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dc.contributor.advisorWalsh, C. M.
dc.contributor.advisorJoubert, G.
dc.contributor.authorPienaar, Michelle
dc.date.accessioned2016-11-28T09:05:54Z
dc.date.available2016-11-28T09:05:54Z
dc.date.issued2013
dc.identifier.urihttp://hdl.handle.net/11660/4821
dc.description.abstractEnglish: HIV-infection has a significant impact on health and quality of life. Nutritional factors can be described as those directly related to food and nutrition (such as diet) and those indirectly related to food and nutrition (such as poverty). Dietary diversity is associated with improved socio-economic status and household food security, both of which impact on nutritional status and health. Poor nutritional status is characterised amongst other indicators, by fatigue, physical inactivity, weight loss and wasting, which are associated with poor prognosis in HIV-infection. All of these factors impact on people living with HIV/AIDS, but remain largely undetermined in the Free State. The objective of the present study was to determine significant independent nutritional factors associated with HIV status in rural and urban communities in the cross-sectional Assuring Health for All (AHA) study, which aimed to determine how living in rural and urban communities can influence lifestyle and health. The AHA study was undertaken in rural Trompsburg, Philippolis and Springfontein during 2007 and in urban Mangaung during 2009. Adults between 25-64 years were eligible to participate. The study was approved by the Ethics Committee of the Faculty of Health Sciences at the University of the Free State (ETOVS 21/07) as well as the Free State Department of Health and local municipalities. The venues where data was collected included stations for the collection of blood and urine samples; a food station; medical examination; as well as anthropometric measurements. Thereafter, questionnaires related to the following were completed: socio-demography (one per household); household food security (one per household); diet (one for each participant); physical activity (one for each participant); and reported health (one for every participant). Logistic regression with forward selection (p < 0.05) was used to select significant independent factors (socio-demography, household food security, dietary diversity, physical activity, anthropometry, reported health) associated with HIV status. Variables with a p-value of < 0.15 were considered for inclusion in the model. Of the 570 rural participants, 567 had HIV results. Of these 97 (17.1%) were HIV-infected. Of the 426 urban participants, 424 had HIV results. Of these 172 (40.6%) were HIV-infected. As expected, in rural areas, HIV-infected participants were significantly younger (median age 40.5 years) than HIV-uninfected participants (median age 51 years) (p = 0.001). The same was found in urban areas, with HIV-infected participants having a median age of 38 years compared to 49 years in HIV-uninfected participants (p = 0.0001). In this sample, the odds of having HIV consistently decreased as age increased. In rural areas more HIV-infected participants were female (73.0%) compared to male (27.0%). The same was found in urban areas where 78.0% of the HIV-infected respondents were women and only 22.0% men. As far as socio-demographic and household food security indicators are concerned, in the rural sample HIV-infection was negatively associated with having a microwave oven (odds ratio 0.15, 95% CI 0.06; 0.42); having access to vegetables from local farmers or shops (odds ratio 0.43, 95% CI 0.21; 0.89); and being married (odds ratio 0.20, 95% CI 0.09; 0.41). On the other hand, HIV-infection was positively associated in the rural sample with