A detailed nutritional assessment was carried out on thirteen patients with the Acquired Immunodeficiency Syndrome (AIDS). Estimates of body fat and skeletal muscle were measured using triceps-skinfold, mid-arm circumference, mid-arm muscle area, and creatinine height index. Body weight was compared to standards for height and sex. Serum albumin and transferrin levels were measured to estimate visceral protein stores. The average Kilocalorie and protein intake was assessed from four day records and compared to estimated Kilocalorie and protein needs. The findings of this assessment showed decreased skeletal and visceral protein stores that can be characterized as a mixed type of malnutrition, or marasmic-kwashiokor. Protein intake was also shown to be inadequate when compared to estimated protein needs for stress and/or infection. This could contribute to diminished protein stores and muscle wasting. / M.S.

Thesis (Mnutr)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: INTRODUCTION: The objective of this pilot study was to evaluate the effects of a new micronutrient, glutamine, pre- and probiotic enriched liquid nutritional supplement on the nutritional status and immunity of adults living with HIV/AIDS. The study was designed as a prospective randomised double-blind placebo-controlled trial. Subjects were HIV-infected male and female adult volunteers (n = 47) from a community-based hospice centre in a peri-urban area in a resource-poor setting and were included irrespective of duration or clinical stage of HIV/AIDS. None of the subjects received antiretroviral therapy. METHOD: The intervention involved the daily ingestion of 40g (200 ml reconstituted) of either the enriched test product or an lsocalorie carbohydrate placebo for a period of 12 weeks. Anthropometric assessment (weight, height and triceps skinfold thickness; mid-upper arm, waist and hip circumferences) was performed at baseline and thereafter every 4 weeks (4 times). Biochemical (serum total protein, serum albumin and C-reactive protein) and haematological (full blood count and immunophenotyping) assessment was performed at baseline and again after week 12. RESULTS: Statistical analysis of baseline values was performed with Wilcoxon two-sample tests for comparison between the supplemented and placebo groups. Outcomes were evaluated using analysis of variance with Shapiro-Wilk tests and thereafter either pair-wise t-tests or sign tests (for nonparametric data) were used. Thirty-two subjects completed the trial, 14 in the supplemented group and 18 in the placebo group. Weight increased significantly in the supplemented group (2.73 ± 3.53 kg, P = 0.013). Triceps skinfold thickness increased significantly in both the supplemented (p = 0.047) and placebo group (p = 0.001). No other significant anthropometric change was observed. Serum albumin increased significantly in the supplemented group (p = 0.003) and was associated with a significant decline in C-reactive protein (p = 0.028). Haemoglobin decreased significantly in both groups. A significant decline in CD4+ count was observed in the placebo group while the decline in the supplemented group did not reach significance. CONCLUSION: Oral nutritional supplementation in limited quantities was well tolerated for a period of 3 months. This study demonstrated that an enriched nutritional supplement was able to promote weight gain and ameliorate hypoalbuminaemia and possibly inflammation in adults living with HIV/AIDS in the short to medium term. The enriched nutritional supplement does not appear to have an effect on the immunity of people with HIV/AIDS. The small sample is a limitation of the study and the conclusions pertain to the test product as a whole and not to any of its respective ingredients. Although further studies are required to evaluate long-term feasibility, these findings suggest that the use of an enriched nutritional supplement has a role in the management of weight loss in persons with HIV/AIDS. / AFRIKAANSE OPSOMMING: INLEIDING: Die doel van hierdie loodsstudie was om die uitwerking van 'n nuwe mikronutriënt, glutamien, pre- en probiotika verrykte voedingsaanvulling in vloeistof vorm te ondersoek. Die studie is ontwerp as 'n prospektiewe ewekansige dubbelblinde plasebogekontroleerde toets. Proefpersone was MIV-geïnfekteerde manlike and vroulike vrywilligers (n = 47) van 'n gemeenskapsgebaseerde hospitium in a semi-stedelike gebied in 'n hulpbron-arme omgewing. Proefpersone is ingesluit ongeag die duur of kliniese graad van MIVNIGS. Geen proefpersoon het antiretrovirale behandeling ontvang nie. METODE: Die intervensie het die daaglikse inname van 40g (200 ml gerekonstitueer) van óf die toetsproduk óf 'n isokaloriese koolhidraatplasebo gedurende 'n 12 week periode behels. Antropometriese evaluering (gewig, lengte en trisepsvelvoudikte; midbo-arm-, middel- en heupomtrekke) is uitgevoer met aanvang en daarna weer elke 4 weke (4 keer). Biochemiese (serum totale protein, serumalbumien en C-reaktiewe protein) en hematologiese (volbloedtelling en immunofenotipering) evaluering is uitgevoer met aanvang en weer na 12 weke. RESULTATE: Statistiese verwerking van basislyndata is gedoen deur middel van Wilcoxon twee-steekproef toetse waarmee vergelyking tussen die aangevulde en plasebogroep uitgevoer is. Studiegevolge is geëvalueer deur verspeidingsanalise met behulp van Shapiro-Wilk toetse waarna óf paargewyse t-toetse óf tekentoetse (vir nie-parametriese data) gebruik is. Twee-en-dertig proefpersone het die studietydperk voltooi, 14 in die aangevulde groep en 18 in die plasebogroep. Gewig het betekenisvol toegeneem in die aangevulde groep (2.73 ± 3.53 kg, p = 0.013). Triseps velvoudikte het betekenisvol toegeneem in beide die aangevulde (p = 0.047) en die plasebogroep (p = 0.001). Geen ander betekenisvolle antropometriese veranderinge is waargeneem nie. Serumalbumien het betekenisvol gestyg in die aangevulde groep (p = 0.003) en het gepaard gegaan met 'n betekenisvolle daling in C-reaktiewe protein (p = 0.028). Hemoglobienwaardes het in beide groepe betekenisvol gedaal. 'n Betekenisvolle daling in CD4+ telling is waargeneem in die plasebogroep terwyl die daling in die aangevulde groep nie betekenisvol was nie. GEVOLGTREKKING: Mondelingse voedingsaanvulling van 'n beperkte hoeveelheid was goed aanvaar en verdra oor 'n 3-maande tydperk. Hierdie studie toon dat 'n verrykte voedingsaanvulling in staat is om gewigstoename te bevorder en om hipoalbumienemie en moontlik ook inflammasie te verlig in volwassenes met MIVNIGS oor 'n kort tot medium tydperk. Die verrykte voedingsaanvulling blyk nie 'n effek op die immuniteit van mense met MIVNIGS te hê nie. Die klein steekproef is 'n beperking van die studie en die gevolgtrekkinge is slegs van toepassing op die toetsproduk as 'n geheel en nie op enige van die onderskeie bestanddele daarvan nie. Hoewel verdere studies nodig geag word om langtermyn uitvoerbaarheid te ondersoek, dui hierdie bevindinge daarop dat die gebruik van 'n verrykte voedingsaanvulling 'n rol speel in die beheer van gewigverlies in persone met MIVNIGS.

