Abstract:
Undernutrition among HIV-positive children can be ameliorated if they are given adequate foods in the right frequency and
diversity. Food insecurity is known to undermine such efforts, but even in food rich areas, people have undernutrition. As
yet no study has examined feeding practices and their associations with nutrition status among as HIV-positive children in
regions with high food production. We therefore examined the magnitude of undernutrition and its association with
feeding practices among HIV-positive children in a high food production region in Tanzania.
Methods: We conducted this mixed-method study among 748 children aged 6 months-14 years attending 9 of a total of 32
care and treatment centers in Tanga region, Tanzania. We collected quantitative data using a standard questionnaire and
qualitative data through seven focus group discussions (FGDs).
Results: HIV-positive children had high magnitudes of undernutrition. Stunting, underweight, wasting, and thinness were
prevalent among 61.9%, 38.7%, 26.0%, and 21.1% of HIV-positive children, respectively. They also had poor feeding
practices: 88.1% were fed at a frequency below the recommendations, and 62.3% had a low level of dietary diversity. Lower
feeding frequency was associated with stunting (b = 0.11, p = 0.016); underweight (b = 0.12, p = 0.029); and thinness
(b = 0.11, p = 0.026). Lower feeding frequency was associated with low wealth index (b = 0.06, p,0.001), food insecurity
(b =20.05, p,0.001), and caregiver’s education. In the FGDs, participants discussed the causal relationships among the key
associations; undernutrition was mainly due to low feeding frequency and dietary diversity. Such poor feeding practices
resulted from poor nutrition knowledge, food insecurity, low income, and poverty.
Conclusion: Feeding practices and nutrition status were poor among HIV-positive children even in food rich areas.
Improving feeding frequency may help to ameliorate undernutrition. To improve it, tailored interventions should target
children of poor households, the food insecure, and caregivers who have received only a low level of education.