paediatric hiv/aids and nutrition sharon dawson ; stephen robinson
DESCRIPTION
PAEDIATRIC HIV/AIDS AND NUTRITION Sharon Dawson ; Stephen Robinson CCDC (FEB. 2006). JAMAICA DATA. - There were 700 paediatric AIDS cases between 1986-2005. The proportion of paediatric HIV cases moved from 8-6% (2004-2005) - PowerPoint PPT PresentationTRANSCRIPT
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PAEDIATRIC
HIV/AIDS
AND
NUTRITION
Sharon Dawson ; Stephen Robinson CCDC (FEB. 2006)
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JAMAICA DATAJAMAICA DATA
-There were 700 paediatric AIDS cases between 1986-2005.
- The proportion of paediatric HIV cases moved from 8-6% (2004-2005)
- Thirteen (13) out of every 1,000 pregnant women are infected.
- The age group 15 - 45yrs. accounts for 54% of HIV/AIDS cases.
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JAMAICA cont’dJAMAICA cont’d
• HIV/AIDS is the leading cause of death in the age group 1- 4 years.
• Each week in Jamaica, 1-2 babies are born HIV- infected.
• In 2003, 283 infected babies were born.
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KSA / VJH DATAKSA / VJH DATA
• The average number of mothers receiving infant formula (K.S.A.) per month is 40.
• The average number of deliveries
(HIV +ve mothers) per month = 10-13*
*25 deliveries in Nov ‘05
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Effects on Immune SystemEffects on Immune System
Malnutrition HIV
CD4 t-lymphocyte number
CD8 t-lymphocyte number
Delayed cutaneous hypersensitivity
CD4/CD8 ratio
Serologic response after immunizations
Bacteria killing
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Role of Nutrition Care and SupportRole of Nutrition Care and Support
• Studies have shown that the clinical outcome of HIV is poorer in individuals with compromised nutrition.
• Improving nutrition can help prevent weight loss, strengthen the immune system and delay HIV disease progression.
• Nutrition care should be part of a comprehensive program that helps the HIV-infected individual and her family.
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• Nutrition assessment.– Anthropometry (weight, length, MAC).– Dietary.– Clinical.– Biochemical.
• Nutrition education and counseling.
Should be : accurate and adapted to needs and resources.– Food safety and hygiene to be included.
• Nutritional supplementation (includes) :– Food / Medical Nutritionals.– Multi-vitamin and mineral supplements.
Components of Nutritional Care Components of Nutritional Care and Supportand Support
Bentler, M (2000) Support Line Vol. 22 Bentler, M (2000) Support Line Vol. 22 No.4No.4
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Nutrient RecommendationsNutrient Recommendations (Pediatrics) (Pediatrics)
• ENERGY:– Asymptomatic --- 100% RDA– Symptomatic --- 150% RDA
• PROTEIN:– 50% TO 100 % RDA
* Do not exceed 4 g / kg body weight• VITAMINS & MINERALS:
– Multivitamins/ mineral supplements providing at
least 100% RDA
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PMTCT A SUCCESS STORY?PMTCT A SUCCESS STORY?
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PMTCT GLOBALLYPMTCT GLOBALLY
• Prior to 1994, in developed countries ~25% of the infants became infected.
• With current use of HAART, elective C/S and the avoidance of breastfeeding,
transmission has decreased to <2% for women identified early in pregnancy.
*USA has <1.0%
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PMTCT LOCALLYPMTCT LOCALLY
• Decrease in paediatric (MTCT) cases.
• Decrease in paediatric deaths.
• Increase in mother’s lifespan - decrease in OVCs.
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CHALLENGES OF PMTCTCHALLENGES OF PMTCT
• Stigma and discrimination
• Repeat pregnancies - (x5); HIV/pregnancy in teenagers.
• Use of ARV’s – resistance; OVC’s ?;
• Follow-up visits
• Resources –staff shortages, frustration, ‘burn out’
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OBSTACLES TO REPLACEMENT OBSTACLES TO REPLACEMENT FEEDINGFEEDING
• STIGMA
• AFFORDABILITY
• DISCRIMINATION
• RISK OF OTHER INFECTIONS
• MALNUTRITION
• ANTI-RETROVIRAL THERAPY
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STIGMASTIGMA
Do we set-up mothers to advertise their
status, by formula feeding?.
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The VOICES OF THE WOMENThe VOICES OF THE WOMEN(Focus Groups)(Focus Groups)
• “Sometimes I wake up in the night to look if she is still breathing…I say ‘thank God’
“ask yourself ‘ah wha me do?”
• “I thought about death a lot …my mother had to hide the knives and the scissors”
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VOICESVOICES
• “Hard when visitor…nurse…ask why you not breastfeeding?…”
• “A lot of lying and lies…like not breastfeeding”
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Mother’s Major ChallengesMother’s Major Challenges
CHILDREN’S ISSUES
STIGMA &
DISCRIM.
FINANCIAL
HIV +VEMOTHER
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CHALLENGES RELATED TO CHALLENGES RELATED TO FEEDING OF CHILDRENFEEDING OF CHILDREN
• Financial : no money to purchase the proper foods (weaning); foods purchased have to ‘stretch’ or be shared ; no bus fare to access supplies
• Orphans & Vulnerable Children (OVCs) and
DIET :- due to limited resources in relevant Institutions
or homes, dietary needs may not be fully met.
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CHALLENGES RELATING TO CHALLENGES RELATING TO FEEDING CHILDREN cont’dFEEDING CHILDREN cont’d
• Problems related to child’s appetite :
- not sure what to do when appetite is poor …. mom satisfied with ‘anything’ that is eaten.
- little access to relevant nutrition education
• Stigma related to formula-feeding :
- may be asked why not b/feeding ?
- may be seen accessing ‘formula’.
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LINKAGESLINKAGES
CFNI,CHARES
JAS ;JN+
Nt’l AIDSC’tee / PAAs
CHURCHES
RegionalC’tees
CHART
Nutrition personnel
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PAEDIATRIC HOMESPAEDIATRIC HOMES
• DARE -TO - CARE (34)
• MATTHEW 25 : 40 (16) ≤ 6YRS.
• *NORTH STREET (30)
* Feb 2006
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What Can We Do?What Can We Do?
• Support women to make and carry out their own informed infant feeding decision.
• Help HIV positive women obtain accurate and complete information regarding infant feeding options.
• Encourage appropriate research regarding HIV, breastfeeding and human milk.
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Future studies Future studies
- Impact of nutrition counselling & supplementation on overall health status in children.
- Effect of nutrition on infected children on ARVs.
- Nutrition challenges of the institutionalized child vs. those in ‘family homes’.
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• Maintaining adequate nutrition may be one of the most important things a newly infected person (asymptomatic) can do to prolong well-being.
• Improving nutritional status and promoting healthy lifestyle can: – Preserve health.– Improve quality of life.– Delay disease progression & mortality.
• Prevention of food and water-borne infections reduces the risk of diarrhea, a common cause of weight loss, malnutrition and HIV disease progression .
SUMMARYSUMMARY
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SUMMARYSUMMARY
• Systems must be put in place to address social needs.
• Optimal management of clients can only be achieved by utilizing a ‘team approach’.
• Opportunities for training & research should be actively explored.
• Nutritional care and support should be part of a comprehensive program that deals with the needs of the child and his / her family.
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THAT’S IT
FOLKS !!!