The purpose of this study was to develop a support programme for facilitating the integration of nutrition and food security with HIV prevention, treatment and care. The study was organised in three phases. Phase one was a quantitative cross-sectional survey that employed a structured interview with people living with HIV among selected two public hospitals and three health centres. The second phase employed focus group discussion with senior health experts to explore their perspective and experience in integrating nutrition and food security with HIV prevention, treatment, and care. The findings indicated that malnutrition and food insecurity were highly prevalent and significantly affected the treatment outcome and quality of life of PLWHA in the region. Socio-economic, clinical features and structural factors, such as educational status, place of residence, household income, source of drinking water, kind of toilet facility, inadequate dietary diversity, poor asset possession, opportunistic infections, duration on ART, CD4 cell count, and health system-related factors such as lack of viral and CD4 analysis laboratories and inconsistent antiretroviral medication supply were found as predictors of malnutrition and food insecurity. To cope up with the dire impact of malnutrition and food insecurity, short term, erosive and unsustainable food consumption coping strategies were employed. Based on the findings, the researcher developed a support programme for facilitating the integration of nutrition and food security with HIV prevention, treatment and care as phase three of the study. The developed programme is holistic and focuses on multi- and intersectoral collaboration to improve the treatment outcome, quality of life and overall wellbeing people living with HIV. / Health Studies / D. Litt. et Phil. (Health Studies)

