An evaluation of nutrition care to adult patients on Highly Active Antiretroviral Therapy (HAART) attending primary healthcare facilities in Mbombela North, Mpumalanga

Schiever, Jane Frances (2015-12)

Thesis (MNutr)--Stellenbosch University, 2015.

Thesis

ENGLISH SUMMARY : Background: South Africa has the most people infected with the human immunodeficiency virus (HIV) in the world; however the rollout of highly active antiretroviral therapy (HAART) is expanding. Treatment of HIV is changing and improving, altering the nutritional status of patients in this era. Mpumalanga has the second highest HIV burden, with most patients accessing care from primary healthcare (PHC) facilities. However, information regarding the current nutrition care received by adult patients on HAART attending these facilities is lacking. Aim: To evaluate the nutrition care received by adult patients on HAART attending PHC facilities in Mbombela sub-district, in Ehlanzeni district, Mpumalanga. Methods: A cross-sectional descriptive study design was used. Subjects included 263 adult patients on HAART and 75 nursing professionals. An assessment of 19 PHC facilities was also conducted. An interviewer-administered questionnaire was completed for each patient, along with pre-defined anthropometric measurements. Nursing professionals completed a self-administered questionnaire. An assessment tool was completed for each PHC facility. Results: A combined total of 41.4% of patients were overweight or obese, and most (51.8%) females had a body mass index (BMI) ≥ 25. Based on waist circumference, 52.7% of females and 8.4% of males were at increased risk of cardiovascular disease. Although nurses were aware of a nutrition supplementation programme (NSP), knowledge of the national nutrition supplementation programme guideline (NNSPG) details was inadequate and the programme was poorly implemented. Only three nurses correctly identified entry criteria into the NSP. Clinical judgement, rather than eligibility criteria, was used to identify patients eligible for supplementation, with 13.3% of patients receiving nutrition supplementation at the time of the study, when only 4.9% qualified for supplementation according to the guidelines. Nurses were confident about their knowledge of nutrition-related topics, but this did not match actual knowledge. Nutrition counselling was frequently (66.2%) guided by general knowledge and patients expressed a need for more nutrition information. Most patients (70.7%) had a previous weight recorded on file, while only 6.1% had height and 4.6% had BMI records available. PHC facilities generally had sufficient equipment available, storage conditions were fair, but stock shortages of nutrition supplements posed a major problem. Most patients (76.0%) and nurses (69.3%) rated the nutrition care received/provided as ‘Good’ or ‘Excellent’. Conclusion: Certain aspects of nutrition care to adults on HAART are good. However, care could be improved through training and support to professional nurses, focusing particularly on BMI and nutrition counselling to encourage the consumption of appropriate portions of balanced meals and promote household food security. Counselling should be guided by recognised guidelines and focus on preventing over-nutrition and associated disease. Nurses should be familiarised with the NNSPG through formal training and have a constant nutrition supplement supply, in order to implement them correctly. It may be worthwhile to consider modifying the supplementation programme to better meet the needs of the majority of patients who are not undernourished, but who are food insecure. However, better monitoring and evaluation of nutrition care to adult patients receiving HAART from PHC facilities are needed.

AFRIKAANSE OPSOMMING : Agtergrond: Suid-Afrika het die meeste mense wat geïnfekteerd is met die menslike immuniteitsgebreksvirus (MIV) in die wêreld, met die implementering van hoogs aktiewe antiretrovirale terapie (HAART) wat uitbrei. Die behandeling van MIV is besig om te verander en verbeter, met die gevolg dat die voedingstatus van pasiënte in hierdie era verander. Mpumalanga het die tweede hoogste MIV las, met die meeste pasiënte wat toegang tot sorg verkry van publieke gesondheidsorg-(PGS) fasiliteite. Tog is inligting onvoldoende wat betref die voedingsorg wat volwasse pasiënte op HAART wat hierdie fasiliteite besoek, tans ontvang. Doel: Om die voedingsorg te evalueer wat volwasse pasiënte op HAART ontvang by PGS-fasiliteite in die Mbombela sub-distrik, in die Ehlanzeni distrik, Mpumalanga. Metodes: 'n Deursnee-beskrywende studie ontwerp is gebruik. Proefpersone het ingesluit 263 volwasse pasiënte op HAART, 75 verpleegsters, en 'n assessering van 19 PGS-fasiliteite. 'n Vraelys wat deur die onderhoudvoerder voltooi is, is vir elke pasiënt ingevul; tesame met vooraf-bepaalde antropometriese metings. Verpleegpersoneel het self 'n vraelys ingevul. 'n Assesseringsinstrument is vir elke PGS-fasiliteit voltooi. Resultate: 'n Gekombineerde totaal van 41.4% pasiënte was oorgewig of vetsugtig, en die meeste (51.8%) vroue het 'n liggaamsmassa-indeks (LMI) ≥ 25. Gebaseer op middellyf-omtrek het 52.7% van vroue en 8.4% van mans ‘n verhoogde risiko gehad vir kardio-vaskulêre siektes. Alhoewel verpleegpersoneel bewus was van 'n voedingaanvullingsprogram (VAP), was hulle kennis van die besonderhede van die nasionale VAP-riglyne gebrekkig en die implementering daarvan swak. Slegs drie verpleegsters het toelatingskriteria vir die VAP korrek geïdentifiseer. Kliniese oordeel, eerder as geskiktheidskriteria, is gebruik om pasiënte te identifiseer wat in aanmerking kom vir aanvullings, met 13.3% van pasiënte wat tydens die studie aanvullings ontvang het, terwyl slegs 4.9% volgens die riglyne vir aanvullings gekwalifiseer het. Verpleegsters was selfversekerd oor hulle kennis van voedingsverwante onderwerpe, maar hierdie self-persepsie het nie ooreengestem met hulle werklike kennis nie. Voedingsvoorligting was dikwels (66.2%) gebaseer op algemene kennis en pasiënte het 'n behoefte aan meer voedingsinligting uitgespreek. Die meeste pasiënte (70.7%) het 'n voorheen aangetekende gewig in hulle rekords gehad, terwyl slegs 6.1% se lengte en 4.6% se LMI-rekords beskikbaar was. PGS-fasiliteite het oor die algemeen oor voldoende toerusting beskik, bergingsomstandighede was redelik, maar tekorte aan voorraad van voedingaanvullings was 'n groot probleem. Die meeste pasiënte (76.0%) en verpleegpersoneel (69.3%) het die voedingsorg wat ontvang/gelewer is as ‘Goed’ of ‘Uitstekend’ bestempel. Gevolgtrekking: Sekere aspekte van voedingsorg aan volwassenes op HAART is goed. Tog kan sorg verbeter word deur die opleiding en ondersteuning van professionele verpleegpersoneel, met spesifieke klem op LMI en voedingsvoorligting om die verbruik van geskikte porsies van gebalanseerde maaltye aan te moedig, en huishoudelike voedselsekerheid te bevorder. Voorligting behoort gedryf te word deur aanvaarde riglyne en deur te fokus op die voorkoming van oorvoeding en verwante siektes. Verpleegpersoneel behoort deur formele opleiding vertroud gemaak te word met die nasionale VAP en behoort 'n konstante voedingaanvullings-voorraad te hê sodat dit korrek geïmplementeer kan word. Dit kan waardevol wees om dit te oorweeg om die aanvullingsprogram aan te pas om beter aan die behoeftes te voldoen van die meerderheid pasiënte wat nie ondervoed is nie, maar wat voedsel-onseker is. Beter monitering en evaluering van voedingsorg aan pasiënte wat HAART van PGS-fasiliteite ontvang, word benodig.

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