This study was set out with the aim of assessing magnitude of nutritional status and its associated factors among adult on ART in Gamo zone public hospitals. The magnitude of underweight and overweight/obese was 28.3% and 13.3% respectively. And also marital status, Cotrimoxazole preventive therapy, individual dietary diversity, household food security and khat chewing were positively associated to underweight. On the other way alcohol drinking was positively and average monthly income was negatively associated with overweight/obese.
The magnitude of underweight in this study is consistent to the study from east Harerge zone (30%) (39), Ethiopia a systematic review and meta-analysis (27.4%) (40), Arba Minch town public health facilities (24%) (41), and Bench Shako zone (29.2%) (42).
However it is lower as compared to the study in eastern zone of Tigray (42.9%) (12). The difference may be attributable to difference in the feeding style. Study from northern part of Ethiopia showed that food prepared from cereals (sorghum, barley, white, maize, teff,) are the common food eaten by the population (43). On the other hand wild fruit, vegetables and animal source food are common food type in southern and south west Ethiopia(44). Besides, it might be due to the difference and improvements in healthcare services. Or it might be as a result of the patients reporting with advanced stage of HIV infection to medical facilities.
When compared with the result from Iran (11.08%), the magnitude of underweight is much higher. The discrepancy may be difference in year of study and setting of the study since the study was conducted in 2015 at community level (45). Similarly the magnitude of underweight is also higher as compared with the study from Nepal (18.3%). It seems possible that these results are due to difference in socio economic deference observed from the population and time of study. Another possible explanation for this is that difference in health care service and food supplement program might had difference in the magnitude of underweight (46).
The magnitude of underweight in this study is also much higher than the study from Cameron 8.5% and Gahanna 13.8%. The inconsistence might be due to difference in the sample size and nature of study. The study done in Cameroon was a pilot study that was conducted in 82 individual (47).While the study from Gahanna was done on 152 individuals (48). As compared to the study done in south Africa 2020 (8.9%)(49), Zimbabwe (13%) (50), and Uganda (10.28%) (51),the magnitude of underweight is also higher. This may be due to population difference and year of study. The evidence from this study also suggests that the magnitude of underweight is also higher than the findings reported from different parts of Ethiopia; 18.3% in Asela town(52),18.8% in LegaTafo and surrounding (41),15.1% HIV-infected adults in Addis Ababa (53),19.1% at Selected Health Facilities of Addis Ababa (54),18.23% in Arba Minch town and Arba Minch Zuria (35). This differs from the findings presented here may be difference in health care awareness of the community, socio demographic difference and year of study.
On the other way the most interesting finding is that the magnitude of overweight/obese is 13.3%( 95% CI: 10.2–17.0). The yields in this investigation is higher compared to those of other studies conducted in bench Sheko zone 9.6%(42). The potential difference might be due to difference in study period and the studies also include only hospitals that may miss population at health center level.
The magnitude of overweight/obese observed in this investigation is far below those observed by the study in Nepal (46.4%). The difference may be difference in BMI cut off point to which the study categorized nutritional status as underweight (BMI < 18.5 kg/m2), normal (BMI 18.5–22.9 kg/m2), overweight (BMI 23.0–27.4 kg/m2) and obese (BMI ≥ 27.5 kg/m2) (46), The overall magnitude of overweight/obese is also lower than that of previous study conducted in south Africa 39%(49) and Gahanna 28.3% (48). Socio demographic and economic difference between the populations may be attributable for the variation.
This finding is also lower to previous studies done in Addis Ababa (22.1%)(53). The existence of different socio-economic status of population could be the reason for the discrepancy. There is also difference in the year of study. Another possible explanation for this is that different in sample size that may add or reduce the target population. Another important finding was that magnitude of overweight/obese was lower than the study from jima (21%)(55). This can be explained by most of the participant were follower of orthodox Christianity and the data was collected during fasting month as compare to the study from jima. The sample size of this study is also higher and includes all health facilities (hospitals & health centers), but the study from jima zone was conducted only at hospital level on 252 participants.
Results of this study showed that divorced respondent were 3.71 times more likely to be underweight as compared to married in comparison to normal. This finding is not supported by the study from Nepal which stated that being married was positively associated with undernutrition(46). The potential discrepancy may be population difference and difference in the reference population since married is the reference group in this study. This might be explained by psychological disorder and stress after divorce may affect food intake.
