FACTORS CONTRIBUTING TO MALNUTRITION AMONG UNDER-FIVES LIVING WITH

HIV/AIDS ATTENDING CCC AND MCH AT MPEKETONI SUB COUNTY HOSPITAL.

A DISSERTATION SUBMITTED AS A PARTIAL FULFILMENT FOR THE

AWARD OF THE DIPLOMA IN CLINICAL MEDICINE AND SURGERY
KENYA MEDICAL TRAINING COLLEGE.

FRANKLIN GITAU WANJIKU

D/CM/18008/2474

MARCH 2018.
DECLARATION
This dissertation is as a result of my original and independent investigation and I
hereby declare that it has not been submitted to any institution for academic
qualification.

FRANKLIN GITAU

D/CM/18008/2474

P. O. BOX 110,

NAIROBI.

_________________________ ______________________________
Signature Date

_________________________ ______________________________
Signature Date
Name of Supervisor
Madame Fatma

ii
ACKNOWLEDGEMENT
This thesis was completed with the support, guidance and encouragement from many
people. First and foremost, am deeply indebted to my supervisor, Madam Fatma, for
devoting her ocean of experience and professional knowledge throughout the initial
stages to the completion of this work.

I also acknowledge the Mpeketoni sub-county Hospital in collaboration with the

hospital health staff, my friends George, Madam Marembo and all my classmates as
well as all the mothers whose children were under study for their cooperation. I also
thank anybody else who assisted me in one way or another.

May the Almighty God bless you all abundantly

iii
 DEDICATION
This study is dedicated to my mother, Esther Wanjiku for securing a future for us, to
my grandmother Jecinta Wanjiru for her prayers, moral and financial support as well
as encouragements that kept me strong throughout my study. Special gratitude to my
grandfather, Benson Kahara for his unwavering support and guidance.

Special dedication goes to all under 5 years old living with HIV/AIDS and their
families.

iv
 ACRONYMS
HIV - Human immunodeficiency virus

AIDS - Acquired immune deficiency syndrome

MTCT - Mother to child transmission

STIs - Sexually transmitted infections

ARVs - Anti-retroviral drugs

PCR - Polymerase chain reaction

NAIDS - Nutritional acquired immune deficiency syndrome

KDHS - Kenya demographic health survey

PLWHA - People living with HIV/AIDS

ART - Anti-retroviral therapy

AFASS - Affordable, feasible, acceptable, sustainable and safe

PSC - Patient support centre

CCC - Comprehensive care centre

SSA - Sub-Saharan African

EI - Enteric infection

TB - Tuberculosis disease

O.I’s - Opportunistic infections

IGAs - Income generating activities

WHO - World Health Organisation

v
 OPERATIONAL DEFINITIONS
Malnutrition - State of having insufficient necessary nutrients

Household size - Number of people in a family

Morbidity : State of being diseased

Mortality : Death due to morbidity

Food security : State whereby people at all times have both physical and
economic access to sufficient food to meet their dietary
lives for a productive life

Complementary : Feeds given to children to supplement breast milk

feeding

Income : Any activity that can enable one to get some money eg
generating selling vegetables
activities

Wet nursing : Having another woman breastfeed a baby, in these case a

tested HIV negative woman

Exclusive : Giving only breast milk and the prescribed medicine but
breastfeeding not water, other liquids or foods to the infants for the first
6 months of life.

vi
 ABSTRACT

This was a cross-sectional study design aimed at finding out the risk factor of
malnutrition among children aged 0-5 years in Mpeketoni sub-county Hospital. The
study was conducted from March-June 2021. Specific objectives include; to
determine the socio-economic factors contributing to malnutrition in under-fives
living with HIV/AIDS and to find out the relationship between feeding frequency and
nutritional status of the children. Interviewing method was used to obtain information
from 70 respondents; mothers who attended the comprehensive care clinic (CCC) and
the maternal child health (MCH) for counselling, weight and growth monitoring,
ARVs and other services. Data was collected, analysed using, Excel and the analysed
data was presented by use frequency tables, pie charts and graphs. From the findings,
mothers aged 15-34 years old had children whose wasting percentage was 55% while
those from mothers aged 35-50 had a wasting percentage of 40%, among the
unmarried women, 76.5% of the children were wasted. Mothers who had low
education levels had children with a wasting percentage of 65.9% compared to
mothers with high education level whose children had a wasting percentage of 32.1%.
Maternal education is an important indicator in the growth of children. Children of
unemployed mothers had a wasting percentage of 69.2% compared to employed
mothers whose children had a wasting percentage of 22.6% and this is because two
parents bring more financial stability compared to single parents. Children who were
not exclusively breastfed had a wasting percentage 78.6% compared to children who
were exclusively breastfed who had a wasting percentage of 28.6%. This is an
indication that insufficient breastfeeding has a negative effect on the child’s growth.
The study reveals that more than half of the children;55.8%, who were wasted came
from families that acquired their food from the market while those children who came
from families who acquired their food farms / donations had a wasting percentage of
37.0% because most families practice farming.

The study also revealed that children who suffered ill health in the past one month had
a wasting percentage of 60%. Children who were not on ARVs had a wasting
percentage of 56% while those who were on ARVs had a wasting percentage of
44.4% and this is because some drugs affect nutrient metabolism, absorption and
excretion which had a negative effect on nutritional status.

