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Aberman N.-L.,International Food Policy Research Institute | Rawat R.,International Food Policy Research Institute | Drimie S.,Stellenbosch University | Claros J.M.,Nutrition and HIV AIDS Policy | And 2 more authors.
AIDS and Behavior | Year: 2014

The number of people receiving antiretroviral therapy in developing countries has increased dramatically. The last decade has brought an increased understanding of the interconnectedness between HIV/AIDS, food insecurity, and undernutrition and a surge of evidence on how to address the food security and nutrition dimensions of the epidemic. We review this evidence as well as the corresponding evolution of policy support for incorporating food security and nutrition concerns into HIV programming. The available evidence, although varied in scope and methodologies, shows that nutrition supplementation and safety nets in the form of food assistance and livelihood interventions have potential in certain contexts to improve food security and nutrition outcomes in an HIV/AIDS context. In the face of funding uncertainties and competing priorities, we must maintain momentum towards effective and sustainable solutions to the epidemic through continued systematic research to inform policy and through the strengthening of monitoring systems to dynamically inform intervention development. © 2014, Springer Science+Business Media New York.

Semba R.D.,Johns Hopkins University | De Pee S.,Nutrition and HIV AIDS Policy | Bloem M.W.,Nutrition and HIV AIDS Policy
CAB Reviews: Perspectives in Agriculture, Veterinary Science, Nutrition and Natural Resources | Year: 2012

Human immunodeficiency virus (HIV) infection and malnutrition remain major causes of morbidity and mortality among children in developing countries. Malnutrition also exacerbates the clinical course of HIV-infected children by further compromising immunity and increasing the severity of opportunistic infections. This review summarizes current scientific knowledge regarding the role of nutrition in the pathophysiology of HIV infection in children and presents the perspective of integrating nutritional interventions with programmes in resource-limited settings to increase survival of HIV-exposed and -infected children. The three major programming areas for identifying and caring for HIV-infected and HIV-exposed children are: (1) prevention of mother-to-child transmission (PMTCT) of HIV, which is the earliest possible detection of HIV-exposure of the child, (2) care for HIV-infected children and (3) treatment of malnourished children, as for many children whose HIV exposure is unknown, malnutrition can be a first sign of HIV infection. Care for HIV-exposed and -infected infants and children requires early diagnosis of HIV exposure and status, especially through PMTCT services, availability of antiretrovirals (ARVs) and nutritional services including growth monitoring, use of specially formulated foods, micronutrient supplementation, vitamin A supplementation, zinc therapy and micronutrient supplementation for the treatment of diarrhoea, use of iodized salt and exclusive breastfeeding according to national guidelines. Given that the scale-up of PMTCT is expected to accelerate in the next several years, basic nutritional interventions should be part of the standard of care of these programmes. © CAB International 2012.

Bloem M.W.,Nutrition and HIV AIDS Policy | Bloem M.W.,Tufts University | Bloem M.W.,Johns Hopkins University | Semba R.D.,Johns Hopkins University | Kraemer K.,In.Sight
Journal of Nutrition | Year: 2010

The global food supply system is facing serious new challenges from economic and related crises and climate change, which directly affect the nutritional well-being of the poor by reducing their access to nutritious food. To cope, vulnerable populations prioritize consumption of calorie-rich but nutrient-poor food. Consequently, dietary quality and eventually quantity decline, increasing micronutrient malnutrition (or hidden hunger) and exacerbating preexisting vulnerabilities that lead to poorer health, lower incomes, and reduced physical and intellectual capabilities. This article introduces the series of papers in this supplement, which explore the relationships between crises and their cumulative impacts among vulnerable populations, particularly through hidden hunger. © 2010 American Society for Nutrition.

Sari M.,Helen Keller International | De Pee S.,Nutrition and HIV AIDS Policy | De Pee S.,Tufts University | Bloem M.W.,Nutrition and HIV AIDS Policy | And 8 more authors.
Journal of Nutrition | Year: 2010

Because the global financial crisis and high food prices affect food consumption, we characterized the relationship between stunting and nongrain food expenditure at the household level among children 0-59 mo old in Indonesia's rural and urban poor population. Expenditure and height-for-age data were obtained from a population-based sample of 446,473 children in rural and 143,807 in urban poor areas in Indonesia. Expenditure on food was grouped into categories: animal, plant, total nongrain, and grain. The prevalence of stunting in rural and urban poor areas was 33.8 and 31.2%, respectively. In rural areas, the odds ratios (OR) (5th vs. first quintile) for stunting were similar for proportion of household expenditure on animal (0.87; 95% CI = 0.85-0.90; P < 0.0001), plant (0.86; 95% CI = 0.84-0.88; P < 0.0001), and total nongrain (0.85; 95% CI = 0.83-0.87; P < 0.0001). In urban poor areas, the relationship between stunting and proportion of household expenditure on animal sources was stronger than in rural areas (OR 0.78; 95% CI = 0.74-0.81; P < 0.0001), whereas the relationship with nongrain was similar to rural areas (OR 0.88; 95% CI = 0.85-0.92; P < 0.0001) and no relationship was observed with plant sources (OR 0.97; 95% CI = 0.93-1.01; P = 0.13). For grain expenditure, OR for stunting in highest vs. lowest quintile was 1.21 (95% CI = 1.18-1.24; P < 0.0001) in rural and 1.09 (95%CI = 1.04-1.13; P < 0.0001) in urban poor areas. Thus, households that spent a greater proportion on nongrain foods, in particular animal source foods, had a lower prevalence of child stunting. This suggests potential increased risk of malnutrition associated with reductions of household expenditure due to the current global crises. © 2010 American Society for Nutrition.

