect our likes and dislikes of the subject which determine our behaviour concerning the subject matter. They often come from our experiences or from those of people close to us. They either attract us to things, or make us wary of them. Sometimes they could be based on limited experience. We may form attitudes without understanding the whole situation (WHO, 1988; Rokeach, 1976). Generally, theory suggests that the more directly related knowledge is to behaviour, the more likely it is to have an impact on the behaviour, and also the more on the practices. However, knowledge regarding nutrition and its influence on health and longevity has greatly increased over the last decades, yet few or no known work has been done on the knowledge, attitude and practice of adequate diet among people living with HIV in Ekiti State.

1.2 Statement of the Problem

People with HIV–infection often exhibit progressive loss of weight and poor nutritional status. These problems, which may appear at all stages of the HIV–infection, may be explained by wrong selection of nutrients, inadequate intake of food as a result of ignorance, poverty, negative attitude to adequate nutrition and also anorexia and eating problems, impaired gastro-intestinal function, increased metabolic rate, secondary to opportunistic infections or the HIV infection itself.

Studies from both industrialized and developing countries have shown that HIV–infected individuals have decreased absorption, excessive urinary losses and low blood concentrations of vitamins A, B1, B2, B6, B12, C, E as well as foliate, beta-carotene, selenium, zinc and magnesium (FANTA, 2001). Compromising on nutritional status may therefore have a negative effect on the outcome of treatment, and may lead to malnutrition-related immune depression and rates of infection. Malnutrition in turn increases both the susceptibility to HIV infection and the vulnerability to its various effects; any immune impairment because of HIV/AIDS leads to malnutrition and poor nutritional status. Conversely, malnutrition increases the severity of the HIV disease by further weakening the immune system, which decreases the body‟s ability to fight HIV and other infections. Thus, malnutrition can both contribute to and result from the progression of HIV. According to Piwoz and Preble (2000), the effect of HIV/AIDS on nutrition results in weight loss and the wasting that is common in people living with AIDS. Danielles (2008) added that infection with HIV/AIDS can lead to malnourishment, and studies have shown that progression of the disease can be increased by a poor diet. FANTA (2001) corroborated this while agreeing that deficiencies of total calories, protein, vitamin A, vitamin B6, vitamin B12, vitamin C, vitamin E, magnesium, iron, selenium, and zinc are associated with HIV, and normalization of these vitamin and mineral deficiencies may be linked to slower disease progression. Therefore, a person who is malnourished maybe due to ignorant, negative attitude towards adequate nutrition as well as inadequate practice of nutrition and then acquires HIV is more likely to progress faster to AIDS, because his/her body is already weak and cannot fight infection. It may seem logical that higher levels of nutrition knowledge and more favourable attitudes towards nutrition would be associated with adequate diet intake, and good nutritional status all thing being equal; and so nutrition issues are of vital importance to HIV-infected persons. Although nutrition does not promise a “magic bullet”, nutritional knowledge and right or positive attitude towards nutrition by the PLWH may enhances their practice of feeding on balanced diet (adequate nutritional practices) as a means of survival as well as their good nutritional status. However, despite the growing body of knowledge related to HIV/AIDS and Nutrition, little or nothing is known about the knowledge, attitude and practices relating to nutrition among PLWH in Ekiti State. Hence, the justification for this study is contingent upon the importance of adequate nutrition to PLWH for their nutritional status, wellbeing and longevity.

1.3 Objectives of the Study

The overall aim of this study is to critically examine the knowledge, attitude and practice of adequate diet among people living with HIV in Ekiti State.

Hence, the study will be channeled to the following specific objectives;

  1. Describe the socio-economic characteristics of people living with HIV/AIDS;
  2. Describe the respondents attitude towards the practice of adequate nutrition
  3. Assess the anthropometric indices- (height, weight) and the body mass index (BMI) of the respondents;
  4. Determine the relationship between the variables assessed (level of education, occupation, income, nutritional knowledge and nutritional practice) and the nutritional status of the respondents.

1.4 Research Questions

  1. What are the socio-economic characteristics of people living with HIV in Ekiti State?
  2. What are the level of nutritional knowledge, attitude and practices of PLWH in Ibadan and Ekiti State?
  3. What is the nature of the nutritional status of PLWH in Ekiti State?
  4. What are the relationship of the socioeconomic status, level of nutritional knowledge, attitude and practices on the nutritional status of PLWH in Ekiti State?