Inter-sectorial collaboration is very vital in order to support both the infected and
affected families to fight against HIV/AIDS in relation to children under 5 years old.

vii
 TABLE OF CONTENTS

Page

Declaration II

Acknowledgement III

Dedication IV

Acronyms V

Operational definitions VII

Abstract VIII

CHAPTER 1: INTRODUCTION

Background information 12

Problem statement 13

Justification 14

Research question 14

Research objective 14

CHAPTER 2: LITERATURE REVIEW

Introduction 16

Infant feeding practices 18

Nutritional care for HIV infected children 19

Child nutritional status 20

Maternal socio-demographic characteristics 20

8
CHAPTER 3: RESEARCH METHODOLOGY

Study area, design, time. 23

Study population, variables 24

Selection criteria, sample size determination 24

Data collection, Ethical consideration, critical assumption 25

Study limitations 25

CHAPTER 4: STUDY RESULTS

Respondent socio-demographic information 27

Child characteristics 30

Relationship between dependent and independent variables 36

CHAPTER 5: DISCUSSION

Socio-demographic and economic information 39

Child feeding practise 40

Child health status 41

CHAPTER 6: CONCLUSION AND RECOMMENDATION

Conclusion 42

Recommendations 43

Questionnaire 44

Appendixes 53

9
 CHAPTER I
INTRODUCTION
1.1 Background Information
Acquired Immune Deficiency Syndrome (AIDS) is caused by an RNA virus called
Human Immunodeficiency Virus (HIV). HIV infects and weakens an individual’s
immune system making them vulnerable to sickness and unable to fight through other
infections (WHO, 2003). The virus invades and debilitates the immune system and
since it cannot be cured, it results to the ultimate mortality of the affected person by
opportunistic infections. The incubation period from initial infection time to the
development of AIDS is between 2-20 years in adults (Ms. A Krystal et al 2000) and
between 1-3 years in children (NASCOP, 2009). AIDS has killed more than 25
million people since it was first detected in 1981 making it one of the most destructive
epidemics recorded in history. Despite recent improved access to Anti-retroviral drugs
(ARV) in many regions of the world, AIDS epidemic claimed 3.1 million people
lives. In 2010, over 570,000 children and close to 5 million people were infected with
this virus (UNAIDS, WHO, 2010).

Infants can acquire HIV through mother to child transmission (MTCT), transfusion of
infected blood, infected blood products and or use of contaminated instruments.
Transmission of HIV from an infected mother to her infant can occur during
pregnancy, delivery or after delivery. The risk of transmission through breast milk is
15% for infants who are breastfed up to 6 months and about 20% for children
breastfed to their second year of life.

HIV/AIDS has severe effects on the health and nutrition of children. It affects
children directly and indirectly in countries with severe HIV/AIDS epidemics such
sub-Saharan countries like Kenya. This has been seen in the increasing rates of
children mortality especially on children under the age 5 years (Family health
international, 2007). More often than not, many of these children suffer from
malnutrition, higher morbidity levels and inaccessibility to affordable health care as a

10
result of poverty. As a result of this, the growth and development of these children is
adversely affected because they are more likely to be underweight, wasted or stunted.
Some of the challenges facing these children include HIV/AIDS related opportunistic
infections, orphan-hood, malnutrition, illness of parents and or the child,
inaccessibility to good education and psychological distress (APHRC, 2007).

Malnutrition has been an endemic problem in African sub Saharan countries for
decades. It is complicated by a combination of factors and more recently of all
children under 5 years old is sub-Saharan African (SSA) are stunted and more than
half suffer from some form of micro-nutrients malnutrition. HIV/AIDS and
malnutrition increases the risk of infection through attack on the immune system and
its impact on nutrient intake, absorption and utilization (Ellen et al 2009). HIV/AIDS
infection has been long recognized to have negative impact on the nutritional status of
People Living with HIV/AIDS (PLWHAS) and leads to malnutrition. The relationship
between HIV/AIDS and malnutrition is a classic example of the vicious cycle of
immune dysfunction, infectious diseases and malnutrition.

Malnutrition can weaken the immune system and increase the vulnerable to infections
and in turn speed up the progression of the disease (RCQHC et al, 2016).

1.2 Problem Statement

Globally there are 1.6 million children with HIV infection (WHO 2015) and out of
this figure, 1.45 million which is approximately 90% of the children are found in sub-
Saharan African (UNAIDS 2015). It is estimated that 90% of HIV infected children is
as a result of mother to child transmission.

In Kenya, It’s estimated that there are 120,000-150,000 children who are infected.
About 13,000 children acquire HIV annually and without intervention, approximately
100 babies become infected daily. Currently 40,000-50,000 children, approximately
30% - 40% require Anti-Retroviral Therapy (ARTs) yet only less than 20,000
children have access to recommend ed Anti-Retroviral treatment (HWR 2014).

11
Factors such as low socio-economic status, poor feeding practices and opportunistic
infections have rendered many of these children undernourished and susceptible to
HIV/AIDS related infections. This situation requires immediate intervention to ensure
proper all-round nutrition.

1.3 Justification of study

HIV infection has long been recognized to have possible negative impact on the
nutritional status of people living with HIV/AIDS and thus leads to malnutrition.
Malnutrition weakens the immune system and increases vulnerability to infection and
speeds up the disease progression (WHO, 2007).

The study endeavoured to find out the factors affecting nutritional status in HIV
infected children under the age of 5 years attending CCC and MCH services at
Mpeketoni sub-county Hospital. The findings from this study will be useful to those
planning for interventional measures in Mpeketoni sub-county Hospital and the
community at large. This will be important in ensuring that the affected children lead
a healthy near-normal live despite the burden of HIV.

Mpeketoni, in Lamu County has a population based prevalence of HIV/AIDS at 20-

25%. HIV/AIDS has contributed to a compromised health status which has not been
adequately addressed. The high prevalence rates of HIV/AIDS are due to
irresponsible sexual practices, illiteracy on transmission of HIV/AIDS and proper
protective measures (Mwariri et al 2017).

