Determinants of Undernutrition Among Adult People on Antiretroviral Therapy in Goba Hospital, Southeast Ethiopia: A Case Control Study

Abstract

Background: Undernutrition significantly affects the effectiveness and adherence to antiretroviral therapy (ART), survival status and quality of life in people living with HIV. Prevalence of undernutrition among HIV infected people in Ethiopia ranges from 12.3-55.6%. Limited case-control studies conducted on this topic, and factors like food insecurity, dietary diversity, depression and substance use were not adequately addressed. Objective: To identify determinants of undernutrition among adult people on antiretroviral therapy in Goba Hospital, Southeast Ethiopia. Methods: A facility-based case-control study was conducted from March 16 to May 26, 2019. Consecutive sampling method was used to select 92 cases and 184 controls. Cases were undernourished (Body Mass Index (BMI) < 18.5 kg/m2) adult people living with HIV attending antiretroviral therapy. Controls were well-nourished (BMI=18.5-24.9 kg/m2) adult people living with HIV who are on antiretroviral therapy. A pretested structured questionnaire was used to collect data by face-to-face interviewer and checklist was used collect clinical data from medical records. Data were entered into Epi-data version 4.4 & then exported to SPSS version 23 for analysis. Bivariate logistic regression was computed and candidate variables with p≤0.20 were entered to multivariable logistic regression model. Absence of multicollinearity and interaction was checked using variance inflation factor and Breslow-Day test of homogeneity respectively. P-value <0.05 was considered statistically significant and Adjusted Odds Ratio (AOR) at 95% Confidence Interval (CI) was used to assess the strength of association. Results: Factors independently associated with undernutrition were household food insecurity [AOR=3.24, 95% CI:(1.72–6.08)], having depression [AOR=2.07, 95% CI:(1.16–3.72)], current alcohol consumption [AOR=3.80, 95% CI:(1.71–8.43)] and non-adherence to antiretroviral therapy [AOR=2.61, 95% CI:(1.28–5.30)]. Conclusions: Household food insecurity, having depression, alcohol consumption and nonadherence to ART were independently associated with undernutrition in adult PLHIV. Integrating food insecurity interventions to HIV program at the hospital level is required. Strategies and program targeting PLHIV need to consider psychosocial problem like depression and alcohol consumption. Healthcare providers need to strengthen awareness creation activity on adherence and psychosocial factors that can affect nutritional status of adult PLHIV.