Nutrition status and associated Dietary diversity factors among adolescents living with HIV in Ilala municipal council, Dar es salaam

Abstract

ABSTRACT Background: The global burden of HIV/AIDS significantly impacts vulnerable populations, particularly adolescents. Adolescents living with HIV continue to face significant nutritional challenges that compromise their treatment. These challenges are often due to low adherence to ART, influenced psychosocial factors such as fear of stigmatization, lack of social support and mental health issues such as depression and anxiety. In Tanzania, undernutrition emerges as the predominant challenge among adolescents with HIV, but comprehensive data on their nutritional status is limited. Objective: To assess the nutritional status and associated dietary diversity factors among adolescents living with HIV in Ilala Municipal Council, Dar es Salaam. Materials and Methods: A hospital based, cross-sectional descriptive study was conducted among adolescents living with HIV attending CTCs at Amana Regional Referral Hospital and Mnazi Mmoja Health Center. Sociodemographic, clinical and dietary diversity information were collected through face-to-face interviews using a structured questionnaire. Anthropometric measurements were conducted, and z-scores were computed based on the WHO 2007 Growth Reference Charts. Data analysis was done using Stata Version-17. Descriptive, chi-square tests, pearson’s correlation, and multivariate regression analysis were applied. A p-value of <0.05 was considered statistically significant. Results: A total of 132 HIV positive adolescents were recruited, majority of the participants were below 15 years of age. Malnutrition was prevalent, with 31.1% showing stunting, 25.8% underweight and 15.9% wasting. Significantly associated factors included food insecurity, low feeding frequency, advanced HIV stage and history of opportunistic infections. Dietary diversity was low, with 84.8% of the participants having inadequate dietary diversity. Key predators of poor dietary diversity were meal skipping (AOR = 12.2, P < 0.001, 95% CI: 3.5 - 41.7), and snacking (AOR = 5.0, P = 0.007, 95% CI: 1.6 – 16.4). Conversely, the majority of participants 62.1% reported better adherence to their ART regimen. Contributing factors were adequate food intake and dietary patterns, as well as use of medication reminders or schedules. Inadequate food intake and missing medication doses due to side effects were associated with poor adherence. Conclusion: This study reveals the critical nutritional and health challenges faced by HIV-positive adolescents, particularly malnutrition and poor dietary diversity. Factors such as food insecurity and low feeding frequency highlight the need for comprehensive strategies to improve their well-being. Enhancing dietary diversity is vital, as it affects physical health and supports ART adherence. The findings underscore the importance of addressing barriers related to nutrition and medication side effects to improve medication adherence. Recommendation: Engage stakeholders such as nutritionists and healthcare providers to implement nutritional programs, provide dietary counseling, and involve family support to enhance adolescent’s medication adherence.