National Nutrition and HIV/AIDS Guidelines for Service Providers of ...

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5.1.1 Nutritional Screening It is recommended that all children with HIV infection be screened for risk of malnutrition within 3 months of diagnosis and every 1-6 months thereafter, relative to age, problems and nutritional status. The nutrition screening tool provided in section 4.2 Nutrition Screening) can be used to facilitate this process. Nutrition screening may be performed by the consulting health care professional or a professional from another more appropriate practice area/ agency through a referral. In both situations, however, it is important that the needs of the caregiver/ family unit are considered. Where possible health facility visits must be kept to a minimum as these have social and financial implications on the caregiver/ family unit. All efforts must be taken to support the caregiver or family unit by arranging appointments in a manner that lightens their schedules and financial burdens. For example, appointments can be arranged such that caregivers can come for multiple services within the same day. 5.1.2 Nutritional Assessment Nutritional assessment is to be carried out by a dietitian. Any of the nutrition assessment methods described in Chapter 4 can be used. What is crucial is that the child's measurements be compared to a suitable reference standard for age and gender. 5.2 Nutritional Requirements Nutritional requirements for children are best estimated by the dietitian because the recommended dietary allowances (RDA) for children infected with HIV are not well established. The increase in basal energy expenditure (BEE) associated with HIV infection observed in adults is not well understood in children. However, since the energy needs of asymptomatic adults are reported to increase by about 10% due to increased basal energy expenditure, it is probable that the same is true for children. Although the evidence is still inconclusive the energy needs for HIV infected children are set at 10% above that of their HIV negative counterparts. Refer to the table below for the recommended energy needs of children infected by HIV. These recommendations were provided by the WHO technical Working Team on children (2003) 5.2.1 Energy requirements Asymptomatic Symptomatic without wt loss Symptomatic with weight loss An increase of 10% above RDA An increase of 20-30% above RDA An increase of 50 100 % above RDA 5.2.2 Protein and Micronutrients Protein and micronutrient requirements for HIV infected children are similar to those of uninfected children. Therefore, protein and micronutrients RDA for healthy children apply for infected children as well. However, there is some consensus that some increase is warranted especially in symptomatic children in the same manner as the nutrients requirement for malnourished children are higher. 5.3 Nutritional Support and Care 5.3.1 Nutritional care and support for children 0 6 months Nutrition care is discussed in detail in chapter 6 and in the PMTCT guidelines and the Infant and young child feeding policy draft document. Briefly, HIV infected children between 0-6 months can be on exclusive breastfeeding or receive replacement formula feeding. The choice of the feeding method is 24
made by the mother following counseling by a health professional. Which ever method mothers select they are strongly discouraged from mixed feeding as doing so will encourage the transmission of HIV through breastmilk. Please refer to chapter 6 for more details. 5.3.2 Nutrition care and support for children 6-24 months I. Support mothers/caretakers to provide children infected with HIV with nutritious diet and to address factors that result in decreased food intake. In addition to either exclusive breastfeeding or formula feeding children 6-24 should be progressively introduced to complementary foods. Therefore providers should counsel mothers/caretakers on feeding recommendations as provided on the child welfare card (CWC) or IMCI. Recommendations for feeding well and sick children should be shared with the mother. Providers should also encourage mothers to provide children with adequate amounts of and a variety of foods to meet the high needs associated with growth and development. This can de done by teaching parents how to increase the energy and nutrient density of foods, supporting caregivers in developing appropriate child rearing practices, and in using available child survival services. Specific ways of achieving these are outlined under the respective sub headings below; In addition to all these it is important that providers continually increase their knowledge and skill level in the care and support of children. To get additional energy and nutrients, ° Encourage mothers to offer children adequate amount of food, feed more often, offer nutrient dense snacks like; eggs, yogurt between meals ° Promote foods and fluids that are rich in energy and nutrients ° Advise on use of foods fortified with micronutrients e.g. foods issued at the clinics for the under fives (e.g., Tsabana and Enriched Maize Meal) ° Discuss food fortification like addition of oil, sour milk, margarine, peanut butter to porridge (for more examples see CWC card). ° Encourage frequent eating of fruits and vegetables ° Encourage continued adequate milk intake ° Give more nutritious foods if the child wants to eat ° Educate mother of non-nutritious foods (fresh chips, fizzy drinks, etc) and encourage them to restrict their intake. To support the mother/caretaker to: ° Provide nutritious food according to the weight and age of the child, and increase the food portions, as the child grows older. ° Feed the child frequently (five to six times per day) and provide nutritious snacks in between meals ° Make sure the child's food is freshly prepared. To Support mothers/caretakers to use essential child survival services. ° Ensure that each child has a Child Welfare Card. ° Assess children for complete and up-to-date immunization. Immunize or refer children whose immunization is not up-to-date. ° Assess whether children are receiving vitamin A supplementation. If it has not been done in the last 6 months, provide the service. 25
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Page 5: ACKNOWLEDGEMENTS Developing these g
Page 8 and 9: 4.1.3 Symptomatic 18 4.1.4 Advanced
Page 10 and 11: TECHNICAL WORKING TEAM MEMBERS 1 Mr
Page 12 and 13: GLOSSARY LIST Asymptomatic: When a
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Page 16 and 17: 1.8 Layout of the Guidelines Each c
Page 18 and 19: Table 2.1: Summary table for the fo
Page 20 and 21: provide fiber. Nutrients found in v
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Page 26 and 27: CHAPTER 3 THE RELATIONSHIP BETWEEN
Page 28 and 29: Table 3.1 WHO Clinical classificati
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Page 34 and 35: 4.3.3 Clinical The key in clinical
Page 38 and 39: ° Ensure that all immunizations an
Page 40 and 41: neglect children, have mental healt
Page 42 and 43: Table 6.1 Specific feeding recommen
Page 44 and 45: 7.1.2 Protein Requirements The prot
Page 46 and 47: CHAPTER 8 PROTECT THE QUALITY AND S
Page 48 and 49: 8.5 Hygiene in the Kitchen ° Keep
Page 50 and 51: CHAPTER 9 PLWHA may take various ty
Page 52 and 53: As the effect of food on the effica
Page 54 and 55: Medication Purpose Recommendation/
Page 56 and 57: Appropriate dietary responses Appro
Page 58 and 59: that are presently marketed in Bots
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Page 62 and 63: HERB Sore mouth and throat Recommen
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Page 66 and 67: warmth, understanding, and respect
Page 68 and 69: CHAPTER 12 HIV/AIDS, NUTRITION AND
Page 70 and 71: younger siblings. ° Sale of key as
Page 72 and 73: ° Emphasize and support small scal
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Page 76 and 77: ANNEXES ANNEX 1: Scientific Or Engl
Page 78 and 79: ANNEX 3: Nutrient Composition of a
Page 81 and 82: Annex 5: National Nutrition and HIV
Page 83: 12.6. Strongly Disagree 13. During

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