Evaluation of a Nutritional Support Intervention in Malnourished HIV-Infected Children in Bamako, Mali
Julie Jesson1, Aba Coulibaly, Mariam Sylla
1*Bordeaux Population Health Research Center, Inserm U1219- ISPED, University of Bordeaux, Bordeaux, France; †CHU Gabriel Touré, Service de Pédiatrie, Bamako, Mali; ‡Expertise France, Département Santé, Paris, France; and §Inserm UMR 1027, Université Toulouse 3, Toulouse, France.
Insights
Nutritional support improved weight gain and reduced anemia in malnourished HIV-infected children. Chronic malnutrition prolonged recovery, highlighting the need for integrated nutritional care in pediatric HIV programs.
Area of Science:
- Pediatric Nutrition
- Infectious Diseases
- Public Health
Background:
- Malnutrition is a significant concern in children living with HIV.
- Assessing nutritional support interventions is crucial for improving health outcomes in this population.
- The study was conducted within a HIV-care program at the University Hospital Gabriel Touré, Bamako, Mali.
Purpose of the Study:
- To evaluate a nutritional support intervention for malnourished HIV-infected children.
- To assess the impact of Ready-To-Use Therapeutic Food on growth and anemia.
- To identify factors influencing recovery from malnutrition in this cohort.
Main Methods:
- A 6-month prospective interventional cohort study was conducted.
- Malnutrition (acute and chronic) was diagnosed using WHO growth standards.
- Ready-To-Use Therapeutic Food was administered based on malnutrition type until growth targets were met.
Main Results:
- Out of 348 children screened, 198 were malnourished; 158 were included in the study.
- 74% of children with acute malnutrition achieved catch-up growth within 6 months.
- Anemia significantly decreased from 40% to 12% post-intervention (P < 0.001).
Conclusions:
- The nutritional intervention demonstrated benefits in weight gain and anemia reduction for HIV-infected children.
- Associated chronic malnutrition impedes recovery from acute malnutrition, requiring extended support.
- Integrating nutritional screening and care into pediatric HIV services is essential for optimizing growth and preventing complications.
Background:
We assessed a nutritional support intervention in malnourished HIV-infected children in a HIV-care program of the University Hospital Gabriel Touré, Bamako, Mali.
Methods:
All HIV-infected children younger than 15 years were diagnosed for malnutrition between 07 and 12, 2014. Malnutrition was defined according to the WHO growth standards with Z-scores. Two types were studied: acute malnutrition (AM) and chronic malnutrition (CM). All participants were enrolled in a 6-month prospective interventional cohort, receiving Ready-To-Use Therapeutic Food, according to type of malnutrition. The nutritional intervention was offered until child growth reached -1.5 SD threshold. Six-month probability to catch up growth (>-2 SD) was assessed for AM using Kaplan-Meier curves and Cox model.
Results:
Among the 348 children screened, 198 (57%) were malnourished of whom 158 (80%) children were included: 97 (61%) for AM (35 with associated CM) and 61 (39%) with CM. Fifty-nine percent were boys, 97% were on antiretroviral therapy, median age was 9.5 years (Interquartile Range: 6.7-12.3). Among children with AM, 74% catch-up their growth at 6-month; probability to catch-up growth was greater for those without associated CM (adjusted Hazard Ratio = 1.97, CI 95%: 1.13 to 3.44). Anemia decreased significantly from 40% to 12% at the end of intervention (P < 0.001).
Conclusions:
This macronutrient intervention showed 6-month benefits for weight gain and reduced anemia among these children mainly on antiretroviral therapy for years and aged greater than 5 years at inclusion. Associated CM slows down AM recovery and needs longer support. Integration of nutritional screening and care in the pediatric HIV-care package is needed to optimize growth and prevent metabolic disorders.
