Provision and perceptions on nutrition education for people with HIV/AIDS, at the public comprehensive care clinics: a study of Nairobi district clinics in Kenya

Abstract

As early as 2003, The Greater Horn of Africa Capacity Development Initiative in Nutrition had already identified nutrition in HIV/AIDS as an area of capacity development urgently needing attention. The Government of Kenya in collaboration with multilateral and bilateral agencies spearheaded the development of the "Kenya National Guidelines on nutrition and HIV IAIDS" for use in the Comprehensive Care Clinics for harmonised nutritional strategies. This non intervention cross-sectional study was carried out to analyse the nutrition education offered in the Public Comprehensive Care Clinics. Its objectives were to examine the nutrition education in the clinics and establish the nutrition education support materials being used. Levels of awareness of the roles of diet in the management of HIV IAIDS by clients in the clinics were also explored and perceptions of both the nutrition educators and their clients on the nutrition education offered were sought. One hundred and fifty two clients infected with the HIV IAIDS virus and five nutrition educators in three clinics were interviewed. Data was collected using structured pretested and modified questionnaires, focus group discussions and observations. The client's dietary diversity was determined through the Individual Food Dietary Diversity questionnaires. The results indicated that generally more females than males attended these clinics and a majority of the clients (93.4%) had some formal school education. The clients attending xix the clinics were relatively young adults with a mean age of 35.7 years (SD=8.17). The BMI were within the normal limits for majority of the clients (64%). Correlation Analysis and Analysis of Variance tests did not reveal any significant relationship (p>O.05) between BMI and the clients socio-dernographic characteristics. There was a significant association p<O.05 (p=O.OOl) between perceptions of nutrition education and knowledge of key nutritional practices for People with HIV/AIDS. The Individual Food Dietary Diversity Questionnaire (mean score=7) revealed that consumption of foods by the clients was not very diversified implying their diets were likely to be nutritionally deficient. Though nutrition educators expressed satisfaction with their work they were frustrated by lack of adequate tools, insufficient materials, heavy workloads and lack of private space to carry out nutrition education sessions. The recommended nutritional guidelines, information, education and communication materials were not available in the clinics and accordingly they had not been used in the nutrition education sessions. The study concluded that the nutrition education services offered to People With HIVIAIDS in the public Comprehensive Care Clinics are inadequate. The finding led to the recommendation that Ministry of Health should address the issues of understaffing of nutrition educators in the clinics. There is also need for a concerted effort to frequently monitor the provision of nutrition education in the clinics to ensure adherence to the stated government protocols and harmonised intervention strategies. In addition nutrition educators should be meticulously trained on application of guidelines and protocols in the management of nutrition for their clients.