12
1.5 Research Objectives
1.5.1 General Objective
To study risk factors of malnutrition among children under 5 years of age
living with HIV/AIDS seeking CCC and MCH services at Mpeketoni Sub-County
Hospital

1.5.2 Specific Objectives

1. To determine the socio-economic factors contributing to malnutrition in under-
fives living with HIV/AIDS

2. To find out the relationship between feeding frequency and the child’s nutritional
status

1.5.3 Research Question

1. What are the socio-economic factors contributing to malnutrition in under-
fives living with HIV/AIDS?

2. What is the relationship between feeding frequency and the child’s nutritional
status?

13
 CHAPTER II
LITERATURE REVIEW

2.1 Background information

2.1.1 Introduction
Acquired Immune Deficiency Syndrome (AIDS) is caused by a retrovirus called
Human Immunodeficiency Virus (HIV). HIV infects and weakens the immune system
making them (the infected) unable to fight off other infections (WHO, 2009). The
infection invades and debilitates the immune system and since its incurable it results
to ultimate death of the infected person. The incubation period from infection time to
the development stage of AIDS is between 1-10 years in adults and between 1-3 years
in children (C. Jennings 2017).

HIV is a member of group of viruses called Lenti viruses, which means slow virus.
Viruses in this group caused immune deficiency in both animals and human beings.
They are related to HIV-1 and HIV-2, but are in a different family of viruses. There
are only 2 Lenti-II viruses which infects humans, HIV-1 and HIV-2. To-date a
majority of AIDS world over and in Eastern and Southern Africa have been caused by
HIV-1. HIV-2 is found in West Africa (Ms. A. Krystal, 1997). HIV-1 mutates readily
and has different strains, which have many subtypes and groups found distributed
unevenly throughout the world (L. Kathleen et al, 2013).

About 330,000 children under the age of 5 years die in sub-Saharan Africa with HIV
infection annually., HIV infection causes 77% of under 5 deaths. About 90% of HIV
infection is a result of mild infection (NASCOP, 2007). HIV can be passed from
mother to her infant child. In absence of PMTCT interventions, 24-45% of HIV
infected mothers will transmit the virus to their infants by all modes of transmission
(Dabies et al, 2012). In the USA the risk is only 2% in large part because of HIV
counselling, ARVs, elective caesarean section and safe use of infant formula. In
Kenya, without interventions approximately 100 babies become infected daily
(NASCOP, 2012)
14
2.1.2 EFFECTS OF HIV/AIDS IN CHIDLREN
Abnormalities in growth and metabolism are common in children infected with HIV.
Poor growth was amongst the first manifestations of HIV infection to be recognised in
children and has a significant effect on short term survival (WHO, 2010) more
recently alterations in body fat distribution and lipids, glucose and bone metabolism
may place HIV infected children at increased risk of future morbidities.

AIDS wasting is defined as a 10% weight loss or more. There could be presence of
chronic diarrhoea or chronic fever. Gastrointestinal infections (GIT) are a common
cause of childhood malnutrition and growth retardation also contributes significantly
to poor growth in HIV infected children. Children with HIV appear to be especially
vulnerable to diarrhoeal diseases (KU. Ech et al, 2008).

Approximately 30%-60% of HIV infected children are reported to mal-absorb

carbohydrate, 30% mal-absorb fat and 32% mal-absorb protein typical without
clinical symptoms (Miller et al 2009). How HIV affects nutrient absorption
independently or increases risk of entire infection is not known.

HIV affects nutrition on overlapping ways. It is associated with symptoms that cause
a reduction in the amount of food consumed. It interferes with the digestion and
absorption of nutrient consumed and finally it changes metabolism or the way the
body transports, uses and excretes many of the nutrients (RCQHC, 2008).

2.1.3 CHILD FEEDING PRACTICES

HIV/AIDS negatively affects feeding practices especially where the mothers are
unable to breastfeed the children. HIV infected children from poor backgrounds have
been exposed to inadequate nutrition and are often malnourished leading to illness and
stunted growth (MOH, NACC, 2015).

15
All patients irrespective of their HIV status have a right to choose the type of feeding
their children. This choice should be made after adequate counselling and information
from health workers to help them make an informed choice. There is extra need for
continued promotion, protection and support of breastfeeding for HIV negative
couples or where zero status is unknown (UNICEF, WHO, 2014).

2.2 INFANT FEEDING OPTIONS

2.2.1 Exclusive breastfeeding
This is when breast milk and no other liquids or solids, not even water with the
exception of drops or syrups consisting of vitamins, mineral supplements or medicine
for the baby for the first 6 month of life (UNICEF, UNAIDS, WHO, UNFPA, 2016).

Advantages of breast milk care;

 It protects babies from many infections especially diarrhoea & pneumonia by

passing on antibodies which offer immunity

 The baby gets all the nutrients & water they require through breast milk ensuring
proper growth and development

 Breast milk does not need any preparation and therefore it is readily available for
the baby and allows rest which helps the mother recover from child birth and
protects them from getting pregnant too soon (UNICEF, UNAIDS, WHO,
UNFPA, 2016).

2.2.2 Expressed, Heat-treated breast milk

It involves removing the milk from the breast manually or with a pump then heating it
to kill the HIV virus. Heat treated breast milk is nutritionally superior to other milks,
but heat treatment reduces the level of the anti-infective factors in the breast milk.
Highly motivated mother who choose this method may need time. Resources and
support to express and heat – treat breast milk (UNICEF, UNAIDS, WHO, UNFPA,
2016).

16
2.2.3 Wet nursing by A HIV-negative woman

Wet nursing is breastfeeding by a woman who is not the infant’s mother. Advantages
of wet nursing are there is no risk of HIV transmission from breast milk to the baby
and the breast milk is free i.e. not bought(MOH, NACC, 2015). It also protects them
from diseases. Disadvantages are; Some people may face stigmatization since people
may want to know why the mother is not breastfeeding her own baby; may be
tiresome to the nurse as she must be available to breastfeed the baby frequently
throughout day and night.

