Nutrition and Vulnerability Profiling Study Pre-ART, ART, and TB-DOTS clients Somalia. TB the leading opportunistic infection in PLWH

Transcription

1 Nutrition and Vulnerability Profiling Study Pre-ART, ART, and TB-DOTS clients Somalia 1st October 2012 Nutrition Cluster WFP Somalia / Nutrition Background Effect of HIV on nutrition Increase energy requirements Reduced dietary intakes Nutrient malabsorption and loss Metabolic changes TB the leading opportunistic infection in PLWH Malnutrition impacts on rate of HIV progression to AIDS and vice versa Food insecurity predisposes individuals to adopt negative coping strategies 1

2 Situation in Somalia HIV prevalence 1.0% TB prevalence 290/100,000 people Nutrition status among HIV+ or TB-DOTS clients not known HH food security status in HIV+ or TB-DOTS clients not known but 2.1 million food insecure (FSNAU, Sep 2012) No guideline/protocol for nutrition care and treatment for the HIV or TB clients Currently around 35 TB or HIV facilities provide food assistance (untargeted) STUDY DESIGN 2

3 Objectives Establish a baseline for nutritional status and household food security situation of Pre-ART, ART, and TB-DOTS clients in Somalia Provide a rationale for developing a nutrition care & treatment protocol for TB and HIV patients in Somalia Primary Outcomes Prevalence of acute malnutrition among adults ( 15 years) in Pre-ART, ART and TB- DOTs program using BMI (<18.5) Food Insecurity: Proportion of poor and borderline food insecure households using food access and food consumption score (WFP/VAM indicators) Dietary Diversity: Proportion households eating less than 4 food groups 3

4 Sampling Cross-sectional facility-based survey stratified by zone (NE, NW, SCZ) Sample size calculation 5% significance level 6.5% SE Adjusted for 20% non-response 284 units per strata = 852 units Actual sample size NW:283 units NE: 280 units SCZ: 254 units one facility couldn t be accessed 817 units sampled (96% of target) 29.7% ART/pre-ART (n=242) and 70.3% TB (n=574) Sampling First level sampling: Facility 36 accessible facilities included: NW (17); NE(9); SCZ(10) PPS used to define units / facilities Facilities with <5 units excluded and sample redistributed in strata (4 facilities excluded) 32 facilities sampled: 11 HIV and 23 TB Second level sampling: Patient In-patients vs Out-patients: PPS In-patients: SRS Out-patients: Consecutive sampling 4

5 Data collection Questionnaire, informed consent Somaliland ANPPCAN / MOH February 2012 Puntland ANPPCAN / MoH March/Apr 2012 SCZ SCORE Apr/May 2012 Nutrition: BMI by zone Pearson chi2(8) = Pr =

6 Nutrition: BMI by sex Pearson chi2(4) = Pr = Nutrition: BMI by treatment type 6

7 Nutrition: MUAC for PLW Caveat: only 47 PLW in the sample! Food Security: Food Consumption Score Pr = Pr = Overall: 36.1% with poor FCS 15.3% with borderline FCS Strong correlation with zone but not with sex or treatment type 7

8 Conclusion: Nutrition 43.6% of HIV and TB clients wasted in Somalia and in need of nutritional rehabilitation 25.5% increased in odds of wasting in Somaliland (49.6%) compare to Puntland (43.9%), and Puntland to SCZ (36.4%): OR=0.74, CI[ ]; p= Women 27.5% less likely than men to be wasted in Somalia (OR=0.72; CI[ ]; p=0.0314) No evidence of an association of wasting with treatment type. 62% of PLW with low MUAC (<23cm) in Somalia; up to 85% in Somaliland including 23% very low (<18.5cm) Conclusion: Food Security 51.4% of patients live in HH with poor or borderline FCS Strong evidence of an association with zone: Somaliland fare much worst (p<0.001) No evidence of association with sex or treatment type Further analyses required on food security to determine: Dietary diversity Food access Food insecurity Association with nutritional status 8

9 Limitations Sampling: Not fully randomised Access constraints meant Mogadishu over-represented in SCZ strata Data collection Long questionnaire, data quality may have suffered Recommendation Urgent need to initiate nutritional support to ART and TB-DOTS clients across Somalia Refine targeting of food assistance not desirable in Somaliland but need to considered in PTL and Mogadishu 9

10 Acknowledgments Technical partners MOH Somaliland MOH Puntland MOH TFG SOLNAC NAC PTL NAC SCZ SCORE ANPPCAN UNICEF Funding WFP Somalia UNICEF Somalia WFP (RB ECSA) 10