Socioeconomic correlates of dietary diversity and its association with adherence and psychosocial functioning of people living with HIV in rural Zambia

Abstract

Background:

The intersection of nutrition and HIV underscores the importance of adequate food and a diverse diet. In communities with high prevalence of food insecurity and HIV, there is a substantial co-occurrence of low dietary diversity, undernutrition, and adverse health outcomes.

Aim:

The aim of this study was to identify correlates of individual dietary diversity (IDD) and its association with health outcomes for people living with HIV (PLHIV) in rural Zambia.

Methods:

The study used a cross-sectional design using data from 101 PLHIV. We calculated IDD using a composite score based on dietary diversity, food frequency, and the relative nutritional importance of different food groups. Adherence was measured using the visual analog scale. Psychosocial functioning was measured using the Structural Barriers to Medication-taking Scale and the Perceived Stress Scale. Data were analyzed using linear and logistic regressions. Multiple imputation was conducted to address missing data.

Results:

Staples were the most commonly consumed food group. Income and household size were negatively associated with IDD scores. Assets were positively associated with IDD scores. Residing in Lundazi and having a poor or fair self-rated health were associated with lower IDD scores. IDD was also associated, albeit not significant, with desirable health outcomes, including adherence and lower levels of perceived barriers to pill taking and stress.

Conclusions:

Findings suggest a heterogeneous effect of socioeconomic variables on IDD. Understanding this heterogeneity is important for the design of interventions. Interventions that combine opportunities to generate economic resources with food and nutrition coaching may be appropriate and effective.

Keywords

Dietary diversity assets income psychosocial functioning adherence HIV barriers to pill taking perceived stress Zambia

Get full access to this article

View all access options for this article.

References

Allison

(2002) Missing Data Series: Quantitative Applications in the Social Sciences. Thousand Oaks, CA: Sage Publications.

Bahwere

Deconinck

Banda

. (2011) Impact of household food insecurity on the nutritional status and the response to therapeutic feeding of people living with human immunodeficiency virus. Patient Preference and Adherence 5: 619–627.

Banerjee

Duflo

(2011) Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty. New York: Public Affairs.

Barnett

Rugalema

(2000) HIV/AIDS and the Crisis of Rural Livelihood: A Case Study of a Buhaya Village, Bukoba, Tanzania. New York: United Nations Development Programme.

Berhe

Tegabu

Alemayehu

(2013) Effect of nutritional factors on adherence to antiretroviral therapy among HIV-infected adults: a case control study in Northern Ethiopia. BMC Infectious Diseases 13: 233.

Chileshe

Bond

(2010) Barriers and outcomes: TB patients co-infected with HIV accessing antiretroviral therapy in rural Zambia. AIDS Care 22(Supplement 1): 51–59.

Chowa

Masa

(2015) Asset ownership and future orientation of youth and their parents: evidence from Ghana. Child & Youth Services 36(2): 173–200.

Coates

Swindale

Bilinsky

(2007) Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide. Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development.

Coetzee

Kagee

(2013) The development of an inventory to assess the structural barriers to clinic attendance and pill-taking amongst users of antiretroviral therapy. AIDS and Behavior 17(1): 319–328.

10.

Cohen

Williamson

(1988) Perceived stress in a probability sample of the US. In: Spacapam

Oskamp

(eds) The Social Psychology of Health: Claremont Symposium on Applied Social Psychology. Thousand Oaks, CA: Sage Publications, pp.31–67.

11.

Cohen

Kamarck

Mermelstein

(1983) A global measure of perceived stress. Journal of Health and Social Behavior 24(4): 385–396.

12.

Dao-Tran

Anderson

Seib

(2017) The Vietnamese version of the Perceived Stress Scales (PSS-10): translation equivalence and psychometric properties among older women. BMC Psychiatry 17(1): 53.

13.

Deaton

Drèze

(2009) Food and nutrition in India: facts and interpretations. Economic and Political Weekly 44(7): 42–65.

14.

De Pee

Semba

(2010) Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food and Nutrition Bulletin 31(4): S313–S344.

15.

Dong

Peng

CYJ

(2013) Principled missing data methods for researchers. SpringerPlus 2(1): 222.

16.

Drain

Kupka

Mugusi

. (2007) Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. The American Journal of Clinical Nutrition 85(2): 333–345.

17.

Duran

Almeida

Segurado

. (2008) Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy. Journal of Human Nutrition and Dietetics 21(4): 346–350.

18.

Enders

Dietz

Montague

. (2006) Modern alternatives for dealing with missing data in special education research. Advances in Learning and Behavioral Disorders 19: 101–130.

19.

Enders

(2010) Applied Missing Data Analysis. New York: Guilford Press.

20.

Faber

Wenhold

Laurie

(2017) Dietary diversity and vegetable and fruit consumption of households in a resource-poor peri-urban South Africa community differ by food security status. Ecology of Food and Nutrition 56(1): 62–80.

21.

