Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study
Authors: Jesson Julie , Ephoevi-Ga Ayoko , Aké-Assi Marie-Hélène , Koumakpai Sikiratou , N’Gbeche Sylvie , Dainguy Evelyne , Malateste Karen , Carrié Hugo , D’Almeida Marcelline , Eboua François Tanoh , Takassi Elom , Amorissani-Folquet Madeleine , Leroy Valériane ,   for the IeDEA West African Pediatric Collaboration, Zannou Marcel Djimon , Poda Armel , Sarfo Fred Stephen , Messou Eugene , Chenal Henri , Minga Kla Albert , Bissagnene Emmanuel , Tanon Aristophane , Seydi Moussa , Patassi Akessiwe Akouda , Koumakpai-Adeothy Sikiratou Adouni , Renner Lorna Awo , N’Gbeche Sylvie Marie , Bosse Clarisse Amani , Kouakou Kouadio , Folquet Madeleine Amorissani , Eboua François Tanoh , Dicko Fatoumata , Takassi Elom , Dabis François , Becquet Renaud , Bernard Charlotte , Arikawa Shino Chassagne , Jaquet Antoine , Malateste Karen , Rabourdin Elodie , Tiendrebeogo Thierry , Dahourou Désiré , Desmonde Sophie , Jesson Julie , Leroy Valeriane , Ekouevi Didier Koumavi , Azani Jean-Claude , Coffie Patrick , Cissé Abdoulaye , Gnepa Guy , Horo Apollinaire , Kouadio Christian , Tchounga Boris 
Published: December 2021

Abstract
Background
Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa.

Methods
In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention.

Results
Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d’Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767).

Conclusions
This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV.

Trial registration
PACTR202001816232398, June 01, 2020, retrospectively registered.