1.5 Research Hypothesis

  • Ho: There is no relationship of the socioeconomic status, level of nutritional knowledge, attitude and practices on the nutritional status of People Living With HIV/AIDs.
  • Ha: There is a relationship of the socioeconomic status, level of nutritional knowledge, attitude and practices on the nutritional status of People Living With HIV/AIDs.

1.6 Significance of the Study

Sub-Saharan Africa accounts for more than 70% of all HIV and AIDS cases globally. The first AIDS case in Nigeria was reported in 1986. Since then, the epidemic has steadily grown. All the states of Nigeria have general population prevalence of over 1%. In Oyo State (one of the 36 States in Nigeria), there is no specific town or village that has not reported cases of AIDS. Oyo state has important international and inter-state border towns, which might play significant roles in the wide geographical distribution of HIV and which cut across adult and children (State Ministry of Health –SMOH, 2004). Thus, in a country like Nigeria which may be considered a poor resource country, not only because the country is poor in natural and human resources but because access to basic things like adequate nutrition (food, accessibility to it, sanitation and good health care), shelter, and education are inadequate. Also in a situation where there is no cure for HIV/AIDS yet and many of the PLWH cannot afford or access the ARVs which are to be taken for a lifetime; despite the fact that many projects (with limited time frame) providing free ARVs, having a good knowledge, attitude and practice of appropriate nutrition which according to James (2000), in the developing world, nutrition is the only form of therapy available in addition to other medical therapy, is known to be of significant important in the continuum management of HIV and AIDS.

1.7 Scope of the Study

The study focuses on the knowledge, attitude and practice of adequate diet among people living with HIV. Geographically, this study will be delimited to Ekiti State.

1.8 Limitation of the Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced. Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 Definitions of Terms

Knowledge

Information and awareness acquired through experience and education (Elliott, 2002) In this study it refers to the level of understanding of PLWH dietary practices in prevention of malnutrition.

Attitude

It means a way of thinking or feeling about someone or something. In this study it refers to pattern of mental views or opinion of PLWH towards dietary practices in prevention of malnutrition.

Practice

It means way of doing something. In this study it refers to the knowledge on practice in terms of verbal response of the PLWH regarding dietary practices in prevention of malnutrition.

1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary of the Findings, Conclusions and Recommendations

5.1 Summary of the Findings

Human immuno-deficiency virus (HIV) and acquired immuno-deficiency syndrome (AIDS) remain the greatest health challenges to human race of our age (UNAIDS, 2002). The heavy toil on human lives, large scale devastation and emasculation on human spirit by the scourge of HIV and AIDS adversely affects man‟s social and economic development. The devastating effects on lives of individuals, families and communities and all levels of the society including the young, attest to HIV and AIDS phenomenon as nothing short of war on humanity (Ogundipe, 2007; and Akwa Ibom State SACA, 2005); thus, the need to identify the existing problems and also develop the appropriate strategies to overcome the problems. It has long been established that malnutrition impacts negatively on optimal immune function, thus increasing susceptibility to morbidity and mortality among HIV positive individuals. It is therefore important to include nutritional care and support in the provision of quality care support for people living with HIV/AIDS (PLWH). Nutrition is known to play a major role in the transmission of HIV and the prognosis of a person infected with the virus. Adequate nutrition enhances the immune system and helps reduce the incidence of infections, prevent weight lost and loss of lean body mass. A well nourished person has stronger immune system to fight infection and to cope with HIV/AIDS while malnutrition makes body more susceptible to infections and diseases due to weakening immune system. Persons living with HIV are more susceptible to malnutrition because of the HIV infection itself and inadequate knowledge about relevant diets and wrong attitude to nutrition as well as inappropriate nutritional care practices. The Federal Ministry of Health of Nigeria had developed guidelines on nutritional care and support for people living with HIV in Nigeria hence the need to ascertain the knowledge attitude and the practices of the People Living with HIV in each locality.

