Socio-economic determinants of disease progression among HIV infected adults in Kenya.

BACKGROUND: Socioeconomic determinants have been shown to have an effect on the progression of HIV disease evidenced by studies carried out largely in developed countries. Knowledge of these factors could inform on prioritization of populations during scale up of highly active antiretroviral therapy (HAART) constrained health systems. The objective of this study was to identify socioeconomic correlates of HIV disease progression in an adult Kenyan population. METHODS: We analysed data from 312 HIV positive individuals, drawn from a cohort enrolled in a randomized clinical trial investigating the effectiveness of Acyclovir in the prevention of HIV transmission among serodiscordant couples. In this study we included individuals with CD4 counts ≥ 350 cells/mm(3) and World Health Organization (WHO), clinical stage one or two. The exposure variables measured were: - daily household income available for expenditure, age, gender, housing type and level of formal education. We used a composite outcome of disease progression to WHO clinical stage 3 or 4 or a laboratory outcome of CD4 count below 350 cells/mm(3) after two years of follow-up. Logistic regression was used to determine associations of variables that were found to be significant at univariate analysis, and to control for potential confounders. RESULTS: Seventy eight (25 %) individuals reported HIV disease progression. Majority (79.9 %) were female. The median age was 30 year and 93.6 % had attained a primary level of education. Median CD4 at enrolment into the clinical trial was 564 cells/mm(3); those who had disease progression were enrolled with a significantly (p < 0.001) lower CD4 count. Daily household income available for expenditure adjusted for CD4 count at enrolment was associated significantly (p = 0.04) with HIV disease progression. Disease progression was five times more likely to occur in study subjects with daily income available for expenditure of less than US$1 compared to those with more than US$ 5 available for daily expenditure [adjusted Odds Ratio 4.6 (95 % Confidence Interval 1.4-14.4)]. Disease progression was not associated with age, gender, type of housing or level of education attained (p < 0.05). CONCLUSION: Populations with low household incomes should be considered vulnerable to disease progression and should therefore be prioritized during the scale up of HAART for treatment as prevention.

GROWTH AND NUTRITIONAL STATUS OF THE FIRST SIX MONTHS OF LIFE AMONG SELECTED HOSPITALS--NAIROBI PROVINCE.

BACKGROUND: Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi. OBJECTIVE: To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province. DESIGN: Prospective cohort design SETTING: Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary's Langata and Jamaa Hospitals. SUBJECTS: A sample of 692 mother-infant pairs were recruited at birth and followed up until six months. INTERVENTION: There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months. MAIN OUTCOME MEASURES: Nutritional status and infant feeding practices in the first six months. RESULTS: Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ± 4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ± 0.43 kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P > 0.05) differences in WAZ between infants on different feeding methods. CONCLUSIONS: There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems.

Undernutrition of orphans and vulnerable children: a comparison of cash transfer beneficiaries and non beneficiaries in Korogocho slums, Nairobi.

OBJECTIVE: To assess the prevalence and associated factors for undernutrition among the beneficiaries of Kenya Cash Transfer Program compared to non-beneficiaries in Korogocho, Nairobi. Optimal nutrition reduces the prevalence of undernutrition and contributes to improved child survival and development. METHODS: A comparative descriptive cross-sectional study design in which a total of 336 children were sampled from the two groups each consisting 168 children. A questionnaire was administered to caregivers. A Food Frequency Questionnaire and a 24 Hour Recall sought information on foods consumed. Anthropometric measurements were taken based on standard procedures. Wasting, underweight and stunting were determined based on a z-score of > or = -2 or < -2 SD. A chi-square test was used to test significance associations of wasting, underweight and stunting with other variables. RESULTS: A majority (89.3%) and (73.8%) of the principal caregivers were females among the beneficiaries and non-beneficiaries respectively. Among the beneficiaries, prevalence of wasting was 6%, underweight 6% and stunting 32.7%. Among non-beneficiaries, undernutrition was higher with wasting 9.5%, underweight 17.9% and stunting 37.5%. There was a significant difference (chi2 = 11.351, df = 1, p = 0.001) for underweight among the beneficiaries and non-beneficiaries. Nutrient inadequacies were high in vitamin A, folate and zinc in both beneficiaries and non-beneficiaries. In beneficiaries, undernutrition was significantly (p < 0.05) associated with number of children aged 6-59 months in the household, cash transfer used on food, carbohydrate intake, protein intake and frequency of breastfeeding. Among non-beneficiaries, undernutrition was significantly (p < 0.05) associated with number of household members, number of children 6-59 months in the household and income spent on food. CONCLUSIONS: There was improved nutritional status among the beneficiaries compared to non-beneficiaries. However, there is need of training beneficiaries on the best use of the cash transfers and educating them on consumption of adequate food to improve nutrient intake and eventually their nutritional status.

The effect of pre-lacteal feeding on full breastfeeding in Nairobi, Kenya.

OBJECTIVE: To assess the effect of pre-lacteal feeding on full breastfeeding in the first six months of life in selected hospitals, Nairobi Province. Pre-lacteal feeding has been internationally discouraged because of its negative effect on the duration of breastfeeding. METHODS: A prospective cohort design was used with a sample of 692 mother-infant pairs recruited at birth and followed up until 6 months of age. The sample was drawn from five major hospitals in Nairobi. Data was analyzed using the SPSS computer software. Descriptive analysis was used on all variables. Chi-test was used for univariate analysis. Logistic regression analysis was used to determine the effect of pre-lacteal feeding on full breastfeeding. RESULTS: Slightly more than half (58.8%) of the mothers were formally employed and their mean age was 28.3 +/- 4.9 years. The mean income was KES 26,360 +/- 34,696. The mean birth weight of the infants was 3.24 +/- 0.43 kg and 53.3% were males. The prevalence of pre-lacteal feeding was 26.8% (95% CI 23.5%-30.1%). The most common pre-lacteal feeds used at all hospitals were infant formula and glucose solution. There were significant (P < 0.05) differences across the five study hospitals in this practice. In one hospital nearly all (93%) infants received a pre-lacteal feed. The use of pre-lacteal feeding was significant predictor for early cessation of full breastfeeding at 6, 10, 14 and 19 weeks. CONCLUSIONS: The practice of giving pre-lacteal feeds is a key determinant of early cessation of full breastfeeding. Some hospitals do not appear to be adhering to international recommendations on infant feeding. Polices to promote exclusive and full breastfeeding are necessary to enable infants to attain optimal health and lead to achievement of the Millennium Development Goals in our settings.