The Integrated Nutrition Programme (INP) was implemented in 1995 to target child malnutrition in South Africa. This study assessed the impact of the INP on child malnutrition by province and age group using secondary data. Data from three national nutrition surveys, conducted in 1994, 1999 and 2005, were used to describe trends in child stunting, underweight, wasting, vitamin A deficiency and iron deficiency. The relationship between the prevalence of the human immunodeficiency virus (HIV) in prenatal women and child nutritional status; challenges and constraints to implementing the INP at provincial level; and government responses to nutrition recommendations by lead experts in the 1994 and 1999 surveys were also investigated. Child nutritional status varied across provinces. In some provinces such as the Northern Cape, stunting, underweight and wasting remained consistently high. Stunting decreased in the Eastern Cape, but rates of wasting increased between 1994 and 2005. On the other hand, Gauteng and the Western Cape generally had lower rates of malnutrition compared to the other provinces. This may be due to these provinces being the most economically active in the country thus more opportunities for employment and higher purchasing power of foods rich in micronutrients. By 2005, vitamin A deficiency had doubled in most provinces despite mandatory food fortification being implemented in 2003. KwaZulu-Natal had the highest rates of vitamin A deficiency, while Limpopo had the highest rates of iron deficiency. By 2005, malnutrition had decreased in children aged seven to nine years, but had increased in those aged one to three years. There was a significant positive correlation (p<0.01) between the prevalence of HIV in prenatal women and vitamin A deficiency nationally. The prevalence of HIV in prenatal women was positively correlated (p<0.05) with rates of wasting in children aged one to three years. Limited skills, inadequate monitoring and evaluation, and limited infrastructure were common challenges and constraints to implementing the INP at provincial level. The effect of HIV on human resources and the higher demands of HIV infected patients also posed a challenge to provinces as they implemented the INP. Government responded to most recommendations made by nutrition experts. Supplementation,food fortification, growth monitoring and nutrition promotion programmes were implemented. Based on the data, it would appear that INP activities targeted at school-going children were more effective than those targeting children under-five. Although food fortification was implemented in 2003, the vitamin A content of fortified products might not have met legislative requirements. Additionally, because vitamin A is unstable to heat and light, if vitamin A fortified foods are cooked or stored this may also influence the bioavailability of vitamin A. Maternal HIV status might have attenuated child nutrition outcomes due to the negative effect of HIV on related health conditions such as child caring and feeding practices. Some of the challenges and constraints at provincial level might have negatively affected the implementation of the INP and consequently its impact. Although government responded to most recommendations made by nutrition experts, ongoing monitoring and evaluation of child nutritional status were not adequately done, which might have also negatively affected INP outcomes. In addition, factors in the macro-environment such as food inflation and access to basic sanitation, could have lessened the impact of the INP on child malnutrition. Interventions directed at malnutrition in children under-five need to be prioritised. There needs to be rigorous monitoring of micronutrient content, especially vitamin A, of fortified foods. Future studies need to include assessment of nutritional status in HIV affected and infected children to help identify specific needs and develop appropriate policies. Frequent nutrition surveillance to assess key child malnutrition indicators is required. / Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009.

The purpose of this study was to investigate the role of food gardens in influencing the vulnerability of women in rural communities to HIV-infections. The study was conducted at the Makotse Women's Club in rural Limpopo. Qualitative field research was used and five participants were purposefully selected for participation in face-to-face interviews. The study found that the women's involvement in the food gardens enabled them to take responsibility for their own lives. Participation in food gardens gave these women an opportunity for income generation, the chance to access healthy food sources to improve their and their families' diets and a sense of meaning and purpose in their lives. Financial independence from husbands and male partners freed them from poverty and male domination. Through exposure to HIV and AIDS education programmes offered at the food gardens the women were empowered with knowledge about sexual health, hence reducing their vulnerability to HIV-AIDS. / Sociology / M. A. ((Social Behaviour Studies in HIV/AIDS))

The purpose of this study was to investigate the role of food gardens in influencing the vulnerability of women in rural communities to HIV-infections. The study was conducted at the Makotse Women's Club in rural Limpopo. Qualitative field research was used and five participants were purposefully selected for participation in face-to-face interviews. The study found that the women's involvement in the food gardens enabled them to take responsibility for their own lives. Participation in food gardens gave these women an opportunity for income generation, the chance to access healthy food sources to improve their and their families' diets and a sense of meaning and purpose in their lives. Financial independence from husbands and male partners freed them from poverty and male domination. Through exposure to HIV and AIDS education programmes offered at the food gardens the women were empowered with knowledge about sexual health, hence reducing their vulnerability to HIV-AIDS. / Sociology / M. A. ((Social Behaviour Studies in HIV/AIDS))

This study investigated and evaluated the success and impact of the foodstuff package intervention that is offered by SOS Children’s Villages to households affected by HIV and AIDS. The study population comprised households who were involved in the food parcel distribution intervention, those affected by HIV and AIDS, those individuals who were able to talk freely about their lives as full participants and recipients of food parcels, and those aged 18 years and older. This study determined how food parcel intervention promotes self-sufficiency post-intervention. This was determined by interviewing recipients of food parcels from 2010 to 2018. The food parcel dissemination has been a core intervention to families affected by HIV and AIDS, but yielded very little progress towards assisting people to reach self-reliance. The aim of the study was to gain an understanding of the food parcel intervention using a qualitative research design. This study focused only on families affected by HIV and AIDS, including young people aged eighteen years and above. The study was based on a purposive sampling method with in-depth and focus group interviews as a means of collecting data. The results and implications of this study are discussed in depth in this research report. Essentially, the findings of this study could inform the development of policies and strategies to be considered for possible implementation by NGO’s and government in supporting family units affected by HIV and AIDS. / Sociology / M.A. (Social and Behavioural Studies in HIV and AIDS)