Thesis (Mnutr)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Problem Definition: In the context of HIV/AIDS malnutrition is almost universal among
children, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to be
the occurrence of opportunistic infections with micro-organisms such as oral Candida.
Objective: The aim of this study was to determine the nutritional status of children with oral
complications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritional
status.
Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who were
admitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, South
Africa. The nutritional status of the children was assessed over a maximum period of six months
by nutrient intake, anthropometric status, and by biochemical parameters and clinical and oral
examination on admission and at discharge from hospital.
Results: Children with HIVand TB infection presenting with or without oral lesions were
similarly malnourished throughout the period of hospitalization. There was no improvement in the
nutritional status as indicated by height and weight measurements. Throughout the time of
hospitalization, 7% of the children had a combination of stunting, underweight and wasting.
Average nutrient intake was not found to be higher than the Recommended Dietary Allowance
(RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrate
intake provided most of the daily energy (36% and 42%, the difference not being statistically
significant). There was a significant increase in the intake of energy (p=O.04) and a decrease in
total fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admission
was higher than at time of discharge.
Selected sub-optimal biochemical values were prevalent among the children studied, with 45%
and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at discharge
respectively. Both on admission and at discharge, 38% of the children had Haemoglobin levels
below normal values. Serum ferritin levels below normal values were present in almost all the
children and the trend was similar for the prevalence of low zinc values. Sub-normal plasma
retinol was present in 79% of the children at time of admission, while only 21% had deficient values at time of discharge (p=O.03). On admission, 29% of the children had vitamin evalues
below the normal range whereas at time of discharge 17% of the children had values below
normal (p=O.04).
A total of 29% children presented with oral complications on admission. These included oral
herpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children were
asymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher
(p=O.057) among the children who were not diagnosed with oral complications.
Conclusions: This study confirmed that malnutrition is not only a common and serious problem
associated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolation
where Opportunistic Infections are present. The severity of malnutrition depends on various
factors including oral complications. Additionally, appropriate management and treatment of
tuberculosis did not appear to affect the nutritional status significantly.
Recommendations: On the basis of these findings, and because of the increased risk of growth
failure and developmental delays, children should be referred for full nutritional evaluation as
soon as possible after diagnosis of HIV -infection. In addition, there is a need for intervention
programmes to identify the immediate underlying causes of malnutrition and the ways in which
such causes interact, in order to ensure that such interventions increase the resistance of HIV
infected infants and children to the disease. / AFRIKAANSE OPSOMMING: Probleemdefiniëring: Binne die konteks van MIVNIGS is wanvoeding bykans universeelonder
kinders en van die nadelige effekte van proteïen energie wanvoeding is die voorkoms van
opportunistiese infeksies (Ol) met mikro-organismes soos orale candida die algemeenste.
Doelwit: Die doel van dié studie was om die voedingstatus van kinders met orale komplikasies in
verhouding tot MIVNIGS en die effek van orale letsels op voedingstatus, te bepaal.
Proefpersone/omgewing: 'n Groep van 24 kinders, met beide tuberkulose en MIVNIGSinfeksie,
wat agtereenvolgend in die kindersaal van Brooklyn Bors-Hospitaal in Kaapstad, Suid-
Afrika opgeneem is, is bestudeer. Vir 'n periode van ses maande is die kinders se voedingstatus
geassesseer deur middel van voedingstofinname, antropometriese status en biochemiese
parameters met opname in en ontslag uit die hospitaal. Kliniese en orale ondersoeke was op elke
kind uitgevoer met opname sowel as ontslag.
Resultate: Kindres met HIV en tuberkulose, met of sonder orale letsels, het soortgelyke
wanvoeding tydens hospitalisering ervaar het. Volgens antropometriese metings was daar geen
verbetering in die voedingstatus nie. 'n Kombinasie van belemmerde groei, ondergewig en
uittering het in 7% van die kinders tydens hospitalisering voorgekom.
Nie een van die gemiddeldes van die voedingstowwe was hoër as die Aanbevole daaglikse
toelatings (ADT) in enige van die kinders wat bestudeer is nie. Met opname sowel as ontslag, was
koolhidraatinname die grootste energieverskaffer met onderskeidelik 36% en 42% (alhoewel die
verskil nie statisties beduidend was nie). Daar was 'n beduidende toename in energie-inname
(p=O.04) en 'n afname in totale vetinname (p=O.03) met ontslag. Alhoewel nie beduidend nie, was
die gemiddelde proteïeninname hoër met ontslag.
Die voorkoms van geselekteerde sub-optimale biochemiese waardes met toelating en ontslag wys
dat onderskeidelik 45% en 41% van die kinders lae serum albumienwaardes «2.9g/dL) getoon
het. Subnormale plasma retinol het in 79% van die kinders met toelating voorgekom, terwyl slegs 21% gebrekkige waardes (p=O.03) met ontslag getoon het. Tydens opname, sowel as met ontslag,
was 38% van die kinders se hemoglobienvlakke laer as die normale. Serum ferritienvlakke was
amper by al die kinders laer as die normale vlakke te bespeur, met sinkvlakke wat op soortgelyke
lae vlakke voorkom. Met toelating was 29% van die kinders se Vitamien C-waardes laer as
normaal en met ontslag was sowat 17% se waardes steeds laer as die normaal (p=O.04).
Met toelating het 29% van die kinders orale komplikasies getoon. Ingeslote hierby was orale
herpes, orale sproei, refluks, bloeiende tandvleise en stomatis/ angulêre cheilose. Slegs twee
kinders was asimptomaties met orale Candida van die mondholte gediagnoseer. Die gemiddelde
proteïeninname was hoër (p=O.057) onder die kindres wat nie orale komplikasies getoon het nie.
Gevolgtrekking: Hierdie studie bevestig dat wanvoeding me net 'n algemene en ernstige
probleem is wat met MIV en VIGS geassosieer word nie, maar ook in die teenwoordigheid van
opportunistiese infeksies, die voedingsprobleem nie in isolasie gehanteer kan word nie. Die graad
van wanvoeding hang af van ander faktore, insluitende orale komplikasies. Voldoende
behandeling van TB het ook nie 'n beduidende effek op voedingstatus gehad nie.
Aanbevelings: Op hierdie bevindings gebaseer, en as gevolg van die verhoogde risiko VIr
belemmerde groei en vertraagde ontwikkeling wat al die liggaamstelsels van MIV -positiewe
kinders affekteer, moet kinders so gou as moontlik nadat die MIV-infeksie gediagnoseer is, vir
volle voedingsevaluasies verwys word. Daarmee gepaardgaande is daar 'n behoefte aan
programme wat die onmiddellike onderliggende oorsake van wanvoeding identifiseer, asook om
interaksie van hierdie oorsake met HIV vas te stel, ten einde intervensies wat weerstand van HIVkinders
en-babas verbeter, positieftoe te pas.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/53528 |
| Date | 12 1900 |
| Creators | Phooko, Puleng M. (Puleng Mpopi) |
| Contributors | Labadarios, D., Blaauw, R., Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 141 p. : ill. |
| Rights | Stellenbosch University |
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