Filmer

Scott

(2012) Assessing asset indices. Demography 49(1): 359–392.

22.

Gebrezgabher

Kebede

Kindie

. (2017) Determinants to antiretroviral treatment non-adherence among adult HIV/AIDS patients in northern Ethiopia. AIDS Research and Therapy 14: 16.

23.

Giordano

Lindstrom

(2010) The impact of changes in different aspects of social capital and material conditions on self-rated health over time: a longitudinal cohort study. Social Science & Medicine 70(5): 700–710.

24.

Graham

(2009) Missing data analysis: making it work in the real world. Annual Review of Psychology 60: 549–576.

25.

Graham

Olchowski

Gilreath

(2007) How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prevention Science 8(3): 206–213.

26.

Haberer

Cook

Walker

. (2011) Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects. PLoS One 6(4): e18505.

27.

Hadgu

Worku

Tetemke

. (2013) Undernutrition among HIV positive women in Humera hospital, Tigray, Ethiopia, 2013: antiretroviral therapy alone is not enough, cross sectional study. BMC Public Health 13: 943.

28.

Hampanda

Abougi

Ahmed

(2017) HIV-positive women taking lifelong antiretroviral therapy report better adherence than women taking short-course prophylaxis during and after pregnancy under PMTCT program Option A in Lusaka, Zambia. International Journal of MCH and AIDS 6(1): 27–35.

29.

Hannan

Diaz

Valcourt

. (2016) Psychometric properties of newly translated Creole perceived stress scale and daily hassles scale. Journal of Nursing Measurement 24(2): 190–201.

30.

Haushofer

Fehr

(2014) On the psychology of poverty. Science 344(6186): 862–867.

31.

Hjelm

Handa

de Hoop

. (2017) Poverty and perceived stress: evidence from two unconditional cash transfer programs in Zambia. Social Science & Medicine 177: 110–117.

32.

Ickovics

Meade

(2002) Adherence to HAART among patients with HIV: breakthroughs and barriers. AIDS Care 14(3): 309–318.

33.

Ivers

Cullen

Freedberg

. (2009) HIV/AIDS, undernutrition, and food insecurity. Clinical Infectious Diseases 49(7): 1096–1102.

34.

Jensen

Miller

(2008) Giffen behavior and subsistence consumption. The American Economic Review 98(4): 1553–1577.

35.

Jylhä

(2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine 69(3): 307–316.

36.

Kabore

Muntner

Chamot

. (2015) Self-report measures in the assessment of antiretroviral medication adherence: comparison with medication possession ratio and HIV viral load. Journal of the International Association of Providers of AIDS Care 14(2): 156–162.

37.

Kadiyala

Rawat

(2013) Food access and diet quality independently predict nutritional status among people living with HIV in Uganda. Public Health Nutrition 16(1): 164–170.

38.

Leung

DYP

Lam

Chan

SSC

(2010) Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health 10(1): 1–7.

39.

Long

Freese

(2006) Regression Models for Categorical Dependent Variables Using Stata. College Station, TX: Stata Press.

40.

Mamlin

Kimaiyo

Lewis

. (2009) Integrating nutrition support for food-insecure patients and their dependents into an HIV care and treatment program in Western Kenya. American Journal of Public Health 99(2): 215–221.

41.

Markus

Nurius

(1986) Possible selves. American Psychologist 41(9): 954.

42.

Masa

Chowa

Nyirenda

(2017) Prevalence and predictors of food insecurity among people living with HIV enrolled in antiretroviral therapy and livelihood programs in two rural Zambian hospitals. Ecology of Food and Nutrition 56(3): 256–276.

43.

McDermott

Shevitz

Must

. (2003) Nutrition treatment for HIV wasting: a prescription for food as medicine. Nutrition in Clinical Practice 18(1): 86–94.

44.

Mpontshane

den Broeck

Chhagan

. (2008) HIV infection is associated with decreased dietary diversity in South African children. The Journal of Nutrition 138(9): 1705–1711.

45.

Musumari

Wouters

Kayembe

. (2014) Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study. PLoS One 9(1): e85327.

46.

Mehra

Christian

. (2016) Maternal dietary diversity decreases with household food insecurity in rural Bangladesh: a longitudinal analysis. The Journal of Nutrition 146(10): 2109–2116.

47.

Nagata

Magerenge

Young

. (2012) Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria, Kenya. AIDS Care 24(6): 728–736.

48.

Ndirangu

Sztam

Sheriff

. (2014) Perceptions of food-insecure HIV-positive adults participating in a food supplementation program in central Kenya. Journal of Health Care for the Poor and Underserved 25(4): 1763–1783.

49.

Nsabuwera

Hedt-Gauthier

Khogali

. (2016) Making progress towards food security: evidence from an intervention in three rural districts of Rwanda. Public Health Nutrition 19(7): 1296–1304.

50.

Ntwenya

Kinabo

Msuya

. (2015) Dietary patterns and household food insecurity in rural populations of Kilosa district, Tanzania. PLoS One 10 (5): e0126038.

