Thursday, July 18, 2013

The connection between malnutrition and HIV infection in Cambodia

11-year-old Youen was admitted to hospital in 2012 with severe acute malnutrition
©UNICEF Cambodia/2013/Shepherd-Johnson
In 2011, Cambodia introduced National Paediatric AIDS Care guidelines to incorporate HIV testing for all children hospitalized with severe acute malnutrition whose HIV status was unknown. Today in Kampong Speu province, 11-year-old Youen is alive and healthy thanks to the connection made between these two conditions.

At only 104 cm in height, Youen is extremely small for his age. Along with his brother Vin, aged 8, and his sister Kei, 10, he lives in Samrong Tong Village where he is cared for by his 80-year-old grandmother, Pin Khon. His mother works long hours, six days-a-week in a garment factory in Kampong Speu town. Youen weighs 17 kilograms, but in July 2012 he was admitted to Kampong Speu referral hospital weighing only 9.5 kilograms. He had a fever and diarrhoea, and photos from that time show him looking emaciated. Going to the hospital was a last resort.

His grandmother had followed her usual practice of getting advice and medicines from private pharmacies and clinics in the village but they failed to work this time. “Usually when he had [these symptoms] I took him to the [private] clinic and after he took the medicine he got better. After ten months, my neighbour told me I should take him to the hospital and said, ‘Tell them you are poor and it’s free. It might be the last chance’, so I brought Youen here,” said Mrs Pin.

Nutritional screening and HIV testing

Diagnosed with severe acute malnutrition, Yoeun spent one week at the hospital where he received a therapeutic milk-based liquid food to provide protein and energy. He was also tested for HIV because there is often a link with malnutrition. HIV increases a child’s energy requirements and weakens the immune system. Opportunistic infections as a result of HIV make children lose their appetite and unable to absorb nutrients efficiently; nutrients that are also lost through diarrhoea.

An inadequate diet further exacerbates the situation, which can make the child even more vulnerable to opportunistic infections and can contribute to more rapid progression to AIDS. UNICEF, with funding from the German Committee for UNICEF, is supporting the provision of free paediatric care services that enable children to be diagnosed and treated for malnutrition and HIV.

Paediatric nurse Meas Theary, who has been treating patients with severe acute malnutrition at Kampong Speu referral hospital for the past four years, explained the treatment procedure. “For all severe acute malnutrition cases we check if the caregivers know the child’s HIV status, and if they do not, we do a test. We provide counselling before testing and if the antibody test is positive, we send a blood sample to [the capital] Phnom Penh for analysis to determine the right type of medication,” said Theary.

Ready-to-use therapeutic food and antiretroviral treatment

Mrs. Pin willingly allowed her grandson to be tested. She already knew someone in her village with HIV and the diagnosis helped her to understand why Youen kept getting sick. “I heard people say that if someone has HIV that they have fever and diarrhoea so then I understood the connection,” said Mrs. Pin. When he left hospital Youen was given two months’ supply of ready-to-use therapeutic food (specially-formulated energy bars) to increase his weight, and three weeks after admission he was put on antiretroviral (ARV) treatment.
11-year-old Youen was put on daily antiretroviral medication
© UNICEF Cambodia/2013/Shepherd-Johnson
Youen now takes ARV medication daily: three tablets in the morning and three in the evening.His grandmother takes him for monthly check-ups at the referral hospital and together they attend meetings of the support group for HIV-affected children and caregivers known as Mondul Mith Chouy Mith (friends helping friends). There, Mrs. Pin learned about the importance of good nutrition, hygiene and how to prevent opportunistic infections.

Following Youen’s diagnosis, his mother and siblings were also tested for HIV. His mother was found to be positive and was put on ARV medication.

His brother and sister are negative. His father refused to be tested. Mrs. Pin is happy that Youen is well again. “He now has a better appetite and has gained weight. He’s not ill and he is more active. I have changed the way I feed him and now regularly add meat and vegetables. Even though I don’t have a lot of money, I borrow some to prepare the right food for the children. Money is small but I try.”

Nutritional screening and HIV testing kept Youen from falling through the cracks. Therapeutic food and ARV medication saved his life, but he still faces the challenges caused by years of untreated HIV and malnutrition. He is extremely short for his age and has irreversible learning delays. With UNICEF support, these screening services are expanding to help identify and treat affected children and their families, to stop the spread of HIV and to prevent the long-term negative effects of untreated malnutrition and HIV.