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

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neglect children, have mental health problems, or are poor. 5. 4 Management of Common Nutrition-Related Conditions Intervention for Infants and children with HIV/AIDS Please refer to Table 5.1 for the management of the common nutrition related conditions in infants and children with HIV/AIDS. These suggestions were provided because they were shown to work. However, children who show no improvement despite careful implementation of the recommended interventions should be referred to a dietitian for a thorough nutrition assessment as there may be other underlying conditions. Table 5.1: Suggested Nutritional Intervention for Infants and Children with HIV/AIDS SYMPTOMS Normal/mild symptoms; fever, infection INTERVENTION · Well balanced diet, nutrient dense with snacks · In the case of fever encourage fluids Poor weight gain/growth, poor appetite · High calorie, high protein, nutrient dense diet. · Nutritional supplementation under close dietetic monitoring 6 Diarrhoea /mal-absorption · Give oral rehydration solution and feed soft foods as soon as food can be tolerated. Ideally, children should be fed within 4 hours of re-hydration. · Encourage fluids for dehydration · Avoid concentrated formulas · Avoid excessive fruit juices and foods with sorbitol · Restrict lactose if necessary till diarrhoea resolves · Avoid intake of insoluble fiber; soluble fiber maybe helpful · Avoid high fat foods if steatorrhoea is suspected Nausea, vomiting · Eat cold foods and beverages · Eat dry foods, such as crackers or toast · Small frequent meals · Low fat, bland, non spicy foods · Avoid strong smelling foods · Avoid carbonated drinks Oral/oesophageal/gastric discomfort and pain · Smooth, soft foods · Cold, non-spicy foods · Cut food into small pieces · Milkshakes, ice creams · Drink through straw · Small, frequent meals · To aid swallowing, use mild sauces and gravies on foods Developmental delay · Feeding/swallowing evaluation by trained individuals · Texture modifications or feeding by parent or caretaker 6 For more detailed classification of diarrhoea and recommend feeding consult the IMCI guidelines, page 11. 28
CHAPTER 6 INFANT FEEDING AND PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS 6.1 Transmission of HIV Infection from Mother to Child Infants can acquire HIV infection through mother-to-child transmission (MTCT), blood transfusion or infected blood products, and/or use of contaminated instruments. In MTCT, infants can acquire HIV infection before, during or after delivery. Transmission of HIV from an infected mother to her infant can occur during pregnancy or delivery. The additional risk of transmission from breast milk is about 15% for babies who are breastfed for up to 6 months and about 20% for babies' breastfed in their second year of life. Women who are infected during breastfeeding have a much higher risk (29%) of transmitting the virus through breast milk. Given these risk, feeding recommendations that reduce the rate of MTCT have been provided. See table 8.1 for recommendations of women of different HIV status. All women should be educated fully about the available infant feeding options and their risks and benefits. It is only when women are empowered through education and skill acquisition that they can be in a better position to select feeding options that will work well for them and their infants. 7 While all breastfeeding mothers should be taught proper positioning and attachment to prevent the development of cracked nipples and other breast conditions, this counsel is particularly important in HIV infected women. Cracked nipples, mastitis and breast abscesses increase the risk of HIV transmission through breast milk. Health workers should demonstrate proper positioning and attachment to prevent the development of cracked nipples and counsel mothers on how to prevent and manage other types of breast problems. Further, if breastfeeding HIV positive mothers develop any of these conditions, infant-feeding options should be revisited. 6.2 Care and Support of Women, their Partners and Children Prevention of MTCT starts with well informed and empowered women and their partners. Therefore, women and their partners should be encouraged to know their HIV status and together commit to zero HIV transmission. Women and their partners who are already infected should be supported and helped to access HAART and IPT Prophylaxis as early as possible and accompany each other to all HIV related services. Further, women and children identified as HIV-positive during MCH care should be fully integrated into all routine services. For those couples who have not conceived as yet and have the desire to raise a family, there is need to also educate them about the risks associated with pregnancy and alternative ways of becoming parents. 7 Use the Botswana IYCF training materials 29
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
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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 38 and 39: ° Ensure that all immunizations an
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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