PAEDIATRIC HIV/AIDS AND NUTRITION Sharon Dawson ; Stephen Robinson CCDC (FEB. 2006)

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JAMAICA 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. 2

JAMAICA 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.

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KSA / 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 4

Effects 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

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Role 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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Components of Nutritional Care and Support

•

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.

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

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PMTCT A SUCCESS STORY?

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PMTCT 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% 10

PMTCT LOCALLY

• Decrease in paediatric (MTCT) cases.

• Decrease in paediatric deaths.

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

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CHALLENGES 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’ 12

OBSTACLES TO REPLACEMENT FEEDING

• STIGMA • AFFORDABILITY • DISCRIMINATION • RISK OF OTHER INFECTIONS • MALNUTRITION • ANTI-RETROVIRAL THERAPY 13

STIGMA

Do we set-up mothers to

advertise

their status, by formula feeding?.

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The VOICES OF THE WOMEN (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” 15

VOICES

• “Hard when visitor…nurse…ask why you not breastfeeding?…” • “A lot of lying and lies…like not breastfeeding” 16

Mother’s Major Challenges

FINANCIAL CHILDREN’S ISSUES HIV +VE MOTHER STIGMA & DISCRIM.

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CHALLENGES RELATED TO FEEDING OF CHILDREN

• Financial supplies : no money to purchase the proper foods (weaning); foods purchased have to ‘stretch’ or be shared ; no bus fare to access • Orphans & Vulnerable Children (OVCs) and DIET : - due to limited resources in relevant Institutions or homes, dietary needs may not be fully met.

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CHALLENGES RELATING TO FEEDING 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’. 19

LINKAGES

CHART CFNI, CHARES Nutrition personnel JAS ; JN+ Nt’l AIDS C’tee / PAAs Regional C’tees CHURCHES 20

PAEDIATRIC HOMES

• DARE -TO - CARE (34) • MATTHEW 25 : 40 (16) ≤ 6YRS.

• *NORTH STREET (30) * Feb 2006 21

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. 22

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’. 23

SUMMARY

• • • 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 .

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SUMMARY

• 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.

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THAT’S IT FOLKS !!!

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