Indian Pediatr 2015;52: 250-252
Impact of House-hold Food Insecurity on
Nutritional Status of HIV-infected Children Attending an ART
Centre in Tamil Nadu
E Suresh, *R
Valan, #Joel S
Klinton and *C Padmapriyadarsini
Pediatric Centre of Excellence, Institute of Child
Health and Hospital for Children; *National Institute for Research in
Tuberculosis (ICMR);$Tamilnadu State AIDS Control
#S.R.M. Medical college Hospital, Chennai, India.
We studied the level of food
insecurity among households with HIV-infected children and its
relationship with childhood nutritional indicators. Among the 147
children assessed, food insecurity was present in 59% of households.
Majority of children with stunting belonged to-food insecure families.
Stunting and Underweight were more prevalent among children >5 years of
Keywords: AIDS, Children living with HIV,
Human Immunodeficiency Virus (HIV) infection has been shown to lead to
food insecurity and severe malnutrition, as it hits the productive age
groups the most, thereby causing a fall in the family income, and
reduced food availability for the entire household. . This
malnutrition in early childhood affects the cognitive, psychosocial and
physical development, and also affects academic performance of the child
. A cross-sectional study was conducted in the Anti-retroviral
Treatment (ART) Center of a government tertiary-care hospital in Chennai
between August and December 2012, to evaluate the status of food
security among households with HIV-infected children, and to correlate
it with the nutritional status and growth of the child. Households were
eligible to participate if they had at least one child aged between 1
year to 15 years infected with HIV, living with them for longer than 6
months and getting treatment at the study center. To assess food
insecurity, we used the 9-item Household Food Insecurity Access Scale
(HFAIS) questionnaire adapted from the Food and Nutrition Technical
Assistance project for use in low resource settings . The
questionnaire was administered to the primary caregivers - parent
(mother or father) or a guardian (grandmother or grandfather) by
face-to-face interviews by staff who were familiar with the caregiver.
Nutritional indices, height-for-age (HAZ), weight-for-age (WAZ) and
weight-for-height (WHZ) z-scores were calculated using WHO reference
medians . For this study, Wasting was defined as WHZ of <-2 standard
deviation (SD), Stunting was defined as HAZ of <-2SD, and Underweight
defined as WAZ of <-2 SD below normal. Institutional Ethics Committee
approval and signed informed written consent from participants were
We interviewed caregivers from 150 households during
the study period. Three parents dropped out as they did not feel
comfortable with the questions, leaving a final sample of 147 households
with 147 children. Mean (SD) age and weight of the children was 7.8
(3.6) years and 19.5 (8) kgs, respectively. 66% of the children had
mothers who were infected with HIV. Of the 147 households studied, food
insecurity with hunger was present in 46.3% (95%CI 38.4-54.3), food
insecurity without hunger in 10.9% (95%CI.6.8-16.95) and food security
in 41.5% (95%CI 33.8 - 49.56) (Web Table I).
Prevalence of some degree of food insecurity without consideration of
hunger status was present in more than half of the households surveyed
(58.5%, 95%CI.50.4 to 66.1). 41% (58/142) of children were stunted; 50%
(72/145) underweight and 15% (17/113) wasted. Stunting (31% vs 69%);
underweight (28% vs 72%) and wasting (23.5% vs 76.5%) were more common
among children in >5 year than those below 5 year.
Our study reveals that 58.5% of households with
HIV-infected children are food insecure, which is similar to the
prevalence of food insecurity in general population in India [5,6]. Data
from the NFHS-3 has shown the National average of underweight and
stunting to vary between 40% to 50% and 48% to 60%, respectively for
under-five children . We found a higher proportion of above-five
year old children underweight (72%) and stunted (69%), similar to other
studies [7,8]. However, household food insecurity was not significantly
associated with underweight and stunting, which was unexpected, given
the evidence that a household’s access to food is one of the key
determinants of a child’s nutritional status. However, in countries with
high stunting rates, under-five underweight rates may not be a good
indicator of food insecurity .
This study highlights the fact that over half of the
children living with HIV also suffer from household food insecurity,
which could affect their growth and development leading to stunting and
wasting. Interventions like targeted food assistance to such families,
in addition to ART, is the need of the hour.
Contributors: ES, ASV: Study conduct; RS: Data
cleaning and Data analysis; Joel: Manuscript writing; PP: Study protocol
development, conduct and Manuscript preparation.
Funding: None; Competing Interest: None
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