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Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study

Tesfay, F, Ziersch, A, Mwanri, L and Javanparast, S 2020, Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study, PLoS ONE, vol. 15, no. 4, pp. 1-24, doi: 10.1371/journal.pone.0231859.

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Title Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study
Author(s) Tesfay, FORCID iD for Tesfay, F orcid.org/0000-0003-0399-1711
Ziersch, A
Mwanri, L
Javanparast, S
Journal name PLoS ONE
Volume number 15
Issue number 4
Start page 1
End page 24
Total pages 24
Publisher PLOS
Place of publication San Francisco, CA
Publication date 2020-04-27
ISSN 1932-6203
Keyword(s) HIV
Malnutrition
Food
Nutrition
Ethiopia
Religion
Employment
Socioeconomic aspects of health
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
ANTIRETROVIRAL THERAPY
HEALTH
HIV/AIDS
ADULTS
EDUCATION
BEHAVIOR
Summary Introduction: Addressing malnutrition is one of the key components of HIV care among people living with HIV. Since 2010, a nutritional program has been implemented to address malnutrition amongst HIV patients in Ethiopia, with patients enrolled in the program for 3 months (for mild acute malnutrition) and 6 months (for severe acute malnutrition). However, utilisation and effectiveness of the nutritional programs remain unexplored. This study aimed to examine individual level determinants and contextual factors influencing the effectiveness of the nutritional program in the Tigray region of Ethiopia. Methods and setting: The study employed a mixed-methods approach involving quantitative and qualitative research methods. In the quantitative phase of the study, records from 1757 adult patients, including socio-demographic characteristics, clinical and nutritional program outcomes were retrieved from three selected hospitals in the Tigray region, Ethiopia. Logistic regression analysis was used to identify the individual demographic and socioeconomic, clinical and immunological, and anthropometric and nutritional determinants of nutritional outcomes. The qualitative study included 33 individual interviews with adult patients, health providers, and program managers. Interview data were analysed using a framework analysis approach. Results: Amongst study participants, 55.3% (95% CI = 53.2-57.4) recovered from malnutrition, 19% (95% CI, 17.3-20.7) did not complete the program, and 21% (95% CI = 19.7-23.4) completed the program but failed to recover from malnutrition. In the multivariable logistic regression analysis, those who were: living in urban areas (AOR = 1.44, 95% CI = 1.05-1.97), employed (AOR = 1.39, 95% CI = 1.01-1.93), attending Shul (AOR = 4.6, 95% CI = 3.15-6.71) and Lemlem Karl (AOR = 2.5, 95% CI = 1.69-3.71) hospitals, in clinical stages II (AOR = 2.49, 95% CI = 1.59-3.91) and III (AOR = 1.46(1.02-2.07), on ART for less than six months (AOR = 1.61, 95% CI = 1.09-2.39), anaemic (AOR = 1.77, 95% = 1.29-2.41), and diagnosed with severe acute malnutrition at enrolment (AOR = 6.43, 95% CI = 4.69-8.3); were less likely to complete the program. Results for those who completed the program indicated that urban residence, (AOR = 1.46, 95% CI = 1.4-2.91), attending Shul (AOR = 2.92, 95% CI = 2.04-4.19) and Lemlem Karl (AOR = 1.49, 95% CI 1.05-2.11) hospitals, having bedridden functional status (AOR = 0.36, 95% CI = 0.15-0.83), advanced WHO clinical stage (WHO clinical stage IV) (AOR = 0.52, 95% CI = 0.28-0.98) and severe malnutrition at enrolment (AOR = 4.25, 95% CI = 3.02-5.98)) predicted non-response to the nutritional program. Qualitative interviews revealed that the taste and perceived side effects of the nutritional supplement provided as part of the nutritional program, sharing/selling practices, religious and sociocultural issues, distance and poor access to the health services were barriers to program utilisation. Nutritional counselling and health service-related factors such as a previous enrolment in the program and positive experience in the health service were enablers of program utilisation. Conclusion: There was a clear nexus between contextual factors such as distance, quality of health service and sociocultural factors, and individual patient characteristics with the effectiveness of the nutritional program. Taking individual and contextual factors into consideration in program design, planning and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV.
Language eng
DOI 10.1371/journal.pone.0231859
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2020, Tesfay et al.
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30136586

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