spending less than R50 on food per week versus R101+ (odds ratio 3.29, 95% CI 1.58; 6.87) or spending less than R100 on food per week versus R101+ (odds ratio 1.22, 95% CI 0.68; 2.20). In the urban sample, HIV-infection was also negatively associated with being married (odds ratio 0.54, 95% CI 0.33; 0.89), while HIV-infection was positively associated with experiencing periods of food shortages (odds ratio 2.14, 95% CI 0.91; 0.95). In the rural sample, one out of five participants had low and medium dietary diversity scores. HIV-infection was negatively associated with a person consuming no eggs (odds ratio 0.41, 95% CI 0.20; 0.82) and consuming no sweets (odds ratio 0.19, 95% CI 0.04; 0.85). On the other hand, HIV-infection was positively associated with being sedentary versus very active (odds ratio 3.18, 95% CI 1.31; 7.70); low active versus very active (odds ratio 2.27, 95% CI 1.08; 4.77); and active versus very active (odds ratio 2.44, 95% CI 1.31; 4.55). No significant dietary diversity or physical activity factors were identified in the urban sample. As far as anthropometric indicators in the rural sample are concerned, HIV-infection was positively associated with a low versus high body fat percentage (odds ratio 15.56, 95% CI 0.80; 303.81); an acceptable low versus high body fat percentage (odds ratio 4.21, 95% CI 2.13; 8.31); and acceptable high versus high body fat percentage (odds ratio 1.85, 95% CI 0.81; 4.22). In the urban sample, HIV-infection was negatively associated with male gender (odds ratio 0.29, 95% CI 0.15; 0.53) and positively associated with a low or acceptable low versus high body fat percentage (odds ratio 9.18, 95% CI 4.89; 17.23) and acceptable high versus high body fat percentage (odds ratio 2.73, 95% CI 1.46; 5.12). When indicators of reported health and coping strategies were considered, a negative association was found between being a member of a church and HIV-infection [odds ratio 0.22 (95% CI 0.06; 0.76) in the rural sample and odds ratio 0.46 (95% CI 0.23; 0.91) in the urban sample]. In rural areas, HIV-infection was positively associated with losing weight involuntarily (>3kg in the past 6 months) (odds ratio 1.86, 95% CI 1.08; 3.20); ever being diagnosed with TB (odds ratio 2.50, 95% CI 1.18; 5.23); being on TB treatment (odds ratio 3.29, 95% CI 1.00; 10.80); and having experienced death of a spouse during the past year (odds ratio 4.91, 95% CI 2.06; 11.73). In the urban sample, HIV-infection was positively associated with having diarrhoea for at least 3 days in the past 6 months (odds ratio 2.04, 95% CI 1.23; 3.41) and having ever been diagnosed with TB (odds ratio 2.49, 95% CI 1.37; 4.53). When all factors identified above were considered for the final model, the odds of having HIV decreased as age increased. In rural areas, HIV-infection was negatively associated with microwave oven ownership (odds ratio 0.20, 95% CI 0.07; 0.57) and being married (odds ratio 0.17, 95% CI 0.08; 0.36). HIV-infection was positively associated with spending less than R50 per week on food versus R101+ (odds ratio 3.15, 95% CI 1.43; 6.95); having a body fat percentage of <5% versus 25%+ (odds ratio 4.41, 95% CI 1.69; 11.51); or having been diagnosed with tuberculosis (odds ratio 3.81, 95% CI 1.93; 7.52). In the urban sample, HIV-infection was negatively associated with male gender (odds ratio 0.29, 95% CI 0.15; 0.57). On the other hand, HIV-infection was positively associated with experiencing periods of food shortage (odds ratio 2.34, 95% CI 1.26; 4.37) and having a body fat percentage of <15% versus 25%+ (odds ratio 8.62, 95% CI 4.42; 16.84). Lower socio-economic status [spending very little on food (rural); and food shortage (urban)], was positively associated with