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

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° Ensure that all immunizations and vitamin A supplementation have been recorded on the CWC ° Counsel mothers/caretakers about the importance of taking their children for monthly growth promotion and monitoring. ° Children brought for growth monitoring should be weighed accurately; children should be weighed without shoes, diapers and clothing. ° The weights should be plotted accurately against the ages on the Child Welfare Card. ° Mothers or caregivers whose children have growth failure should be advised accordingly. ° Nutrition counseling should be given to all mothers/caretaker irrespective of the growth status/pattern of the child. ° Mothers should be counseled on proper care and use of the CWC. ° The child's diet should be reviewed at every contact to ensure appropriate feeding. ° Help mothers to practice active responsive feeding ° Assess and promote good hygiene and proper food and water safety and handling (as detailed in Chapter 8.) ° Encourage mothers to seek healthcare and support if the child is either not growing well, loosing weight, has eating problems, has sores/ulcers in its mouth, or gets opportunistic and other infections, such as malaria/fever, diarrhoea and respiratory infections. ° Promote continued adequate dietary care and support during and after illness. Create awareness about psychological and socio-economic support that households with HIV/AIDS infected children can access in their locality 5.3.3 Nutritional care and support for children over 2 years In addition to providing nutrition care and support guidelines for children 6 24 months, mothers of children 2 years and older must be advised to provide children with a balanced diet that is based on the principles of a healthy diet as detailed in Chapter 2. However the portions of the food provided must be smaller than adult portions to match those recommended for children. In general serving portions for children are about ½ of adult sizes. As the child grows the amount of food given should be increased gradually. 5.3.4 Care and Support for Severely Malnourished Children with HIV/AIDS Severely malnourished children with HIV/AIDS are about five times more likely to die than uninfected children. Such children rarely respond to conventional nutritional rehabilitation and take much longer to recover. Providers are strongly encouraged to refer children with acute and severe malnutrition to the hospital where they can receive care from a team of medical doctors and dietitians. All children with weight for height less than 70% or below -3 standard deviations with or without oedema are considered to have acute and severe malnutrition. The Management of severely malnourished children with HIV involves achieving high energy and high nutrient intakes to realize complete recovery. However, the high energy and nutrient dense diet should be progressed as tolerated and with extreme caution. Given the seriousness of severe malnutrition in all children let alone those infected with HIV, providers should encourage caregivers to request healthcare promptly when children are not growing well. To this end, regular attendance of Growth Monitoring should be encouraged. In addition to all these, providers must familiarize themselves with the signs and symptoms of severe malnutrition. Refer to the Tables 5.1 for the 26
suggested nutrition interventions for children with common nutrition related conditions. Providers must; Be aware of signs of severe malnutrition: ° Look out for visible severe wasting, especially of the trunk and buttocks. ° Look out for oedema (swelling) of both feet. ° Look for anaemia, pallor of the palms and mucus membranes. ° If possible weigh the child and record on the child welfare card. ° Look for possible signs of parent's negligence; caregivers can play a major role in putting their children as risk for malnutrition. If the child has severe malnutrition and is being transferred to the nearest hospital check for and attend to complications that might lead to death: ° If the child has a very low body temperature (below 35 degrees centigrade), keep the child warm. ° If the child is dehydrated or has diarrhoea, give resomal or diluted oral rehydration ° solution as is described in the Acute and Severe Malnutrition guidelines to replace lost fluids. ° If the child has hypoglycemia (characterized by drowsiness and stupor), give a glucose solution (use intravenous fluids in moderation) as per guidance provided in the Acute and Severe Malnutrition (ASM) guidelines. ° Provide broad-spectrum antibiotics to all children with severe malnutrition. ° Hospitalized children should be provided with F75 if it is available within two hours of admission to start with and progress as outlined in the ASM guidelines Counsel the mothers/caretakers on the need for referral and urgently refer children with severe malnutrition to the hospital or an appropriate nutritional rehabilitation institution. ° When in a hospital or a Nutritional Rehabilitation Centre, severely malnourished children should be managed according to the Botswana guidelines for management of severe malnutrition. ° Severely malnourished children with HIV/AIDS who are not on ARVs should be referred to providers of anti-retroviral therapy services. ° Severely malnourished infants are at higher risk of serious illnesses and mortality than older children. For children who had been hospitalized, upon discharge caregivers must be encouraged ° To feed the child frequently with energy and nutrient-dense food. ° To involve the child in play and stimulation in order to foster the child's development. ° To take the child for regular follow-up to ensure the child completes immunization receives 6-monthly vitamin A and undergoes monthly growth monitoring. ° To see a social worker, if providers suspect the child severe malnutrition was related to problems that might require the intervention of a social workers, such as parents who 27
Page 1: NATIONAL NUTRITION AND HIV/AIDS GUI
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
Page 14 and 15: declining though still high, from 4
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
Page 22 and 23: 2.3.5 Milk and Dairy Foods Milk and
Page 24 and 25: social and health effects. Some of
Page 26 and 27: CHAPTER 3 THE RELATIONSHIP BETWEEN
Page 28 and 29: Table 3.1 WHO Clinical classificati
Page 30 and 31: clients, preference should be given
Page 32 and 33: nutrition. PLWHA found to fit in th
Page 34 and 35: 4.3.3 Clinical The key in clinical
Page 36 and 37: 5.1.1 Nutritional Screening It is r
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
Page 60 and 61: ° For PLWHA living in areas where
Page 62 and 63: HERB Sore mouth and throat Recommen
Page 64 and 65: CHAPTER 11 NUTRITION EDUCATION AND
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
Page 74 and 75: ° Are there any dietary changes am
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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