title: High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa.
abstract: BACKGROUND
  Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.
  
  
  METHODS
  We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.
  
  
  RESULTS
  One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).
  
  
  CONCLUSIONS
  Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, United States of America.
authors.forename: Noelle A
authors.initials: NA
authors.lastname: Benzekri
authors.affiliation: Centre de Santé de Ziguinchor, Ziguinchor, Sénégal.
authors.forename: Jacques
authors.initials: J
authors.lastname: Sambou
authors.affiliation: Centre Hospitalier Universitaire de Fann, Dakar, Sénégal.
authors.forename: Binetou
authors.initials: B
authors.lastname: Diaw
authors.affiliation: Centre de Santé de Ziguinchor, Ziguinchor, Sénégal.
authors.forename: El Hadji Ibrahima
authors.initials: el HI
authors.lastname: Sall
authors.affiliation: Centre Hospitalier Universitaire de Fann, Dakar, Sénégal.
authors.forename: Fatima
authors.initials: F
authors.lastname: Sall
authors.affiliation: Centre de Santé de Ziguinchor, Ziguinchor, Sénégal.
authors.forename: Alassane
authors.initials: A
authors.lastname: Niang
authors.affiliation: Centre Hospitalier Universitaire de Fann, Dakar, Sénégal.
authors.forename: Selly
authors.initials: S
authors.lastname: Ba
authors.affiliation: Centre Hospitalier Universitaire de Fann, Dakar, Sénégal.
authors.forename: Ndèye Fatou
authors.initials: NF
authors.lastname: Ngom Guèye
authors.affiliation: Centre Hospitalier Universitaire de Fann, Dakar, Sénégal.
authors.forename: Mouhamadou Baïla
authors.initials: MB
authors.lastname: Diallo
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, United States of America; Department of Epidemiology, University of Washington, Seattle, WA, United States of America.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Hawes
authors.affiliation: Centre Hospitalier Universitaire de Fann, Dakar, Sénégal.
authors.forename: Moussa
authors.initials: M
authors.lastname: Seydi
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, United States of America; Department of Global Health, University of Washington, Seattle, WA, United States of America.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012675:Senegal