51.

Oketch

Paterson

Maunder

. (2011) Too little, too late: comparison of nutritional status and quality of life of nutrition care and support recipient and non-recipients among HIV-positive adults in KwaZulu-Natal, South Africa. Health Policy 99(3): 267–276.

52.

Onyango

Walingo

Othuon

(2009) Food consumption patterns, diversity of food nutrients and mean nutrient intake in relation to HIV/AIDS status in Kisumu district Kenya. African Journal of AIDS Research 8(3): 359–366.

53.

Palermo

Rawat

Weiser

. (2013) Food access and diet quality are associated with quality of life outcomes among HIV-infected individuals in Uganda. PLoS One 8(4): e62353.

54.

Paterson

Swindells

Mohr

. (2000) Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine 133(1): 21–30.

55.

Popkin

Horton

Kim

. (2001) Trends in diet, nutritional status, and diet-related noncommunicable diseases in China and India: the economic costs of the nutrition transition. Nutrition Reviews 59(12): 379–390.

56.

Posse

Baltussen

(2013) HIV/AIDS patient satisfaction with a food assistance programme in Sofala province, Mozambique. African Journal of AIDS Research 12(4): 203–210.

57.

Rawat

McCoy

Kadiyala

(2013) Poor diet quality is associated with low CD4 count and anemia and predicts mortality among antiretroviral therapy-naive HIV-positive adults in Uganda. Journal of Acquired Immune Deficiency Syndromes 62(2): 246–253.

58.

Rebick

Franke

Teng

. (2016) Food insecurity, dietary diversity, and body mass index of HIV-infected individuals on antiretroviral therapy in rural Haiti. AIDS and Behavior 20(5): 1116–1122.

59.

Rodas-Moya

Kodish

Manary

. (2016) Preferences for food and nutritional supplements among adult people living with HIV in Malawi. Public Health Nutrition 19(4): 693–702.

60.

Ruel

(2003) Operationalizing dietary diversity: a review of measurement issues and research priorities. The Journal of Nutrition 133(11 Supplement 2): 3911S–3926S.

61.

Salomon

De Truchis

Melchior

(2002) Nutrition and HIV infection. The British Journal of Nutrition 87(Supplement 1): S111–S119.

62.

Seume-Fosso

Rajabiun

Cogill

(2004) HIV/AIDS: A Guide for Nutritional Care and Support. Washington, DC: Food and Nutrition Technical Assistance, Academy for Educational Development.

63.

Shefrin

Thaler

(1988) The behavioral life-cycle hypothesis. Economic Inquiry 26(4): 609–643.

64.

Sherraden

(1991) Assets and the poor: a new American welfare policy. Armonk, NY: M.E. Sharpe.

65.

Simoni

Huh

Wang

. (2014) The validity of self-reported medication adherence as an outcome in clinical trials of adherence-promotion interventions: findings from the MACH14 study. AIDS and Behavior 18(12): 2285–2290.

66.

StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp.

67.

Sunguya

Poudel

Mlunde

. (2014) Poor nutrition status and associated feeding practices among HIV-positive children in a food secure region in Tanzania: a call for tailored nutrition training. PLoS One 9(5): e98308.

68.

Teare

Dimairo

Shephard

. (2014) Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: a simulation study.Trials. 5:264.

69.

Tiyou

Belachew

Alemseged

. (2012) Food insecurity and associated factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia. Nutrition Journal 11: 51.

70.

Tsai

Bangsberg

Emenyonu

. (2011) The social context of food insecurity among persons living with HIV/AIDS in rural Uganda. Social Science & Medicine 73(12): 1717–1724.

71.

Van Buuren

(2007) Multiple imputation of discrete and continuous data by fully conditional specification. Statistical Methods in Medical Research 16(3): 219–242.

72.

Weiser

Young

Cohen

. (2011) Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition 94(6): 1729S–1739S.

73.

White

Royston

Wood

(2011) Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine 30(4): 377–399.

74.

World Food Programme (2008) Food Consumption Analysis. Calculation and Use of the Food Consumption Score in Food Security Analysis. Rome: World Food Programme, Vulnerability Analysis and Mapping Branch.

75.

Zambia Central Statistical Office (2012a) 2010 Census of Population and Housing. Population Summary Report. Lusaka, Zambia: Central Statistical Office.

76.

Zambia Central Statistical Office (2012b) 2010 Census of Population and Housing (Volume 11 National Descriptive Tables). Lusaka, Zambia: Central Statistical Office.

77.

Zambia National AIDS Council (2014) Zambia Country Report: Monitoring the Declaration of Commitment on HIV and AIDS and the Universal Access. Lusaka, Zambia: National AIDS Council, Ministry of Health.

78.

Zimba

(2015) Lundazi: small town with big dreams. Zambia Daily Mail Limited, 25 February. Available at: www.daily-mail.co.zm/lundazi-small-town-big-dreams/ (accessed August 4, 2017).