11

PAEDIATRIC

HIV/AIDS

AND

NUTRITION

Sharon Dawson ; Stephen Robinson CCDC (FEB. 2006)

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JAMAICA DATAJAMAICA DATA

-There were 700 paediatric AIDS cases between 1986-2005.

- The proportion of paediatric HIV cases moved from 8-6% (2004-2005)

- Thirteen (13) out of every 1,000 pregnant women are infected.

- The age group 15 - 45yrs. accounts for 54% of HIV/AIDS cases.

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JAMAICA cont’dJAMAICA cont’d

• HIV/AIDS is the leading cause of death in the age group 1- 4 years.

• Each week in Jamaica, 1-2 babies are born HIV- infected.

• In 2003, 283 infected babies were born.

44

KSA / VJH DATAKSA / VJH DATA

• The average number of mothers receiving infant formula (K.S.A.) per month is 40.

• The average number of deliveries

(HIV +ve mothers) per month = 10-13*

*25 deliveries in Nov ‘05

55

Effects on Immune SystemEffects on Immune System

Malnutrition HIV

CD4 t-lymphocyte number

CD8 t-lymphocyte number

Delayed cutaneous hypersensitivity

CD4/CD8 ratio

Serologic response after immunizations

Bacteria killing

66

Role of Nutrition Care and SupportRole of Nutrition Care and Support

• Studies have shown that the clinical outcome of HIV is poorer in individuals with compromised nutrition.

• Improving nutrition can help prevent weight loss, strengthen the immune system and delay HIV disease progression.

• Nutrition care should be part of a comprehensive program that helps the HIV-infected individual and her family.

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• Nutrition assessment.– Anthropometry (weight, length, MAC).– Dietary.– Clinical.– Biochemical.

• Nutrition education and counseling.

Should be : accurate and adapted to needs and resources.– Food safety and hygiene to be included.

• Nutritional supplementation (includes) :– Food / Medical Nutritionals.– Multi-vitamin and mineral supplements.

Components of Nutritional Care Components of Nutritional Care and Supportand Support

Bentler, M (2000) Support Line Vol. 22 Bentler, M (2000) Support Line Vol. 22 No.4No.4

88

Nutrient RecommendationsNutrient Recommendations (Pediatrics) (Pediatrics)

• ENERGY:– Asymptomatic --- 100% RDA– Symptomatic --- 150% RDA

• PROTEIN:– 50% TO 100 % RDA

* Do not exceed 4 g / kg body weight• VITAMINS & MINERALS:

– Multivitamins/ mineral supplements providing at

least 100% RDA

99

PMTCT A SUCCESS STORY?PMTCT A SUCCESS STORY?

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PMTCT GLOBALLYPMTCT GLOBALLY

• Prior to 1994, in developed countries ~25% of the infants became infected.

• With current use of HAART, elective C/S and the avoidance of breastfeeding,

transmission has decreased to <2% for women identified early in pregnancy.

*USA has <1.0%

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PMTCT LOCALLYPMTCT LOCALLY

• Decrease in paediatric (MTCT) cases.

• Decrease in paediatric deaths.

• Increase in mother’s lifespan - decrease in OVCs.

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CHALLENGES OF PMTCTCHALLENGES OF PMTCT

• Stigma and discrimination

• Repeat pregnancies - (x5); HIV/pregnancy in teenagers.

• Use of ARV’s – resistance; OVC’s ?;

• Follow-up visits

• Resources –staff shortages, frustration, ‘burn out’

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OBSTACLES TO REPLACEMENT OBSTACLES TO REPLACEMENT FEEDINGFEEDING

• STIGMA

• AFFORDABILITY

• DISCRIMINATION

• RISK OF OTHER INFECTIONS

• MALNUTRITION

• ANTI-RETROVIRAL THERAPY

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STIGMASTIGMA

Do we set-up mothers to advertise their

status, by formula feeding?.

1515

The VOICES OF THE WOMENThe VOICES OF THE WOMEN(Focus Groups)(Focus Groups)

• “Sometimes I wake up in the night to look if she is still breathing…I say ‘thank God’

“ask yourself ‘ah wha me do?”

• “I thought about death a lot …my mother had to hide the knives and the scissors”

1616

VOICESVOICES

• “Hard when visitor…nurse…ask why you not breastfeeding?…”

• “A lot of lying and lies…like not breastfeeding”

1717

Mother’s Major ChallengesMother’s Major Challenges

CHILDREN’S ISSUES

STIGMA &

DISCRIM.

FINANCIAL

HIV +VEMOTHER

1818

CHALLENGES RELATED TO CHALLENGES RELATED TO FEEDING OF CHILDRENFEEDING OF CHILDREN

• Financial : no money to purchase the proper foods (weaning); foods purchased have to ‘stretch’ or be shared ; no bus fare to access supplies

• Orphans & Vulnerable Children (OVCs) and

DIET :- due to limited resources in relevant Institutions

or homes, dietary needs may not be fully met.

1919

CHALLENGES RELATING TO CHALLENGES RELATING TO FEEDING CHILDREN cont’dFEEDING CHILDREN cont’d

• Problems related to child’s appetite :

- not sure what to do when appetite is poor …. mom satisfied with ‘anything’ that is eaten.

- little access to relevant nutrition education

• Stigma related to formula-feeding :

- may be asked why not b/feeding ?

- may be seen accessing ‘formula’.

2020

LINKAGESLINKAGES

CFNI,CHARES

JAS ;JN+

Nt’l AIDSC’tee / PAAs

CHURCHES

RegionalC’tees

CHART

Nutrition personnel

2121

PAEDIATRIC HOMESPAEDIATRIC HOMES

• DARE -TO - CARE (34)

• MATTHEW 25 : 40 (16) ≤ 6YRS.

• *NORTH STREET (30)

* Feb 2006

2222

What Can We Do?What Can We Do?

• Support women to make and carry out their own informed infant feeding decision.

• Help HIV positive women obtain accurate and complete information regarding infant feeding options.

• Encourage appropriate research regarding HIV, breastfeeding and human milk.

2323

Future studies Future studies

- Impact of nutrition counselling & supplementation on overall health status in children.

- Effect of nutrition on infected children on ARVs.

- Nutrition challenges of the institutionalized child vs. those in ‘family homes’.

2424

• Maintaining adequate nutrition may be one of the most important things a newly infected person (asymptomatic) can do to prolong well-being.

• Improving nutritional status and promoting healthy lifestyle can: – Preserve health.– Improve quality of life.– Delay disease progression & mortality.

• Prevention of food and water-borne infections reduces the risk of diarrhea, a common cause of weight loss, malnutrition and HIV disease progression .

SUMMARYSUMMARY

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SUMMARYSUMMARY

• Systems must be put in place to address social needs.

• Optimal management of clients can only be achieved by utilizing a ‘team approach’.

• Opportunities for training & research should be actively explored.

• Nutritional care and support should be part of a comprehensive program that deals with the needs of the child and his / her family.

2626

THAT’S IT

FOLKS !!!