Severe acute malnutrition as a major predictor for poor nutritional outcome among adult HIV patients treated with FPB program: a case-control study

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Nigest Abebaw
Mulualem Endeshaw
Mamaru Ayenew


Different studies had explained the treatment outcomes of the food by prescription (FBP) program among people living with HIV (PLHIV). This study aimed to assess factors affecting nutritional treatment outcome among PLHIV using FBP.

An institution-based unmatched case control study was conducted from August 1 to September 30, 2017 in public health facilities. A total of 566 samples (283 cases and 283 controls) was drawn using random sampling technique. Data were collected from FBP, ART/PRE-ART registers and client’s follow up charts. Bivariate and multivariate logistic regression analyses were conducted to estimate the relationship of the independent variables with the outcome variable, and a p-value <0.05 was considered as statistically significant at 95% confidence level. All statistical analysis was performed using SPSS version 23.

In this study severe acute malnutrition at admission (AOR=4.45. 95% CI: 2.63–7.55), moderate acute malnutrition at admission (AOR=3.8, 95% CI: 2.18–6.67), lack of regular follow up (AOR=3.81, 95% CI: 2.18–6.67), low CD4 count below 100 (AOR= 2.93, 95% CI: 1.19–7.20), hemoglobin value below 10mg/dL (AOR=2.72, 95% CI: 1.17, 6.35), and male sex (AOR=1.77, 95% CI: 1.19, 2.63) were found to be significant predictors for poor nutritional treatment outcome.

Severity of malnutrition was the major predictor for poor nutritional treatment outcome of patients who were on FBP program. The policy makers can use the information to improve HIV and nutrition interventions based on the result.

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How to Cite
Abebaw, N., Endeshaw, M., & Ayenew, M. (2019). Severe acute malnutrition as a major predictor for poor nutritional outcome among adult HIV patients treated with FPB program: a case-control study. Universa Medicina, 38(2), 121–130.
Original Articles


Koethe JR, Heimburger DC. Nutritional aspects of HIV-associated wasting in sub-Saharan Africa. Am J Clin Nutr 2010;91:1138S-42S. doi: 10.3945/ajcn.2010.28608D.

Food and Nutrition Technical Assistance II Project (FANTA-2). Review of Kenya’s Food by Prescription Program. Connecticut Ave., NW Washington, DC: Food and Nutrition Technical Assistance II Project (FANTA-2);2009.

Sadler K, Bontrager E, Rogers B, et al. Food by Prescription: measuring the impact and cost-effectiveness of prescribed food on recovery from malnutrition and HIV disease progression among HIV+ adult clients in Ethiopia. Boston: Feinstein International Center;2012.

UNAIDS. Global report: UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2013.

UNAIDS. People living with HIV: the gap report. Geneva: UNAIDS; 2014.

Ethiopian Health and Nutrition Research Institute Federal Ministry of Health. HIV related estimates and projections for Ethiopia. Addis Ababa, Ethiopia: Ethiopian Health and Nutrition Research Institute;2012.

Gedefaw M, Tariku M. Determinates of regain in body mass index among malnourished Aids patients on therapeutic food in Amhara national regional state, Northwest Ethiopia: a retrospective cohort study. Open J Epidemiol 2015;5:122-8. doi: 10.4236/ojepi.2015.52016.

Sicotte M, Langlois ÉV, Aho J, et al. Association between nutritional status and the immune response in HIV + patients under HAART: protocol for a systematic review. Syst Rev 2014;3: 9. doi: 10.1186/2046-4053-3-9.

Swaminathan S, Padmapriyadarsini C, Yoojin L, et al. Nutritional supplementation in HIV-infected individuals in South India: a prospective interventional study. Clin Infect Dis 2010;51:51–7. doi: 10.1086/653111.

Ivers LC, Cullen KA, Freedberg KA, et al. HIV/AIDS, under- nutrition, and food insecurity. Clin Infect Dis 2009;49:1096-102. doi: 10.1086/605573.

Bontrager E, Sadler K. Early stages of a ‘Food by Prescription’ programme for HIV infected adults. ENN Strategy; 2011.

Ndekha MJ1, van Oosterhout JJ, Zijlstra EE, et al. Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomized, investigator blinded, controlled trial. BMJ 2009; 338:b1867. doi: 10.1136/bmj.b1867.

Olsen MF, Abdissa A, Kæstel P, et al. Effects of nutritional supplementation for HIV patients starting antiretroviral treatment: randomised controlled trial in Ethiopia. BMJ 2014;348:g3187. doi: 10.1136/bmj.g3187.

Evans D, McNamara L, Maskew M, et al. Impact of nutritional supplementation on immune response, body mass index and bioelectrical impedance in HIV-positive patients starting antiretroviral therapy. Nutr J 2013;12:111. doi: 10.1186/1475-2891-12-111.

Lategan R, Steenkamp L, Joubert G, et al. Nutritional status of HIV-infected adults on antiretroviral therapy and the impact of nutritional supplementation in the Northern Cape Province, South Africa. S Afr J Clin Nutr 2010;23:197-201.

Rawat R, Kadiyala S, McNamara PE. The impact of food assistance on weight gain and disease progression among HIV-infected individuals accessing AIDS care and treatment services in Uganda. BMC Public Health 2010;10:316. DOI:

Tafese Z, Birhan Y, Abebe H. Nutritional care and support among adults living with HIV at Hawassa referral hospital, southern Ethiopia: a qualitative study. Afr J AIDS Res 2013;12:105-11. doi: 10.2989/16085906.2013.825301.

Kebede MA, Haidar J. Factors influencing adherence to the food by prescription program among adult HIV positive patients in Addis Ababa, Ethiopia: a facility-based, cross-sectional study. Infect Dis Poverty 2014;3:20. doi: 10.1186/2049-9957-3-20.

Moench-Pfanner R, Van Ameringen M. The Global Alliance for Improved Nutrition (GAIN): a decade of partnerships to increase access to and affordability of nutritious foods for the poor. Food Nutr Bull 2012;33(4Suppl):S373-80. doi: 10.1177/15648265120334S313.

Ahoua L, Umutoni C, Huerga H, et al. Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study. J Int AIDS Soc 2011;14:2. doi: 10.1186/1758-2652-14-2.

Nagata JM, Cohen CR, Young SL, et al. Descriptive characteristics and health outcomes of the food by prescription nutrition supplementation program for adults living with HIV in Nyanza Province, Kenya. PLoS One 2014;9:e91403. doi: 10.1371/journal.pone.0091403.

Gebremichael D, Hadush K, Kebede E, et al. Food insecurity, nutritional status, and factors associated with malnutrition among people living with HIV/AIDS attending antiretroviral therapy at public health facilities in West Shewa Zone, Central Ethiopia. Bio Med Res Intl 2018, Article ID 1913534. doi: 10.1155/2018/1913534.

Maldey B, Haile F, Shumye A. Outcome of ready to use food therapy among patients on HIV/ AIDS care in Mekelle hospital, Northern Ethiopia: retrospective cohort study. J AIDS Clin Res 2014;5:1-6. doi: 10.4172/2155-6113.1000268.

Bahwere P, Deconinck H, Banda T, et al. Effective therapeutic feeding with chickpea sesame based ready-to-use therapeutic food (CS-RUTF) in wasted adults with confirmed or suspected AIDS. World J AIDS 2011;1:169-81. doi: 10.4236/wja.2011. 14025.

Janz TG, Johnson RL, Rubenstein SD. Anemia in the emergency department: evaluation and treatment. Emerg Med Pract 2013;15:1-15.