Nutrient composition of hypochondiacus amaranthus grain and contribution to nutritional status of HIV and AIDS infected children attending Thika District Hospital

Food and nutrition interventions are critical components of comprehensive responses to the HIV and AIDS pandemic. High nutrition quality of amaranth grain has been established but it remains an underutilized crop in Kenya despite the potential to broaden the food base which is critical in the context of HIV and AIDS. Information on the utilization of amaranth grain and its contribution to the nutrition status of vulnerable groups has not been sufficiently documented. The purpose of this study was to determine the nutrient composition of hypochondriacus amaranthus grain and assess the contribution of amaranth-based porridge consumption to nutrition status of HIV and AIDS infected children attending Thika District Hospital Comprehensive Care Clinic. The study was a longitudinal (6 months), experimental pre and post single group design, with a comprehensive sample of 52 children. The study was conducted in two phases. In phase one, data on nutrient composition and sensory evaluation of researcher-developed amaranth-based porridges were collected (6 months). Phase two included baseline assessment and the intervention. Intervention included monthly provision of adequate amaranth flour to be consumed by the children on a daily basis, nutrition education and counselling. Phase two data comprised demography, dietary intake, anthropometric, morbidity, and CD4 counts) and during and after intervention data on, anthropometry (monthly), morbidity prevalence (monthly) dietary intake (at month six) and CD4counts (at month six). Quantitative data were analysed using SPSS 16.0 and anthropometry data were analyzed using EPI INFO anthro pack then transformed into Z-Score. Dietary intakes were analyzed using Nutrisurvey (2007). Descriptive statistics were used to describe the results on nutrient composition, sensory evaluation, demographic data, and children's dietary, anthropometric and morbidity characteristics. Inferential statistics such as ANOV A, paired t-test, independent t-test were used to determine statistically significant differences at 95% CI, Pearson's product moment correlation for significant relationships 95% CI and linear regression for significant associations between selected variables. The findings indicated that amaranth grain has higher content of proteins (l5.29±0.80g), total lipids (8.50±0.90g) dietary fibre (5.50±0.20g), iron (20±0.8mg), zinc (4.00±0.6mg) and potassium 428.80±1.2mg) compared to the local cereals. The most preferred porridge was the amaranth maize blend followed by fermented amaranth porridge which was used for intervention. Baseline findings indicated inadequate mean intake of kilocalories (l281.10±379.69 kcal), vitamin A (268.35±216.65! lg), calcium (412.41±253.79 mg) and selenium (26±12.93! lg) by the study children. There was significant difference (p< 0.001) between preand postintervention mean intake of all nutrients except for selenium. Pre-intervention stunting was 36.5%, wasting 34% and underweight 30.8%. Post-intervention stunting was 32.7%, wasting was 21.2% and underweight 17.3%. Wasting and underweight reduced significantly (p=O.OOI) after intervention. There was reduced prevalence of illness and significant improvement (p<O.OOl) between pre and post-intervention CD4 counts. The findings indicated that amaranth grain is higher in nutrients and that consumption of fermented amaranth grain porridge had a positive significant contribution to the nutrition status, CD4 counts and reduced morbidity incidences of HIV infected children. It is recommended that public awareness, education on the nutritive value and sensitization on consumption of amaranth grain by persons infected with HIV and AIDS be promoted and scaled up by nutritionists. CHAPTER ONE: INTRODUCTION 1.1 Background Information The science of nutrition is complex and dynamic and it includes all aspects of ingestion, digestion, absorption, transportation and assimilation of chemical compounds (nutrients) present in foods (American Dietetic Association, 2004). The chemical compounds in foods have specific essential functions in the human body along the continuum of wellness and illness (WHO, 2008). Adequate nutrition is vital for growth, maintenance, health and survival for all individuals (WHO, 2008). The demand for food is increasing not only to meet the food security for growing populations but also provide more nutritious foods rich in nutrients and neutraceutical compounds (Barba et al., 2009). A nutritious diet containing adequate nutrients (macronutrients and micronutrients) is vital for all people (WHO, 2008). It is even more critical for people living with HIV/AIDS in order to maintain and strengthen the immune capacity and keep opportunistic infections at bay (UNAIDS, 2004; NASCOP, 2006; Paton et al., 2006; WHO, 2008). Public nutrition IS a multifaceted and broad-based problem solving approach addressing malnutrition in vulnerable groups (Young et al., 2005). Globally, good nutrition has been recognized as essential for promoting health and quality of life of the people living with HIV and AIDS (NASCOP, 2006; WHO, 2008). The HIV and AIDS epidemic poses an inescapable challenge worldwide. HIV and AIDS has become the leading cause of ill health among people globally (UNAIDS, 2009). Towards the end of the twentieth century, HIV and AIDS joined a series of public health challenges so profound and far-reaching that major shifts in public health thinking and action were provoked (UNAIDS, UNHCR, WFP, 2007).