hIarlaithe M.O.,Nutrition and HIV AIDS Policy | Grede N.,Nutrition and HIV AIDS Policy | de Pee S.,Nutrition and HIV AIDS Policy | Bloem M.,Nutrition and HIV AIDS Policy
AIDS and Behavior | Year: 2014

Support to health programming has increasingly placed an emphasis on health systems strengthening. Integration of prevention of mother-to-child transmission (PMTCT) and maternal and newborn child health (MNCH) services has been one of the areas where there has been a shift from a siloed to a more integrated approach. The scale-up of anti-retroviral therapy has made services increasingly available while also bringing them closer to those in need. However, addressing supply side issues around the availability and quality of care at the health centre level alone cannot guarantee better results without a more explicit focus on access issues. Access to PMTCT care and treatment services is affected by a number of barriers which influence decisions of women to seek care. This paper reviews published qualitative and quantitative studies that look at demand side barriers to PMTCT services and proposes a categorisation of these barriers. It notes that access to PMTCT services as well as eventual uptake and retention in PMTCT care starts with access to MNCH in general. While poverty often prevents women, regardless of HIV status, from accessing MNCH services, women living with HIV who are in need of PMTCT services face an additional set of PMTCT barriers. This review proposes four categories of barriers to accessing PMTCT: social norms and knowledge, socioeconomic status, physiological status and psychological conditions. Social norms and knowledge and socioeconomic status stand out. Transport is the most frequently mentioned socioeconomic barrier. With regard to social norms and knowledge, non-disclosure, stigma and partner relations are the most commonly cited barriers. Some studies also cite physiological barriers. Barriers related to social norms and knowledge, socioeconomic status and physiology can all be affected by the mental and psychological state of the individual to create a psychological barrier to access. Increased coverage and uptake of PMTCT services can be achieved if policy makers and programme managers better understand the barriers that may prevent their potential target population from taking up and adhering to their services. The categorisation presented in this review provides further insight into the type of barriers that may exist. © 2014, Springer Science+Business Media New York.

Semba R.D.,Wilmer Eye Institute | de Pee S.,Nutrition and HIV AIDS Policy | Sun K.,Wilmer Eye Institute | Akhter N.,University College London | And 2 more authors.
Journal of Health, Population and Nutrition | Year: 2010

Vitamin A supplementation reduces child morbidity, mortality, and blindness. The coverage of the national vitamin A programme and risk factors for not receiving vitamin A were characterized using data from the Bangladesh Demographic and Health Survey 2004. Of 3,745 children aged 18-59 months, 3,237 (86.4%) received a vitamin A capsule each within the last six months. Children who missed vitamin A were more likely to be stunted (prevalence ratio [PR] 0.97, 95% confidence interval [CI] 0.95-1.00) and come from a family with a previous history of mortality of children aged less than five years (PR 0.95, 95% CI 0.91-0.99). Maternal education of ≥10 years (PR 1.09, 95% CI 1.04-1.13), 7-9 years (PR 1.08, 95% CI 1.04-1.12), and 1-6 years (PR 1.05, 95% CI 1.02-1.08) compared to no formal education was associated with the child not receiving vitamin A in a multivariate model, adjusting for potential confounders. Children missed by the vitamin A programme were more likely to come from families with lower maternal education. Special efforts are required to ensure that the coverage of the national vitamin A programme is increased further so that the most vulnerable children are also better protected against morbidity, mortality, and blindness. © International Centre for Diarrhoeal Disease Research, Bangladesh.

Grede N.,Nutrition and HIV AIDS Policy | Claros J.M.,Nutrition and HIV AIDS Policy | de Pee S.,Nutrition and HIV AIDS Policy | Bloem M.,Nutrition and HIV AIDS Policy
AIDS and Behavior | Year: 2014

This paper reviews evidence on social and economic costs of tuberculosis. Key socio-economic consequences include stigma, social isolation, increased out-of-pocket expenditures for medical and non-medical costs and reduced income. Many of the financing methods that households use have long-term negative impacts and the poor are most vulnerable to these costs. Together, these negative consequences adversely affect TB control, in terms of delayed diagnosis, delayed initiation of treatment, suboptimal adherence and failure to complete treatment, as well as the coping and well being of the individual and household. There are two ways to reduce treatment costs for the patient; one can either reduce the direct and indirect costs of seeking a diagnosis and obtaining treatment and/or provide income transfers to offset some of those costs incurred. Social transfers in the form of food, cash or vouchers can mitigate the negative effects by enabling the individual to seek a diagnosis, protecting minimum food expenditures, reducing the need to accumulate debt and reduce productive assets and reducing the negative impacts on other household members, particularly young children and school-age children. © 2014, Springer Science+Business Media New York.

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