HIV-infection. Being physically inactive [indicated by being sedentary versus very active; low active versus very active; and active versus very active], was positively associated with HIV-infection in the rural sample of this study, probably because lower levels of physical activity are an outcome of HIV-infection. In addition, HIV-infection was positively associated with decreasing body fat percentage (rural and urban). These results confirm the higher prevalence of opportunistic infection and associated symptoms (such as diarrhoea and weight loss) that are outcomes of HIV-infection. Indicators related to wasting, previous tuberculosis and a lower socio-economic status [indicated by being female (urban) and unmarried (rural); spending very little on food (rural); and food shortage (urban)], were associated with HIV-infection, either as outcomes of the disease or as exposures. A vicious cycle develops, with poverty increasing the likelihood of contracting HIV/AIDS and HIV/AIDS contributing to poverty. Interventions that focus on poverty alleviation can make a significant contribution to addressing HIV in South Africa. Interventions of this nature have the potential to improve food security and nutritional status which in turn will assist in preventing weight loss, promoting physical activity and improving quality of life. The social and moral support offered by organisations such as churches is invaluable in the fight against HIV.en_ZA
dc.description.abstractAfrikaans: MIV-infeksie het ’n beduidende impak op gesondheid en lewenskwaliteit. Voedingsfaktore kan beskryf word as dít wat direk verband hou met voedsel en voeding (soos dieet), en dit wat indirek verband hou (soos armoede). Dieetdiversiteit word geassosieer met verbeterde sosio-ekonomiese status en huishoudelike voedselsekuriteit, waarvan albei ’n impak op die individu se voedingstatus en gesondheid het. Moegheid, fisiese onaktiwiteit, gewigsverlies en wegkwyning is onder andere eienskappe van ’n swak voedingstatus. Hierdie tekens word geassosieer met ’n swak prognose in MIV-infeksie. Hierdie faktore wat die persone met MIV-infeksie beïnvloed bly grootliks onbepaald in die Vrystaat. Die doel van die studie was om die beduidende onafhanklike voedingsfaktore, wat met MIV-status in die plattelandse en stedelike gemeenskappe in die dwarssnit Assuring Health for All (AHA)-studie gepaardgaan, te bepaal. Laasgenoemde studie het ten doel gehad om te bepaal hoe die lewe in plattelandse en stedelike gemeenskappe die individu se leefstyl en gesondheid kan beïnvloed. Die AHA-studie is in landelike Trompsburg, Philippolis en Springfontein gedurende 2007 en in die stedelike Mangaung in 2009 onderneem. Volwassenes van 25 tot 64 jaar kon deelneem. Toestemming vir die uitvoering van die studie is verkry van die Etiekkomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit van die Vrystaat (ETOVS 21/07) asook die Vrystaatse Departement van Gesondheid en plaaslike munisipaliteite. Die lokale waar data ingesamel is, het stasies vir die versameling van bloed en uriene; ‘n voedselstasie; mediese ondersoek; sowel as antropometriese metings ingesluit. Daarna is vraelyste in verband met sosio-demografie (een per huishouding); huishoudelike voedselsekuriteit (een per huishouding); dieet (een per deelnemer); fisiese aktiwiteit (een per deelnemer); en gerapporteerde gesondheid (een per deelnemer) voltooi. Logistiese regressie met vorentoe seleksie (p < 0.05) is gebruik om beduidende onafhanklike faktore (sosio-demografies, voedselsekuriteit in die huishouding, dieetdiversiteit, fisiese aktiwiteit, antropometrie en gerapporteerde gesondheid) wat geassosieer is met MIV-status, te bepaal. Veranderlikes met ’n p-waarde van < 0.15 is oorweeg om by die model in te