2.2.4 Commercial infant formula

This refers to specially formulated powdered milk made specifically for infants. The
advantages of this formula milk are; there are no chances of HIV transmission to the
baby because most nutrients needed by the baby are already added in the formula and
other members of the family can also feed the child (WHO, 2010) .

Disadvantages; it is expensive; the mother may get pregnant too fast, and, if the
baby’s cup, spoon or bottle used is not well washed the baby may get infective
diarrhoea

2.2.5 Home modified animal milk

This is fresh or processed animal milk that is modified by the addition of water, sugar
and micro nutrient supplement.

17
2.3 NUTRITIONAL CARE FOR HIV INFECTED CHILDREN
Children of mothers who are HIV infected are especially vulnerable to malnutrition
and mortality, either as a result of their own HIV infection if acquired from their
mother or because of the deteriorating health of one or both of the parents. It is
therefore important that all children born to HIV infected mothers receive well baby
care and have their growth monitored regularly.

HIV infected children have increased nutritional requirements that accompany the
infection and the increased likelihood of fat and other nutrients mal-absorption.

Young children need to be fed patiently and persistently with supervision and love.
The HIV infected children may be frequently ill and suffering from fever, mouth and
sore throat and depressed appetite. The food introduced after 6months of life should
be soft and enriched with energy giving foods from sources e.g. oil, peanut, e.t.c in
small portions .Fruits, vegetable and clean water should also be given for
vitamins(WHO, 2010).

2.4 CHILD NUTRITIONAL STATUS

Nutritional assessment, is the process of evaluating the nutritional status of an
individual (BDA 2012). Among children, measurements of weight and height
expressed as Z score in comparison with median or percentage of international
growth standard is useful as they provide data on nutrition deficiencies that are
associated with increased risk of mortality independently of HIV. Skin fold thickness
can be measured to access re-accumulation of body fat (WHO, 2014).

Height and weight impairment increases with age. I Observed that HIV infected
children were 0.7kgs lighter than and 2.2cm shorter than children 18 months of age
exposed to but not HIV infected. Data for beyond 4 years are limited but an average
weight of deficit of 7kgs and weight deficit of 7.5 cm by age 10 years was reported in
a European collaborative study ( 2010).

18
The above measurements help one to assess and monitor nutrition of a children in
relation to age. They are then used to make corrective actions according the trends.

2.5 MATERNAL SOCIO-DEMOGRAPHIC AND CHARACTERISTICS

2.5.1 Maternal age
According to the results from KDHS (2007) HIV prevalence is higher in woman of
childbearing age of 15-49 years than men of the same age group. This directly
translates into higher number of children born with HIV from mothers who are
infected. Maternal age is said to influence nutritional status of children. Young
mothers aged 19 years and below tend to be ignorant when it comes to feeding their
children as compared to older mothers.

2.5.2 Marital status

Women who are widowed, divorced or separated have higher rates of HIV prevalence
than married women. Also women in a polygamous marriage and women with more
than one sexual partner have higher prevalence to HIV infections (KDHS 2012).
Marital status influences child’s nutritional status. Malnutrition is usually higher
among children of single mothers than the married women.

2.5.3 Household size

A small and well cared for family size in which all children are healthy and live to
grow is more satisfied and more economically stable and have a lower risk to mal-
nutrition than binging up many children some of whom die and some who are sickling
due to inadequate food leading to mal-nutrition.

2.5.4 Maternal education

Several studies show that more educated mothers are able to make use of health
services and provide better practices including feeding, personal hygiene practices,
and are more assertive to change their beliefs in how much they should invest in each

19
child. Level of maternal education is an important predictor of growth in HIV infected
children (Villam or E et al 2014). Maternal health, emotional and psychological
status and the characteristics of care givers did interaction have a strong influence of
child growth. Therefore, one of the best way of boosting child’s nutritional status is to
improve maternal level of education.

2.5.5 Family income and occupation

Limited resources lessen the quantity of food purchased by each family. Parents with
better paying jobs have more access to resources implicated in positive growth and
development of the child. Many poor families are also likely to spend limited
resources on food for survival sake. The food may not be balanced and may be
deficient in nutrients necessary for growth. This results in high infant deaths in
households of low income earner’s than in households of high income earners.

Poor parents frequently have too many mouths to feed for the money of food available
to them so shortages in both quantity and frequency, which is followed by slight
malnutrition, especially in young children. Many malnourished children don’t develop
strong healthy bodies and may not reach their full possibilities of mental development
(J. Ritchie, 2013). Many women in poor settings exchanges sex for material favours
for daily survival and may be their only way of providing for themselves and their
children (Stephanie Nduba, 2008),and this increases their risk to get infected with
HIV/AIDS.

20
 CHAPTER III
RESEARCH METHODOLOGY
3.1 Study Area
Mpeketoni location in Lamu county.
Background Information of the Study Area

3.1.1 Geography of Study Area

Lamu county is located along the Kenyan Coast. Mpeketoni lies in Lamu
county, about 9 kilometers south of the Garsen- Witu-Lamu Highway. The
hospital is located 2⸰23’28.0’’S, 40⸰41’50.0’’E.

3.1.2 Climate of Study Area

The annual rainfall is 1200-1300mm in two rainy seasons in March and
December. The annual temperature ranges between 200c-350c.

3.1.3 Population of Study Area

Population of 50,000 (male-49.9%, female-50.1%)

3.1.4 Education
Primary – 32, Secondary – 6, Tertiary – 1.

3.2 Study Design

Across-sectional descriptive study.