5.1.1 Socio-demographic of the respondents

A large majority of the respondents in this study were females; and the majority of them were widows who could have lost their spouses due to HIV/AIDS. This indicates that female adults constituted a larger sub-group of the population affected by the HIV virus than male counterparts within Oyo State. This observation is in tandem with the report of UNAIDS, (2008) which states that in 2007, an estimated 1.7 million new HIV infections occurred in the sub-Saharan region of Africa, with prevalence rates exceeding 30.0% among adult population and most of the people living with HIV and AIDS were women. However, reason for this is that women are biologically, socio-economically and socio- culturally more at risk of HIV infection than men (Gupta, 2000 and Topouzis, 2000). Biologically, the risk of becoming infected with HIV during unprotected vaginal intercourse is between two and four times higher for women than for men (World Bank, 1997). HIV/AIDS also exacerbates social, economic, and cultural inequalities that define women’s status in society. The predominant culture of silence and passivity regarding sex stigmatizes women who try to access STD treatment services. The norm of virginity restricts adolescent girls’ access to information about sex and increases risk of sexual coercion. Economic vulnerability increases the chance of exchange of sex for food and money. Male power often manifested in sexual violence. Susceptibility to HIV infection is increased through sexual practices, including genital cutting, dry sex and ritual cleansing (www.nlm.nih.gov/medlineplus) are also some of the reasons why females are disproportionally affected with HIV/AIDS. As well females are found to have easier access to health services facilities than their males‟ counterpart (www/unsystem.org./scn). The mean age of the respondents in this study was 35.7 ± 11.4 years. This age is the peak of reproductive stage of life most especially for women; meaning that the respondents were at the stage when they were sexually active and probably with deliberate multiple partners due to cultural norms or religious belief. The age of the respondents is also in agreement with the report of Petrie, (2004) among the South Africans which states that HIV/AIDS exist among the married than the single group of reproductive age. The people residing in the study location were predominantly Yoruba, thus majority of the respondents were Yoruba. More than 50% were Muslim, about a third had either no formal or primary education and two third of the respondent were earning less than N10,000 per month which confirms report of Castetbon, Kadio, Bondurand, Boka Yao, Barouan, Coulibaly, Anglaret, Msellati, Malvy, & Dabis (1997) and Steyn and Walker, (2000) that the low social economic condition and educational capacity of the HIV infected patients might limit their ability to cope with the nutritional demand of their illness. According to Alder et al., (1994), education, occupation and monthly income played prominent role in the nutritional practice of an individual. Earlier study confirmed that poverty and household food insecurity and ignorance are known to be associated with malnutrition and these scenarios are reported to be radically compounded by the emergency of HIV/AIDS (Rutengue, 2004). In a survey conducted by Thai Business Coalition on AIDS, it was also reported that almost a half of the surveyed PLWH were unemployed or without a regular income (UNAIDS, 1997). This information indicates the low socioeconomic status of a large percentage of PLWH and the need to support them to live a better quality of life.