sluit. Van die 570 plattelandse deelnemers, het 567 MIV-resultate gehad. Van hierdie 567, was 97 (17.1%) MIV-geïnfekteer. Van die 426 stedelike deelnemers, het 424 MIV-resultate gehad. Van hierdie 424, was 172 (40.6%) geïnfekteer met MIV. Soos verwag, was MIV-geïnfekteerde deelnemers oorwegend jonger (mediaan-ouderdom van 40.5 jaar) as die MIV-ongeïnfekteerde deelnemers (mediaan-ouderdom van 51 jaar) (p = 0.001) in plattelandse gebiede. Dieselfde is bevind in die stedelike gebiede, met MIV-geïnfekteerde deelnemers met ’n mediaan-ouderdom van 38 jaar in vergelyking met 49 jaar by die MIV-ongeïnfekteerde deelnemers (p = 0.001). In hierdie steekproef het die waarskynlikheid om MIV te hê afgeneem soos wat ouderdom toegeneem het. In die plattelandse gebiede was daar meer vroulike MIV-geïnfekteerde deelnemers (73.0%) as mans (27.0%). Dieselfde is gevind in die stedelike gebiede waar 78.0% van die MIV-geïnfekteerde respondente vroue was met slegs 22.0% mans. Wat sosio-demografiese en voedselsekuriteit-aanwysers betref, was MIV-infeksie in die plattelandse gebiede negatief geassosieer met die besit van ‘n mikrogolfoond (kansverhouding 0.15, 95% CI 0.06; 0.42), om toegang tot groente van plaaslike boere en winkels te hê (kansverhouding 0.43, 95% CI 0.21; 0.89) en getroud te wees (kansverhouding 0.20, 95% CI 0.09; 0.41). Hierteenoor was MIV-infeksie positief geassosieer as ‘n mens minder as R50 ’n week op kos versus R101+ spandeer (kansverhouding 3.29, 95% CI 1.58; 6.87) of R100 ’n week op kos spandeer versus R101+ (kansverhouding 1.22, 95% CI 0.68; 2.20). In die stedelike steekproef was MIV-infeksie ook negatief geassosieer met getroud wees (kansverhouding 0.54, 95% CI 0.33; 0.89). Hierteenoor was MIV-infeksie positief geassosieer met die ervaring van tydperke van voedseltekort (kansverhouding 2.14, 95% CI 0.91; 0.95). In die plattelandse gebied het een uit elke vyf deelnemers lae en medium-voedseldiversiteit-tellings gehad. MIV-infeksie was negatief geassosieer met inname van geen eiers (kansverhouding 0.41, 95% CI 0.20; 0.82) en geen lekkergoed (kansverhouding 0.19, 95% CI 0.04; 0.85) ingeneem het nie. Hierteenoor was MIV-infeksie positief geassosieer met sittende versus baie aktief (kansverhouding 3.18, 95% CI 1.31; 7.70); lae aktief versus baie aktief (kansverhouding 2.27, 95% CI 1.08; 4.77); en aktief versus baie aktief (kansverhouding 2.44, 95% CI 1.31; 4.55). Geen beduidende voedseldiversiteit- of fisiese aktiwiteits-faktore is in die stedelike steekproef geïdentifiseer nie. Wat antropometriese aanwysers betref, was MIV-infeksie in die landelike steekproef positief geassosieer met lae versus hoë liggaamsvetpersentasie (kansverhouding 15.56, 95% CI 0.80; 303.81); ’n aanvaarbaar lae versus hoë liggaamsvetpersentasie (kansverhouding 4.21, 95% CI 2.13; 8.31); ’n aanvaarbaar hoë versus hoë liggaamsvetpersentasie (kansverhouding 1.85, 95% CI 0.81; 4.22). In die stedelike steekproef, was MIV-infeksie negatief geassosieer met die manlike geslag (kansverhouding 0.29, 95% CI 0.15; 0.53) en positief geassosieer met ’n lae of aanvaarbaar lae versus hoë liggaamsvetpersentasie (kansverhouding 9.18, 95% CI 4.89; 17.23) en ’n aanvaarbaar hoë versus hoë liggaamsvetpersentasie (kansverhouding 2.73, 95% CI 1.46; 5.12). Wanneer aanwysers van gerapporteerde gesondheid en hanteringsmeganismes oorweeg is, is ‘n negatiewe assosiasie gevind tussen kerk-lidmaatskap en MIV-infeksie [kansverhouding 0.22 (95% CI 0.06; 0.76) in die plattelandse steekproef en 0.46 (95% CI 0.23; 0.91) in die stedelike steekproef]. In die plattelandse gebiede was MIV-infeksie positief geassosieer met onvrywillige gewigsverlies (>3kg in die laaste ses maande) (kansverhouding 1.86, 95% CI 1.08; 3.20); om ooit met TB gediagnoseer te word (kansverhouding 