3.3 Study population

Under-fives living with HIV/AIDS

21
3.4 Study Variables

Dependent variables

 Nutritional status of children under five years living with HIV/AIDS

Independent Variables

 Socio-demographic characteristics

 Feeding practices and health status

3.6 Selection Criteria

Inclusive- Under-fives living with HIV/AIDS

Exclusive- Under-fives not infected with HIV/AIDS

3.7 Sample size determination

Fishers et al. (1998) method was used.
N= Z2PQ
d2
Whereby: N=Sample size
Z= Confidence level (1.962)
P= Probability of success (0.5)
Q= Probability of failure (0.5)
D= Margin of error (0.00252)

= 1.962 x 0.5 x 0.5

0.052

= 0.9604
0.0025

22
 N= 384.16 =70
3.8 Data collection procedure
The data was collected b administration of questionares and interview methods
with the mothers.
3.9 Data Analysis
The collected data was analysed in tables using Microsoft Excel to generate
frequency tables and development of pie charts and graphs
3.10 Ethical Considerations
Permission was granted from the Ministry of Education Science and
Technology. Permission was also sought from in-charge of support groups for
use of their records. Consent was sought from respondents before
interviewing them and all information given was treated with confidentiality
and privacy was respected. Anonymity of the individuals that gave the
information was protected and observed.

3.11 Critical Assumptions

It was assumed that the respondents knew their HIV status and that
information given was correct and without any influence whatsoever.

3.12 Study limitations

The results cannot be generalized to entire population because the sample size
is not the entire population representation. It is biased to represent the entire
population. A series of difficulties we encountered e.g reluctance to provide
the needed information and raised expectations that the researcher was going
to provide food aid at the end of interview.

23
 CHAPTER IV
RESULTS
4.0 STUDY RESULTS

4.1RESPONDENTS SOCIAL DEMOGRAPHIC INFORMATION

This chapter consist of the findings of the study, a total of 70 children were under
study and the findings were as follows:

Table 1: Age of respondents

Age Frequency (N=70) Percentage %

15-24 10 14.3

25-34 30 42.9

35-44 26 37.1

45 and above 4 5.7

Mothers with the highest percentage of forty-two (42.9%) were in the age bracket of
25-34 while those with the lowest five percent (5.7%) were above 45 years of age.
This shows that most mothers are of reproductive age.

24
Table 2: Maternal marital status

Marital status Frequency (N=70) Percentage %

Married 30 42.9

Single 24 34.3

Divorced/separated 6 8.6

Widowed 4 5.7

The findings showed that forty two percent (42.9%) of the mothers were married
while thirty four percent (34.3%) were single.

Table 3: Maternal education level

Educational level Frequency (N=70) Percentage %

Illiterate 4 5.7

Primary 30 42.9

Secondary 25 35.7

College / tertiary 11 15.7

Forty two percent (42.9%) of the mothers had reached primary level of education
while fifteen percent (15.7%) had their education up to college /tertiary level.

25
Figure 1: Household size

70

60
Frequency (%)

50

40

30

20

10

0
One-two Three-four Five-six Above 6
Household size

The household size of 3-4 had a percentage of sixty two (62.8%) while that of above 6
had a percentage of five (5.7%).
Figure 2: Maternal occupation

19%

Unemployed
Employed
18% 55% Casual labourers
Business

8%

Fifty five percent (55%) of the mothers were not employed, nineteen percent (19%)
were involved in business while those with eight percent (8%) were employed

26
 4.1.2 CHILD CHARACTERISTICS

Table 4: Sex of the child

Sex of the child Frequency (N=70) Percentage (%)

Male 22 31.4

Females 48 68.6

From the study, sixty eight percent (68.6%) were females while thirty one percent
(31.4%) were males.

Table 5: Ages of the children

Age in month Frequency (N=70) Percentage (%)

0-12 20 28.6

13-24 24 34.3

25-36 12 17.1

37-48 8 11.4

40-60 6 8.6

From the study forty two percent (42.9%) of the children were found between the
ages of 13-24 months. The lowest percentage of eleven (11.4%) ranged between 25-
36 months.

27
Table 6: Child order of Birth

Order of birth Frequency (N=70) Percentage (%)

1st 20 28.6

2nd 19 27.1

3rd 18 25.7

4th 8 11.4

5th 5 7.1

Twenty eight percent (28.6%) fell in the category of 1 st born while the lowest
percentage of eleven (11.4%) fell in the category of 4th born.

Table 7: Children who were Breastfeeding

Breastfeeding Frequency (N=70) Percentage (%)

Breastfeeding(below2 yrs) 20 28.6

Not breastfeeding(below 2 16 22.8

yrs)

Twenty-eight percent (28.6%) of the children were still breastfeeding while the
highest percentage of forty-eight (48.6%) were not breast feeding.

28
 Figure 3: Children who were exclusively breastfed (six months and below)

40% Mixed feeding

Exclusively
60% breastfed

Of the 20 children who were still breastfeeding, only 12 of them equivalent sixty
percent (60%) were exclusively breastfed.

Figure 4: How often the children were exclusively breastfed

41.7%

58.3% Breastfed on demand

Others

Forty one percent (41.7%) of the children who were exclusively breastfed were
breastfed on demand while fifty eight percent (58.3%) were not breastfed on demand.

29
Table 8: How often children 2-5 years old were fed in a day

How often Frequency (N=70) Percentage (%)

2-3 times 18 25.7

4-5 times 36 51.4

6-7 times 16 22.9

Fifty one percent (51.4%) of the children were fed 4-5 times in a day while twenty
two percent (22.9%) were fed above 6 times in a day.

Table 9: Family food sources

Food source Frequency (N=70) Percentage

(%)

Farm 17 24.3

Market 43 61.4

Donation 10 14.3

The majority sixty one percent (61.4%) of the families buy food from the markets.

30
Figure 5: Children who had suffered ill health in the past month before the study

38%

Yes
No
62%

Sixty two percent (62%) of the children had suffered ill hea
Sixty two percent (62%) had suffered ill heath in the past month before the study.