5.1.2 Knowledge of Diet and HIV

A healthy diet that is adequate in term of energy, protein, fat and essential micronutrients may help prolong the time it will take for HIV to progress to AIDS. This is because there is a strong relationship between nutritional status and immune system function (FMOH, 2011). Many people live with the virus fourteen years or more if they maintain good nutrition. Thus PLWH need adequate nutrition information and knowledge for their self care. Nutritional status of an individual or population is strongly predictive of the survival and functional status of the individual or the population and this are also true for people with infections such as HIV/AIDS. Poor nutritional status impairs immune response, accelerates diseases progression, increases the frequency and severity of opportunistic infection and impedes the effectiveness of medication (HRSA Care Action, 2004). Thus HIV/AIDS have direct impact on the nutrition of people living with HIV/AIDS. Malnutrition in turn further produced serious consequence of accelerating the onset and further accelerates the rate of damage of the immune system and the progression of the disease (Haddad & Gillespie, 2001 and Piwoz & Preble, 2000). Thus poor nutrition and HIV/AIDS form part of a typical vicious cycle malnutrition-related immuno-suppression and oxidative stress leading to faster disease progression and earlier death (Babameto, 1997). According to James (2000), nutrition is often the main form of therapy available in the developing world and it is crucial in the holistic approach to maintain health in person with HIV/AIDS. Thus people living with HIV/AIDS must be adequate in the knowledge of nutrition, have the positive attitude and also apply the good nutrition information they have, into their day to day life in order to achieve good health and long life (Serena Rajabium, 2001). However, earlier report indicates that many HIV infected individuals fail to consume the required intake for at least one or more nutrients most especially micro nutrients (Dworken et al, 1990; Luder et al, 1995). Good nutritional knowledge is fundamental to maintaining an optimal immune response and accelerates the progress of the problem of HIV/AIDS (Gramlich & Mascidli, 1995; Gay & Meydani, 2001 and Woods, Spiegelman, Knox, Forrester, Connors, Skinner, Silva, Kim, Sherwood, & Gorbach, 2002). According to this survey, although majority of the respondents obtained their nutrition information from the clinics and other sources, the nutrition information were not given by the nutritionists who are experts in the goals of helping individuals or group of individuals achieving good nutritional status and good health. This reflects the low level of employment of qualified nutritionists who are specially trained to educate people on nutrition. It is likely that the respondents could have been given inadequate nutrition information which could negatively influence the level of the attitude and practice of the respondents with regards to nutrition. Nutritionists have been trained to have the skills of educating people to improve their nutritional status in a cost-effective and reasonably simple way, applying this principle to different conditions (Piwoz and Preble, 2000). It is revealed in this study that a high percentage of the respondents were aware that adequate nutrition is an essential mediator in optimising their immune function and that nutrient deficiencies are associated with immune impairment in both HIV-uninfected and HIV-infected subjects. This finding is in tandem with Bukusiba, Kikafunda and Whitehead, (2010) report in a study conducted in Uganda on nutritional knowledge, attitude and practices, and the relationship with socio-demographic characteristics in urban population of women living positive with HIV/AIDS. According to the report, a large percentage of women infected with HIV/AIDS, who were trained on the importance of nutrition for PLWH believed that it is very important to consume an adequate diet. Majority of the respondents in this study (64.0 – 97.7%) knew that HIV/AIDS contribute to malnutrition in various ways such as loss of appetite, development of diarrhea, nausea and vomiting, depression of immune system, increase in the rate of opportunistic infections, general loss of weight and reduce the quality of life and life span of the infected person. They were aware that they need to take varieties of foods including fruits and vegetables and also need to observe various food safety measures. Based on their level of awareness of the importance of the nutritional care in their treatment, the nutritional knowledge score of the respondents was good. The variation in the knowledge scores of the male and female respondents was not significant (p>0.05). Surprisingly, no significant association was observed between level of education, occupation and the monthly income of the respondents with their nutritional knowledge (p>0.05). Strong reason for this can be linked to the fact that the respondents in this study were collected from health facilities, which means that they have been supported at least with ART which has positive effects on their nutritional knowledge inrespective of their level of their education, occupation or monthly income.

5.1.3 Nutritional attitude of the respondents

According to Green et. al., (1991), the presence or absence of knowledge of adequate nutrition and the prevailing beliefs relating to food and nutrition can influence attitude (that is, the way an individual perceives food or good nutrition). In this survey majority of the respondents had positive attitude towards adequate nutrition. For instance, majority of them agreed that eating adequate diet promote immune system and reduces the rate of opportunistic infections; and that nutrition is critical to their survival and longevity, and to the better outcome of their treatment. Also a large majority agreed that malnutrition accelerates HIV to AIDS and consumption of adequate diet is important for maintaining good quality of life by PLWH. The good nutritional knowledge of the respondents is likely to have accounted for this.

5.1.4 Dietary practices of the respondents

Quality nutritional care and support are crucial for PLWH to improve their nutritional status and to prevent and treat opportunistic infections, and also to enhance their quality of life and prolong their survival (FMOH, 2011). With correct nutrition, and holistic approach to HIV and other infections, PLWH can maintain a healthy life (James, 2000).

There is evidence that food insecurity increases the incidence and the gravity of malnutrition and malnutrition impairs the body‟s natural defence against the opportunistic infections, resulting in anorexia, mal-absorption, altered metabolism, weight loss and gradual weakness of the body (FAO, 2002). All these indicate that malnutrition is a serious danger for PLWH and they need to maintain good nutritional practices in order to maintain good nutritional status and delay the progression of the disease.

