Nutritional knowledge, attitude, and practices among pregnant and lactating women living with HIV in the Manzini region of Swaziland.

The prevalence of HIV infection in Swaziland (26%) is among the highest in the world. We investigated nutritional knowledge, attitude, and practices (KAP) and the influence of sociodemographic factors on KAP among pregnant and lactating women living with HIV in the Manzini region of Swaziland. Interviews were conducted using a structured questionnaire to collect data from 324 subjects seeking healthcare from selected regional hospitals, health centres, and clinics in Manzini region. The results showed mean percentage scores of nutritional knowledge (67%), attitude (67%), and practices (51%) whereby educational level (p = 0.002), employment status (p = 0.009), income (p = 0.008), religion (p = 0.007), type of accommodation (p = 0.006), type of transport used when going for shopping (p = 0.001), and BMI (p = 0.015) were significantly associated with nutritional practices. Significant positive correlations between nutritional KAP were observed: nutritional K and A (r = 0.155, p = 0.005), nutritional K and P (r = 0.456, p = 0.001), and nutritional A and P (r = 0.230, p = 0.001). Multiple linear regression analysis indicated that type of transport used when going for shopping (p = 0.002), educational level (p = 0.001), income (p = 0.001), employment (p = 0.038), knowledge of food proportion in a plate (p = 0.000), a positive attitude towards high-fibre diet (p = 0.004), and eating a variety of foods (p = 0.006) were predictors of nutritional practices. Educational level was identified as a common predictor of nutritional knowledge, attitude, and practices, suggesting that both formal and informal education systems are potential factors influencing dietary practices among pregnant and lactating women living with HIV in Swaziland.

Use of a Durnin-Womersley formula to estimate change in subcutaneous fat content in HIV-infected subjects.

BACKGROUND: HIV-infected individuals may develop malnutrition or lipodystrophy, leading to losses of subcutaneous adipose tissue (SAT). OBJECTIVE: We compared the ability of a Durnin-Womersley formula for total adipose tissue (TAT) to estimate change in SAT with the use of whole-body magnetic resonance imaging (MRI) as a criterion measure. DESIGN: We analyzed data from 2 clinical trials: a prospective randomized trial of protein supplements, progressive resistance training, or combined treatment in 29 malnourished, HIV-positive women, and a prospective open-label trial of recombinant human growth hormone in 25 HIV-infected subjects with visceral adipose tissue (VAT) accumulation. Changes in fat by the Durnin-Womersley formula and in SAT, TAT, and VAT by MRI were compared by linear regression, and Bland-Altman analyses were used to assess the agreement between the prediction and criterion methods. The repeatability of the Durnin-Womersley measurement was evaluated in 14 weight-stable, healthy adults studied twice within 1 y. RESULTS: At baseline, Durnin-Womersley fat was significantly associated with SAT (r(2) = 0.75, P < 0.001) and TAT (r(2) = 0.79, P < 0.001) but not with VAT. Change in Durnin-Womersley fat was significantly associated with change in SAT (r(2) = 0.66, P < 0.001) and in TAT (r(2) = 0.57, P < 0.001) but not in VAT. The limits of agreement for the Durnin-Womersley estimation of change in SAT were -3.4 to 2.6 kg and the SEE was 1.5 kg. The SEE for repeated measures of SAT in healthy control subjects was 0.84. CONCLUSIONS: The Durnin-Womersley formula can be used to predict change in SAT. The limits of agreement and the SEE for predicting change in SAT by MRI are approximately twice as great as the error of repeated Durnin-Womersley measures in control subjects.