Table 10: Health problems that were affecting the children

Disease Frequency (N=70) Percentage (%)

Diarrhoea 17 24.3
Vomiting 7 10
Malaria 15 21.4
Pneumonia 2 2.9
Tuberculosis 3 4.2
Oral thrush 2 2.9
Anorexia 2 2.9
Others 2 2.9
Those who were not sick 20 28.5
Twenty four percent (24.3%) of the children had suffered diarrhoea while twenty
eight (28.5%) of the children did not fall ill.

31
Figure 6: Children who were on ARVs

26%

On drugs
Not on drugs

74%

Majority of the children were on drugs with a percentage of seventy four (74%) with
those who were not on drugs had a percentage of twenty six (26%).

Table 11: Children’s nutritional status

Nutritional status Frequency (N=70) Percentag

e (%)

Normal 36 51.4

Mild wasting 14 20

Moderate wasting 7 10

Severely wasting 13 18.6

Fifty one percent (51.4%) of the children were normal while eighteen percent (18.6%)
were severely wasted.

32
4.2 RELATIONSHIP BETWEEN DEPENDENT AND INDEPENDENT
VARIABLES
Table 12: Relationship between Socio-demographic Characteristics and
Nutritional Status

Socio-demographic Nutritional status

characteristics Normal Wasting
Numbe Percentage Numbe Percentage
r % r %
Age of the 15-34 18 45 22 55
mother 35-50 18 60 12 40
Marital status Married 20 55.6 16 44.4
Unmarried 16 23.5 18 76.5
Education Low 14 34.1 27 65.9
level High 22 75.9 7 24.1
Mother’s Employed 24 77.4 7 22.6
occupation Unemploye 12 30.8 27 69.2
d
Household size 1-4 32 64 18 36
5 and above 4 20 16 80

Children belonging to mothers in the age bracket of 15-34 had a wasting percentage
of 55% while those belonging to mothers in the age bracket of 35-50 had a wasting
percentage of 40%.

Majority of the children who were wasted 76.5% belonged to the unmarried mothers
while 44.4% of wasted children belonged to the married mothers. Children belonging
to mothers with low education level had a wasting percentage of 65.9% while children
with a wasting percentage of 24.1% belonged to mothers with a high level of
education.

33
Children belonging to unemployed mothers had a wasting percentage of 69.2% while
children belonging to employed mothers had a wasting percentage 22.6%.

Children from family households of 1-4 had a wasting percentage of 36% while those
from household size of 5 and above had a wasting percentage of 80%.

4.2.1 Child feeding practices

Table 13: Relationship between feeding practices and Nutritional Status

Child feeding practices Nutritional status

Normal Wasting
Numbe Percentage Number Percentage
r % %
Breastfeedin EBF 30 71.4 12 28.6
g Not EBF 6 21.4 22 78.6
Feeding 1-3 12 66.7 6 33.3
frequency
4 and above 24 46.2 28 53.8
Family food Farm / 17 63.0 10 37.0
source Donations
Market 19 44.2 24 55.8

Among the 42 children who were exclusively breastfed, 28.6% were wasted while
those children who were not exclusively breastfed had a wasting percentage of 78.6%
since they were being mixed fed.

Children who were fed 1-3 times in a day had a wasting percentage of 33.3% while
those children fed 4 times and more had a wasting percentage of 53.8%

34
Children from families that access food from the farm / donations had a wasting
percentage of 37% while those from families that access food from the market had a
wasting percentage of 55.8%.

4.2.2 Child health status

Table 14: Relationship between Child Health Status and Nutritional Status

Child health status Nutritional status

Normal Wasting
Number Percentage Number Percentage
% %
Ill health for Ill 20 40 30 60
the past 1 health
month Not ill 16 80 4 20
health
Children on On 26 50 26 50
ARV ARVs
Not on 10 55.6 8 44.4
ARVs

Children who fell ill in the past 1 month had a wasting percentage of (60%) while
those who did not fall sick had a wasting percentage of (20%).

Children who are on ARVs had a wasting percentage of 50% while those who are not
on ARVs had a wasting percentage of (44.4 %,).

35
 CHAPTER V
5.0 DISCUSSION
5.1 SOCIAL DEMOGRAPHIC (ECONOMIC INFORMATION)
With regard to maternal age, children belonging to mothers in the age bracket of 15-
34 had a wasting percentage of 55% while those from mothers in the age bracket of
35-50 had a wasting percentage of 40%. This agrees with the findings of (C.Hamel
2015) that maternal age influences a child’s nutritional status in that younger mothers
give birth to low birth weight babies and at the same time they don’t have enough
knowledge, skills and experiences to take care of their children.

Among the unmarried women, 76.5% of their children were wasted compared to
married women whose children had a wasting percentage of 44.4%. This supports
findings of (KDHS, 2013) that malnutrition is usually greater among children of
unmarried women, single and divorced than the married women.

Children belonging to mothers with a low level of education had a wasting percentage
of 65.9% while those of mothers with a high level of education had a wasting
percentage of 24.1%.

Mothers with no education as well as those with education up to primary level have
been classified as having low education while those with education up to secondary
and tertiary / college have been classified as having a higher education.

Level of maternal education is an important factor in the growth and development of

HIV infected children. Research and studies have shown that educated mothers are
able to make informed decisions, make good use of health services and provide better
caring practices including feeding, personal hygiene and sanitation practices and
change their attitude on how much they should invest in a child (BA Abuya 2012).

Findings from the study show that unemployed mothers had wasted children with a
percentage of 69.2% compared to employed mothers whose children had a wasting
percentage 22.6%. This concurs with the findings of (H. Eshete 2017) that limited

36
resources reduce the quantity purchased by each family. Parents with better paying
jobs are more likely to support their families satisfactorily than those with poor jobs.
Poor families spend less on food in order to survive. On most occasions, the food
lacks the necessary nutrients essential for growth resulting in poor health.

