PAEDIATRIC HIV/AIDS AND NUTRITION Sharon Dawson ; Stephen Robinson

1. PAEDIATRIC HIV/AIDS AND NUTRITION Sharon Dawson ; Stephen Robinson CCDC (FEB. 2006)

2. JAMAICA DATA -There were 700 paediatric AIDS cases between 1986-2005. • The proportion of paediatric HIV cases moved from 8-6% (2004-2005) - Thirteen (13) out of every 1,000 pregnant women are infected. • The age group 15 - 45yrs. accounts for 54% of HIV/AIDS cases.

3. JAMAICA cont’d • HIV/AIDS is the leading cause of death in the age group 1- 4 years. • Each week in Jamaica, 1-2 babies are born HIV- infected. • In 2003, 283 infected babies were born.

4. KSA / VJH DATA • The average number of mothers receiving infant formula (K.S.A.) per month is 40. • The average number of deliveries (HIV +ve mothers) per month = 10-13* *25 deliveries in Nov ‘05

5. Effects on Immune System Malnutrition HIV CD4 t-lymphocyte number CD8 t-lymphocyte number Delayed cutaneous hypersensitivity CD4/CD8 ratio Serologic response after immunizations Bacteria killing

6. Role of Nutrition Care and Support • Studies have shown that the clinical outcome of HIV is poorer in individuals with compromised nutrition. • Improving nutrition can help prevent weight loss, strengthen the immune system and delay HIV disease progression. • Nutrition care should be part of a comprehensive program that helps the HIV-infected individual and her family.

7. Components of Nutritional Care and Support • Nutrition assessment. • Anthropometry (weight, length, MAC). • Dietary. • Clinical. • Biochemical. • Nutrition education and counseling. Should be : accurate and adapted to needs and resources. • Food safety and hygiene to be included. • Nutritional supplementation (includes) : • Food / Medical Nutritionals. • Multi-vitamin and mineral supplements.

8. Nutrient Recommendations (Pediatrics) • ENERGY: • Asymptomatic --- 100% RDA • Symptomatic --- 150% RDA • PROTEIN: • 50% TO 100 % RDA * Do not exceed 4 g / kg body weight • VITAMINS & MINERALS: • Multivitamins/ mineral supplements providing at least 100% RDA Bentler, M (2000) Support Line Vol. 22 No.4

9. PMTCT A SUCCESS STORY?

10. PMTCT GLOBALLY • Prior to 1994, in developed countries ~25% of the infants became infected. • With current use of HAART, elective C/S and the avoidance of breastfeeding, transmission has decreased to <2% for women identified early in pregnancy. *USA has <1.0%

11. PMTCT LOCALLY • Decrease in paediatric (MTCT) cases. • Decrease in paediatric deaths. • Increase in mother’s lifespan - decrease in OVCs.

12. CHALLENGES OF PMTCT • Stigma and discrimination • Repeat pregnancies - (x5); HIV/pregnancy in teenagers. • Use of ARV’s – resistance; OVC’s ?; • Follow-up visits • Resources –staff shortages, frustration, ‘burn out’

13. OBSTACLES TO REPLACEMENT FEEDING • STIGMA • AFFORDABILITY • DISCRIMINATION • RISK OF OTHER INFECTIONS • MALNUTRITION • ANTI-RETROVIRAL THERAPY

14. STIGMA Do we set-up mothers to advertise their status, by formula feeding?.

15. The VOICES OF THE WOMEN(Focus Groups) • “Sometimes I wake up in the night to look if she is still breathing…I say ‘thank God’ “ask yourself ‘ah wha me do?” • “I thought about death a lot …my mother had to hide the knives and the scissors”

16. VOICES • “Hard when visitor…nurse…ask why you not breastfeeding?…” • “A lot of lying and lies…like not breastfeeding”

17. Mother’s Major Challenges

18. CHALLENGES RELATED TO FEEDING OF CHILDREN • Financial : no money to purchase the proper foods (weaning); foods purchased have to ‘stretch’ or be shared ; no bus fare to access supplies • Orphans & Vulnerable Children (OVCs) and DIET : - due to limited resources in relevant Institutions or homes, dietary needs may not be fully met.

19. CHALLENGES RELATING TO FEEDING CHILDREN cont’d • Problems related to child’s appetite : - not sure what to do when appetite is poor …. mom satisfied with ‘anything’ that is eaten. - little access to relevant nutrition education • Stigma related to formula-feeding : - may be asked why not b/feeding ? - may be seen accessing ‘formula’.

20. LINKAGES

21. PAEDIATRIC HOMES • DARE -TO - CARE (34) • MATTHEW 25 : 40 (16) ≤ 6YRS. • *NORTH STREET (30) * Feb 2006

22. What Can We Do? • Support women to make and carry out their own informed infant feeding decision. • Help HIV positive women obtain accurate and complete information regarding infant feeding options. • Encourage appropriate research regarding HIV, breastfeeding and human milk.

23. Future studies • Impact of nutrition counselling & supplementation on overall health status in children. • Effect of nutrition on infected children on ARVs. • Nutrition challenges of the institutionalized child vs. those in ‘family homes’.

24. SUMMARY • Maintaining adequate nutrition may be one of the most important things a newly infected person (asymptomatic) can do to prolong well-being. • Improving nutritional status and promoting healthy lifestyle can: • Preserve health. • Improve quality of life. • Delay disease progression & mortality. • Prevention of food and water-borne infections reduces the risk of diarrhea, a common cause of weight loss, malnutrition and HIV disease progression .

25. SUMMARY • Systems must be put in place to address social needs. • Optimal management of clients can only be achieved by utilizing a ‘team approach’. • Opportunities for training & research should be actively explored. • Nutritional care and support should be part of a comprehensive program that deals with the needs of the child and his / her family.

26. THAT’S IT FOLKS !!!