2.50, 95% CI 1.18; 5.23); om op TB-behandeling te wees (kansverhouding 3.29, 95% CI 1.00; 10.80) en om die dood van ’n huweliksmaat die afgelope jaar te beleef (kansverhouding 4.91, 95% CI 2.06; 11.73). In die stedelike steekproef was MIV-infeksie positief geassosieer met diarree vir ten minste drie dae in die afgelope ses maande (kansverhouding 2.04, 95% CI 1.23; 3.41) en om voorheen met TB gediagnoseer te wees (kansverhouding 2.49, 95% CI 1.37; 4.53). Nadat al die faktore, wat hierbo geïdentifiseer is, vir die finale model oorweeg is, het die MIV-waarskynlikheid afgeneem soos wat die ouderdom van deelnemers toegeneem het. In die plattelandse gebiede was MIV-infeksie negatief geassosieer met mikrogolfoond-eienaarskap (kansverhouding 0.20, 95% CI 0.07; 0.57) en om getroud te wees (kansverhouding 0.17, 95% CI 0.08; 0.36). HIV-infeksie was positief geassosieer met die spandering van minder as R50 versus R101+ per week op kos (kansverhouding 3.15, 95% CI 1.43; 6.95); om ’n liggaamsvetpersentasie < 5% versus 25%+ (kansverhouding 4.41, 95% CI 1.69; 11.51) te hê of om met TB gediagnoseer te wees (kansverhouding 3.81, 95% CI 1.93; 7.52). In die stedelike steekproef, was MIV-infeksie negatief geassosieer met manlike geslag (kansverhouding 0.29, 95% CI 0.15; 0.57). Hierteenoor was MIV-infeksie positief geassosieer met die ervaring van periodes van voedseltekort (kansverhouding 2.34, 95% CI 1.26; 4.37) en om ’n liggaamsvetpersentasie van < 15% versus 25%+ (kansverhouding 8.62, 95% CI 4.42; 16.84) te hê . ’n Laer sosio-ekonomiese status [om baie min aan kos te spandeer (plattelands); en voedseltekort (stedelik)] was positief geassosieer met MIV-infeksie. Om fisies onaktief te wees [aangedui deur sittend versus baie aktief; lae aktief versus baie aktief; en aktief versus baie aktief] was positief geassosieer met MIV-infeksie in die plattelandse steekproef van hierdie studie. Die rede hiervoor is waarskynlik omdat laer vlakke van fisiese aktiwiteit ‘n uitkoms van MIV-infeksie is. MIV-infeksie was ook positief geassosieer met afname in liggaamsvetpersentasie (plattelands en stedelik). Hierdie resultate bevestig die hoër voorkoms van opportunistiese infeksie en geassosieerde simptome (soos diarree en gewigsverlies) wat uitkomste van MIV-infeksie is. Aanwysers wat verband hou met wegkwyning, vorige tuberkulose en ’n laer sosio-ekonomiese status [aangedui deur vroulike geslag (stedelik) en ongetroud (plattelands); spandering van baie min op kos (plattelands); en voedseltekort (stedelik)], was geassosieer met MIV-infeksie, as uitkoms van die siekte of as blootstelling. ’n Bose kringloop ontstaan met armoede wat die waarskynlikheid om MIV/VIGS te kry laat toeneem asook MIV/VIGS wat weer tot armoede lei. Intervensies wat daarop fokus om armoede te verlig kan ’n aansienlike bydrae maak om MIV in Suid-Afrika aan te spreek. Intervensies van hierdie aard het die potensiaal om voedselsekuriteit en voedingstatus te verbeter, wat weer gewigsverlies kan voorkom, fisiese aktiwitiweit kan bevorder en lewensgehalte kan verbeter. Die morele en sosiale ondersteuning wat deur organisasies soos kerke aangebied word, is van onskatbare waarde in die stryd teen MIV.af
dc.language.isoenen_ZA
dc.publisherUniversity of the Free Stateen_ZA
dc.subjectThesis (Ph.D. (Nutrition and Dietetics))--University of the Free State, 2013en_ZA
dc.subjectAIDS (Disease) -- Nutritional aspects -- South Africa -- Free Stateen_ZA
dc.subjectHIV infections -- Nutritional aspects -- South Africa -- Free Stateen_ZA
dc.subjectQuality of lifeen_ZA
dc.titleNutritional factors associated with HIV-infected adults in the Free Stateen_ZA
dc.typeThesisen_ZA
dc.rights.holderUniversity of the Free Stateen_ZA


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