According to the study, both males and females are affected. This suggests that the
disease HIV/AIDS does not discriminate when it comes to gender of the children.
They are both at risk of malnutrition.

Children from families having a household size of 1-4 had a wasting percentage of
36% while those who were from families having a household size of 5 and above had
a wasting percentage of 64%. Studies have shown that families that have too many
mouths to feed for the little food available may result in inadequacy in both food
quality and quantity and thus may result in malnutrition in especially younger children
(KDHS 2009).

5.2 CHILD FEEDING PRACTICES

Exclusively breastfed children had a wasting percentage of 28.6% while those who
were not exclusively breastfed had a wasting percentage 78.6% and this is because the
mothers practiced mixed feeding. The time of transmission following birth is
difficulty to determine (WHO, 2010). All in all, children born to HIV positive
mothers, in most cases are usually of low birth weight and thus contribute largely to
their short term survival (Oleske et al, 1983).

Among the children who were fed 3 times in a day, 33.3% of them were wasted
compared to a wasting percentage of 53.8% for children fed 4 times and more. Small
portions of food should be fed frequently preferably 200-250mls throughout the day.
These children still get wasted even though they are fed the required number of times
in a day as this could be a result of increased nutrient requirements in HIV with
inadequate nutrients to support their growth (Ellen et al, 2009).

37
HIV infected people have increased risk of diarrhoea and this may greatly contribute
to malnutrition (UNICEF 2016).

Children from families who obtained food from the market had a wasting percentage
of 55.8% while those from families who obtained food from the farm /donations had a
wasting percentage of 37.0%. Most families do not practice agriculture hence depend
on buying food from the market which could prove be expensive thus families will
buy food only for survival sake hence may result to malnutrition.

5.3 CHILD HEALTH STATUS

Out of the children who had fallen ill one month before the study, 60% of them were
wasted while only 20% were wasted for children who did not suffer ill health. The
wasting may have been as a result of suffering from opportunistic infections leading
to weight loss, loss of muscle tissue and subcutaneous fat, reduced immune
competence and increased susceptibility to infections.

Poor nutritional status may result from multiple causes including depressed appetite,
poor nutrient intake and limited food availability, chronic infection, malabsorption
and metabolic disturbance. The above conditions cause malnutrition (Jayshree Bhagat
2017) 50% of children on ARV drugs were wasted while 44.4% of children who are
not on ARV drugs were wasted.

According to (Ayodo, 2013), there is nothing much drugs can do if taken on an empty
stomach. Certain modern drugs affect nutrient absorption, metabolism and excretion.
This agrees with the findings of (V. Heerden 2011) that medication can inhibits or
enhance nutrient absorption and metabolism may have negative effects on nutritional
status.

38
 CHAPTER VI

6.0 CONCLUSION AND RECOMMENDATIONS

6.1 CONCLUSION
This study was conducted to assess the risk factors of malnutrition among children
less than five years of age living with HIV/AIDS in Mpeketoni Lamu County. The
study established that different aspects of maternal socio-demographic and child
characteristics influenced the child’s nutritional status.

The maternal socio-demographic characteristics included age, occupation, household

size, level of education and marital status. The child’s socio-demographic
characteristics include sex, age and order of birth.

The study also looked at the child’s feeding practices eg how often the child feeds in a
day, if the child is breastfeeding, the family’s source of food and how the mentioned
factors influenced the child’s nutritional status.

Weight for height was parameters used to arrive at the nutritional status of the
children under study.

The study was also trying to find out whether the child’s health status (ill health)
influences the nutritional status or not.

It can be concluded that the above mentioned factors have a negative effect on the
child’s nutritional status according to findings of the study.

39
6.2 RECOMMENDATIONS
The following are some of the recommendations from the study:

1. Mothers of children living with HIV/AIDS should be imparted with knowledge

and skills about nutrition and ways of curbing malnutrition among HIV/AIDS
children.

2. Jobless women/mothers should be encouraged to start income generating

activities e.g. kitchen gardening.

3. More nutritionists should be employed by the government to cater for the

increasing solutions to combat malnutrition and its associated effects of
morbidity and mortality associated with HIV/AIDS.

4. Regular growth and monitoring and promotion which includes regular weighing
of children and plotting their weighs on the child’s road to health card, follow-up
on child’s progress, providing nutrition and health education and providing
vitamin A supplementation to help boost the child’s immune system

5. Non-Governmental organizations NGOs, the government and other stakeholders

should work together to provide financial, physical and moral support for the
affected families because unity is strength and the fight against HIV/AIDS in
relation to malnutrition in children of five years & below can be won.

40
1. QUESTIONNAIRRE
My name is Franklin Gitau, a student at Kenya Medical Training College Port
Reitz Campus conduction a research on malnutrition among children aged five
years and below living with HIV/AIDS. Kindly enter an honest opinion. The
details of the respondents will be kept private and confidential. Mark the box
appropriately.

SECTION A: SOCIODEMOGRAPHIC AND ECONOMIC

1 Age ____________________

2. Marital Status
1. Married
2. Single
3. Widowed
4. Divorced/Separated

3. Educational level…………….

4. Occupations……………

5. Household Size
1.1-2
2.3-4
3.5-6
4. Above 6

41
Child characteristics
6. Sex of the child
1. Male
2. Female

7. Age of the child.......................

8. Order of birth
1st born
2nd born
3rd born
Others specify

Child feeding practices

9. Is your child breastfeeding
1. Yes
2. No

10. If yes, in the question above, is it exclusive breastfeeding (for children of six
months and below)
1. Yes
2. No

11. If No, in the question 9 above which feeding practices?

1. Wet Nursing
2. Formula breast milk substitute
3. Heating of expressed breast milk

42
12. How do you often breastfeed in a day?