The results of this study indicated that the odd of underweight was 2.96 times more common among respondents who finished CPT as compared to those who were not finished CPT in comparison to normal. These findings is concurred with the study from Arba Minch town public health facilities(56), and the study from eastern zone of Tigray region(12). More over Cotrimoxazole preventive therapy have antimicrobial effect of on some bacterial diseases such as pneumonia, diarrhea, malaria, and other opportunistic infections that may help to improve the overall status of the patients (57).
The present study also stated that adults who were taking less than five food groups in the past 24 hours were 2.87 times more likely to be underweight as compared to those who were consuming more than five food groups in comparison to normal. This might be explained by poor dietary diversity has direct effect to the nutritional status of the population. Healthy nutrition plays a central role in the management of HIV/AIDS, especially those symptoms such as diarrhea, anorexia, sore mouth, fever, and muscle wasting – directly associated with the disease. Adequate dietary intake enhances the therapeutic effect of medicines, boosts the immune system (thus helping to fight against the disease and to maintain body weight), prolongs the progression of HIV infection to AIDS, prolonging life and promotes healthy living (39). This finding is supported by the study done Arba Minch town, Asela town public health facilities and Arba Minch Zuria public health facilities(35, 52, 56).
The finding of this study also reviled that food insecured respondents were 2.69 times more likely to be underweight as compared to those who were food secured in comparison to normal. This finding is in line with other studies done in bale Goba, LegaTafo and surrounding, bench shako zone, east Harerge zone and west Shewa zone which stated that household food insecurity was significantly independently associated with undernutrition (27, 39, 41, 42, 58). This was obviously due to lack access to sufficient food to meet dietary needs for productive and health life and it leads to deficiency of macro and micronutrient.
Finding of this study also showed that khat chewer respondents were 2.78 times more likely to be underweight as compared to non-khat chewer in comparison to normal. This finding is not in line with study conducted in east Harerge zone which stated that khat chewing HIV positive adults were half times less likely to be undernourished(39). The possible explanation for this finding may be analysis difference. But This study is supported by other study which was conducted on other population group that stated that khat chewing was significantly associated with underweight(59). This can be explained by khat can have loss of appetite, gas trio intestinal disorder, stomatitis, and esophagitis. The tannins and cathinone from the khat contributes to constipation which is the common medical complain in khat chewer(60).
On the other hand finding of present study showed that respondents whose monthly income less than 2000 ETB were 67% less common to had overweight/obese as compared to those who had more than 2000 ETB monthly income in comparison to normal. This finding is supported by the study in Asela town (52). This can be explained by good income increase the chance of getting junk and high energy food is increased. But low income restricts an individual from getting adequate food and nutrients that may affect the nutritional status of the person.
Present study also showed that the odd of overweight/obese among adult on ART were 1.61 times more common in alcohol drinker as compared to non-drinker in comparison to normal. This can be explained by alcohol can cause weight gain in different ways. It can stop our body from burning fat, alcohol by itself has high kilojoules, and it can increase feeling of hungry that leads to poor food choice(61). This finding was not supported by a study from bale Goba that stated that alcohol consumption was significantly associated with undernutrition among PLHIV. The potential difference might be difference in the study design.
LIMITATION OF THE STUDY
Even if we are giving enough time to remember what they did or the data collector were probing the respondents, we may introduce recall bias when measuring household food security, physical activities and dietary diversity. The data was collected in Abiy Fasting month and Ramadan that can affect daily dietary diversity score. All of the respondents were not the head of the house hold or care giver for the member of the house hold and HFIAS may be affected. Social desirability bias was also the limitation when collecting data regarding alcohol consumption, cigarette smoking and khat chewing, since the data collector was health care providers.
RECOMMENDATIONS
Therefore, based on the finding of this study the following recommendation is forwarded to the concerned bodies.
Federal ministry of health and other nutritional programmer would
- Strength nutritional supplementations to improve the nutritional status of adults living with HIV in the study area.
Health care providers and office administrators would
- Focus on achieving routine patient-centered nutritional assessment and providing supplementation, counseling, care, and support.
- Providing health education to bring behavioral change on the health risks of khat chewing and alcohol drinking associated with benefits of eating fruits and/or vegetables, physical exercise.
Future researcher would
Address factors not assessed in this study like environmental related factors and focus on follow up study especially on those modifiable and clinically important variables.