In this study, more than half of the respondents claimed to have enough food available to them always; however, more than a third could not sufficiently obtain the quantity and quality as well as the varieties of food they needed daily. This group of people were prone to the serious danger of malnutrition, poor health and poor quality of life as well as short life. Due to changes in metabolic alterations and release of pro-oxidant cytokines and other reactive oxygen species, AIDS is known for causing increased utilization of anti-oxidants (vitamin A, E, C and beta-carotene) as well as several minerals such as zinc and selenium. The increased utilization increases the risk of damage to cells, proteins and enzymes. This leads to severe weight loss (wasting) which strongly predicts illness and death among PLWH (Piwoz and Pebble, 2000). With regards to the quality of food eaten by the respondents, most of the respondents were not eating extra food than what they normally eat. However, some who could not eat the normal texture of food were taking either soft or fluid diets which were prescribed by a dietitan. Also majority of the PLWH were taking vitamins and mineral supplements along with fruits and vegetables which they took occasionally. Nutritional well being is also determined by consuming safe foods that are free from pathogenic organisms and appropriate or adequate in nutrients and calorie (Friis, 2002).

With regards to food safety control, majority of the PLWH ensured they stored their foods well and protected them from contamination by insects, rodents and domestic animals. Majority also ensured raw foods were kept separately from cooked foods and also ensured they cooked their raw foods very well before eating. Almost all PLWH claimed to keep their food utensils clean and ate their foods as soon as they were prepared. Many also claimed to maintain general personal hygiene.

Nutritional status is easily compromised during any type of infection and generalized infections such as HIV/AIDS often result in reduced food intake, poor absorption and utilization of nutrients and loss of nutrients. All these physiological stress of disease along with ignorance and poverty contribute to poor nutritional status.

The healthy lifestyle of an individual influences the extent to which food contribute to good physical, mental and social wellbeing (FAO/WHO, 1992). It is well known that smoking suppresses appetite and leads to reduced food intake and alcohol consumption can be harmful to the body especially the liver, increases vulnerability to infection and reduces food intake (FMOH, 2011). In this study, only a few of PLWH were still taking alcohol occasionally however majority were taking carbonated drinks. Among the lactating mother, with regards to breastfeeding practices less than half were not breast feeding their infants. The general assessment of the PLWH in this study indicates that about a half of them were practising adequate nutrition.

Assessing the nutritional status of PLWH is an essential part of monitoring their nutrition in relation to their health and wellbeing (WHO, 1996). Assessing their nutritional status will also serve as appropriate process to develop an accurate planning and implementation of interventions to reduce morbidity and mortality associated with malnutrition, as good nutrition is known to improve the quality of life and health of PLWH (WHO, 1996). With the use of BMI, majority (64.0%) of the PLWH in this study had normal weight only a few (8.3%) were underweight and about a quarter were overweight or obese. More females compared to males were underweight while more males compared to females were either overweight or obese. About a third of the PLWH were malnourished.

5.2 Conclusion

People Living with HIV/AIDS in Ekiti State, Nigeria had low socioeconomic status, good nutritional knowledge, their attitudes were found to be positive; however, their overall practices of nutrition was only sub-optimal (fairly adequate).

5.3 Recommendations

  1. The report from this study necessitates the continuous nutritional intervention to help the People Living with HIV/AIDS. There is need for continuous information that will develop a better attitude toward nutrition and also put into practice the healthy eating plan in the management of their diseases. This will help to achieve better self care, good nutritional status, optimal health and survival most especially for those patients not qualifying for the antiretroviral programmes.
  2. Malnutrition has direct negative impact on HIV/AIDS thus food fortification of cereals with micro nutrients and proteineous foods given free as food supplement will likely assist in addressing the nutritional problem of the people living with HIV/AIDS.
  3. Nutrition education is known to be important public health tools to improve the nutritional status of people especially when it is well planned and executed. Thus, the government should employ the nutritionist (specially trained nutrition educators with adequate nutrition education skills) in every hospitals and clinics to train PLWH how to maintain good nutritional status in a cost effective way.
  4. Most of the PLWH were unemployed or without irregular income, thus they need to be well supported by their relations, philantrophist and Government to help them obtain sufficient quantity and quality as well as varieties of foods they need daily. PLWH should not be neglect practice of adequate nutrition as it is an important self care which they must not neglect.

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Samphina Academy

Samphina Academy is an Online Educational Resource Center that is aimed at providing students with quality information and materials to aid them in succeeding in their academic pursuit.