1. On demand

2. 4 times

3. 6 times

4. Others Specify

13. How often do you feed he/she

1. 2-3 times
2. 4-5 times

3. 6 and above

14. What feeds do you give? ..................

15. Do you have any food taboo?

1. Yes

2. No

43
16. What is the family’s source of food?
1. Farm

2. Market

3. Donation

4. Other specify

17. At what age was the child weaned? .........................

18. Which food(s) was introduced (specify the contents)……………

19. After introduction of complementary feeds, did the child continue to

breastfeed…..

Child health status

20. Has the child suffered from any health problem for past 1 month?

1. Yes

2. No

21. If yes, in the question above, which one?

Disease Year 1 No.

1. Oral Thrush

2. Tuberculosis

3. Malaria

44
 4. Diarrhoea

5. Pneumonia

6. Anorexia

7. Vomiting
8. Others specify

22. Is the child on ARVs drugs?

1. Yes

2. No

23. Does the child have any ARV side effects?

1. Yes

2. No
24. If yes in the question above, which ones?
1. Nausea/Vomiting

2. Diarrhoea

3. Sore throat

4. Abdominal pain

5. Others specify

45
 To be filled by the attachee

25. Anthropometric measurement

Child Weight_______kgs

Child Height/length ________cm

Child expected weight for height/length---------------------

26. Remarks

1. Normal

2. Mild wasted

3. Moderated wasted

4. Severely wasted

46
 REFERENCES
1. A guide for health care managers and supervisors 2014, Geneva,

UNICEF, WHO, UNAID 2014, HIV and infants.

2. A publication by Kenyatta National Hospital, 2014, Laltahon

management course manual

3. A publication of the government of Kenya and UNICEF Kenya, a

situation analysis 1992 of children & women in Kenya

4. Dabis J.F Leroy. Castetbon 2000, prevention of MTCT of HIV in

developing countries healthy policy plan.

5. Dr. Ayusi Robert (DDMS/Deputy director NASCOP/NLIP PMTCT

Manage 2007) Infant feeding.

6. Ellen G and Elizabeth A prebble, 2000, HIV/AIDS and nutrition,

review of literature and recommendations for nutritional care and

support in Sub-Saharan Africa.

7. Felicity Savage king and Ann Burges. Oxford medical publication,

2008.Nutrition in developing countries.

8. Human Watch Rights, 2016, Nutrition and dietetics for health care

9. J.A.M and young J. 1997, HIV and medical nutrition therapy

10. Jean A.S Ritchie 1990, Nutrition and families

11. Jean W.C HSU, Paul B. Pencarz, Derik Macllan and Andrew

Tomskins, WHO department of nutrition for health and development,

Macronutrients and HIV/AIDS review of current evidence.

47
12. L. Kathleen Mahan, Kruses food and nutrition and diet therapy 11 th

edition. 2004

13. Lepage P. (Pediatric infectious disease journal 1996). A prospective

study in Kigali-Rwanda 2007-2008, Growth of human

immunodeficiency virus type I, infected and uninfected children.

14. MC Latham, OBE Professor of international nutrition, Cornell

University. Ithaca, New York, USA printed by FAO, 2009. Nutrition

in tropical African

15. Move J. 1999, natural history of somatic growth in infants born to

women infected by HIV, Journal of pediatrics

16. MS Abigail Krystall (coordinating author) and joint working group,

University of Nairobi and KMTC 1997, Training in sexually

transmitted infections (STIs0

17. Pediatrics infections disease in less journal, 2013, endocrinology and

immunology factors associated with recovery of growth in children

with HIV syndrome virus type I

18. Peter R. Camptecy, Jami L. Johnson and Mary Khasa, population

Bulleting volume 6 No.1 March 2006. The global challenge of

HIV/AIDS.

19. Randa J. Saadah, Peggy Hendersons and Cota Vallenas, WHO 2015,

Department of child and development, Infant feeding and HIV

transmission.

20. Ritchard J.B. Willis, Marshall David PhD. C. Copyright, 2005. The

AIDS pandemic

48
21. Ronald Lambert and H.J Lee Bennet, UNICEF, WO, USAID, 2005.

HIV and Infant feeding counseling tools reference guide

22. S A Alkhatar 2009, Immune deficiency syndrome in children

23. Semba and Tang AM 1999. Micronutrient and the pathogenesis of

human immunodeficiency virus infections.

24. Stephen M. Apradi, WHO department of nutrition for health and

development, 2015. Growth failure in HIV infected children.

25. Stephen Nduba, Dr. Ingrid, 2007. Home-based care training manual for

health professionals as facilitators and HBC givers

26. UNAIDS and WHO, AIDS epidemic update, 2015

27. UNICEF, WHO, June 2014, Infant and young child feeding guidelines

in the context of HIV/AIDS

28. USAID, UNICEF, 2016, Kenya National Guidelines on nutrition and

HIV/AIDS

29. Vellar, Comakins A. Ndiku J. Marshall, 1992. Determinants of child

mortality in southwest Uganda.

49
 APPENDIX I

RESEARCH BUDGET

ITEMS QUALITY COST PER TOTAL

UNIT
Pens 5 20 100
Rubbers 2 10 20
Pencils 2 30 60
Rulers 1 50 50
Counter book 1 500 500
Fool scups 1 ream 500 500
Paper clip 2 boxes 150 300
Box file 2 1,200 1,200
Flash disk 1 500 500
Calculator 1 - 1,225
Questionnaires 245 1,500 1,500
Typing and printing 1,000 1,000
Binding cost 150 150
TOTAL 7,105

50
 APPENDIX II

WORK PLAN-

MONTH March April May

ACTIVITY

TOPIC SELETION

PROPOSAL WRITING

DATA COLLETION

DATA ANALYSIS

REPORT WRITING

RESEARCH
PRESENTATION

51