Poor nutrition status and associated feeding practices among HIV-positive children in a food secure region in Tanzania: a call for tailored nutrition training.
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 (β = 0.11, p = 0.016); underweight (β = 0.12, p = 0.029); and thinness (β = 0.11, p = 0.026). Lower feeding frequency was associated with low wealth index (β = 0.06, p<0.001), food insecurity (β =  -0.05, 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.


CONCLUSIONS
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.
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Bruno F
BF
Sunguya
Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America.
Krishna C
KC
Poudel
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Linda B
LB
Mlunde
School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
David P
DP
Urassa
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Junko
J
Yasuoka
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masamine
M
Jimba
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D005523:Food Supply; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology*; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology