Assessment Of Nutritional Status Of The HIV Infected Children Attending ART Centre And Its Relation With Immunodeficiency A Hospital Based Study

Research Article

æ Assessment of Nutritional Status of
WY. the HIV Infected Children Attending
ART Centre and its Relation with
Immunodeficiency - A Hospital Based
Study

International Journal of Current Research and Review
DOI: http://dx.doi.org/10.31782/IJCRR.2019.1217

IJCRR

Section: Healthcare
Sci. Journal Impact

Factor: 5.385 (2017)
ICV: 71.54 (2015)

Raghavendra N.:, R. G. Viveki?

‘MBBS, MD, Assistant Professor, Department of Community Medicine, MV] Medical College and Research Hospital- 562114;
"MBBS, MD, Professor and Head, Department of Community Medicine, Belagavi Institute of Medical Sciences, Belagavi- 590001.

ABSTRACT

Introduction: Malnutrition is a common complication among HIV-infected children. HIV impairs the immune system, making the
body vulnerable to various infections. Infections leads to malnutrition which further contributes to a weakened immune system
making a vicious cycle. This leads to a rapid progression to AIDS.

Objectives: To assess the burden of malnutrition and to know its effect on immune status of HIV infected children attending
Anti-Retro viral Therapy (ART) Centre.

Methodology: The study was conducted among HIV positive children aged 0-14 years, attending ART Centre of Belagavi
Institute of Medical Sciences (BIMS) Hospital, Belagavi. Anthropometric measurements and CD4 counts were recorded. An-
thropometric indicators were expressed in Z-scores. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ <
-2 SD and HAZ 2 -2SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ 2 -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD
and HAZ < -2SD).

Results: The study included 180 HIV infected children (112 boys, 68 girls). The prevalence of malnutrition was 78.3%. Acute,
chronic and mixed malnutrition was seen in 17 (9.4%), 106 (58.9%), 18 (10.0%) of the study participants respectively. Immu-
nodeficiency was seen in 42% of them. The presence of malnutrition in the study participants was significantly associated with
immunodeficiency.

Conclusion: There was high prevalence of malnutrition among the HIV infected children. HIV acts as an independent risk fac-
tor for malnutrition. Malnutrition should be treated and prevented to ensure optimal response to ART and reduce early mortality.

Key Words: ART, Children, CD4 count, HIV, Malnutrition

INTRODUCTION AIDS related illnesses.'By 2015, India has 21.17 lakh people
living with HIV with adult prevalence (15-49yrs) of 0.26%.
In Karnataka there were 1, 99,060 people living with HIV
with adult prevalence of 0.45%. In India 1,38,456 children

(<15yr) were living with HIV, with prevalence of 6.54% and

According to world health organization (WHO), by 2017 an
estimated 36.9 million people were living with Human Im-
munodeficiency Virus(HIV) worldwide, 1.8 million People

were newly infected with HIV and 9, 40,000 people died
from Acquired Immune Deficiency Syndrome (AIDS) re-
lated illnesses. Children (<15yr) living with HIV accounts
for an estimated 1.8 million of which 1, 80,000 children were
newly infected with HIV and 1, 10,000 children died due to

7,526 deaths due to AIDS related illnesses.”

Infants and young children who have been infected through
the route of mother to child transmission (perinatal infection)
have very high loads of HIV virus in their body. Furthermore,

Corresponding Author:

ISSN: 2231-2196 (Print)

Received: 25.03.2019 Revised: 14.04.2019

Dr. Raghavendra N., Assistant Professor, Department of Community Medicine, MVJ Medical College and Research Hospital, Kolathur
post, Hoskote, Bangalore, Karnataka-562114, India; Mobile: 9483855119; E-mail: dr.raghavendra89@gmail.com

ISSN: 0975-5241 (Online)

Accepted: 26.04.2019

Int J Cur Res Rev | Vol 11 « Issue 09 - May 2019

Raghavendra et.al.: Assessment of nutritional status of the hiv infected children attending art centre and its relation...

the body’s response against the HIV virus is inadequate be-
cause the immune system is still immature and developing.
Thus, these children progress rapidly towards severe symp-
tomatic disease or AIDS. HIV impairs the immune system,
making the body vulnerable to various infections. In order
to cope with HIV and other infections, the need for energy
and other nutrients is increased. If these increased needs are
not met, malnutrition sets in. Malnutrition contributes to a
weakened immune system, which worsens the effect of HIV.
This leads to a rapid progression to AIDS. Thus forming a vi-
cious cycle.’ Even at the early stage of HIV when the effects
may not be visible (asymptomatic phase), HIV infection has
a substantial impact on the nutritionalstatus of infected peo-
ple due to poor food intake as a result of poor appetite and
difficulty eating, intestinalmalabsorption because of chronic
diarrhea and HIV caused intestinal cell damage, metabolic
changes and increased nutrient requirements related to op-
portunistic infections (OIs).* HIV infected children remain
nutritionally challenged due to low socio-economic status,
orphan hood, food insecurity, poor dietary patterns, low ma-
ternal education and other specific health related factors. ©!
Children also differ from adults as they have higher rate of
viral replication hence high viral load and higher rate of CD4
cell destruction.Protein—energy /calorie malnutrition (PEM)
is the commonest cause of immuno-deficiency.* Hence this
study was undertaken to assess the burden of malnutrition
and its effect on immune status of HIV positive children.

MATERIALS & METHODS

This Hospital based observational study was conducted
among HIV positive children aged 0-14 years of age who
were on Anti-Retro viral Therapy (ART) attending ART
Centre of Belagavi Institute of Medical Sciences (BIMS)
Hospital, Belagavi for a period of 12months from January
2015 to December 2015.

SELECTION CRITERIA:
(a) Inclusion Criteria:

¢ Confirmed case of HIV infection
e Age 0-14years
e On Anti-Retroviral Therapy (ART)

(b) Exclusion criteria:

e Parents/ guardians of children not willing to partici-
pate in the study.

e Children whose complete details were not known/
could not be accessed.

Sample size was estimated by considering the prevalence of
malnutrition among HIV infected children.® Calculated sam-
ple size was 154. However, the present study included 180

individuals. Children attending ART Centre of BIMS Hos-
pital, Belagavi who fulfilled selection criteria were studied.
Each child had a unique ART number. Hence repetition was
avoided and every child was studied only once during the
study period.

After obtaining consent, data was collected from parents or
guardians of study participants by using a structured, pre-
validated, questionnaire. Information regarding Socio-de-
mographic profile (date of birth, religion, education, month-
ly income, and parental history), immunization history, and
disease (HIV) related history was collected. Anthropometric
measurements like height and weight of the child was taken.
Immunological profile (Recent CD4 count) of the child was
collected from case records of ART Centre.

To define malnutrition, several anthropometric indicators
were used according to WHO definitions: Height-for-Age,
for children up to 19 years, Weight-for-Height for children <
5 years and Body Mass Index (BMI)-for-Age for children >
5 years, and Weight-for-age, for children < 10 years. These
indicators are standardized using Z-scores, which quantify
how many Standard Deviations (SDs) child’s weight and
height is from the median value of a child of the same age
and sex, in a reference population. For this analysis, we used
the 2006 WHO growth charts for children <5, and the 2007
WHO growth charts for children > 5.” Each indicator allows
to define three types of malnutrition: wasting when Weight-
for-Height Z score (WHZ) or BMI-for-Age Z-score (BAZ)
<-2 SD, stunting when Height-for-Age Z-score (HAZ) < -2
SD, and underweight when Weight-for-Age Z-score (WAZ)
< -2 SD. A child is defined as moderately malnourished if the
Z score is between -3 and -2 SD, and severely malnourished
if the Z-score < -3 SD. For those children who knew exact
date of birth, Z-scores were calculated using WHO Anthro
Software (version 3.2.2, January 2011) and WHO Anthro
Plus. In this study, we combined these indicators to define
three categories of malnutrition: (1) acute malnutrition de-
fined by WHZ or BAZ<-2 SD and HAZ> -2 SD; (2) chronic
malnutrition defined by WHZ/BAZ > -2 SD and HAZ< -2
SD, and (3) mixed malnutrition as WHZ/ BAZ < -2 SD and
HAZ < -2 SD. WAZ was not used here. [6

WHO Immunological classification® was used to categorize
immune status of the study participants. CD4+ count >500
was considered to be normal. Those with CD4+ count 350-
499, 200-349, <200 or <15% were categorized to have mild,
moderate and severe immunodeficiency respectively.

Statistical analysis was done using Microsoft excel sheet
2007 and SPSS version 22. The categorical data was ex-
pressed in terms of rates, ratios and percentages while con-
tinuous data was expressed as mean + standard deviation.
Chi square test was used to test the association between dif-
ferent qualitative variables. At 95% CI a probability value (p
value) of < 0.05 was considered as statistically significant.

Int J Cur Res Rev | Vol 11 - Issue 09 - May 2019

Raghavendra et.al.: Assessment of nutritional status of the hiv infected children attending art centre and its relation...

Ethical Clearance:

The study was approved from Institutional Ethics Commit-
tee BIMS, Belagavi. Permission to conduct the study was
obtained from head of the institute and Nodal Officer and
Medical Officer of Anti-Retroviral Therapy (ART) Centre
of Belagavi Institute of Medical Sciences (BIMS) Hospital,
Belagavi.

RESULTS

This present study included 180 HIV infected children of
which boys were 112 (62.2%) and girls were 68 (37.8%)
with boys to Girls ratio of 1.65:1. The study participants
were of the age group 0-14 years. The mean age (in years) of
study participants was 11.11+ 2.87 SD. Table 1 describes the
socio-demographic profile of the study participants. In this
study, majority of the study participants 167 (92.7%) were
Hindu’s. More than half of the study participants 115(63.9%)
belonged to rural area. More than half of them 101 (56.1%)
were doing primary education. More than 3/4th of study par-
ticipants 143 (79.4%) belonged to class 5 socioeconomic sta-
tus according to modified BG Prasad classification. Preva-
lence of orphan hood was 73.3% (132).

Table 2 describes the demographic and HIV infection related
parameters of the parents of the study participants. Majority
of the fathers i.e., 57 (31.7%) and mothers 100 (55.6%) of
the study participants were illiterates. Majority of the fathers
69 (38.3%) were farmers by occupation followed by drivers
32 (17.8%) and laborers 35 (19.4%). Half of the mothers 92
(51.1%) were house wives by occupation followed by farm-
ers 45 (25.0%) and laborers 25 (13.9%) etc. Only 70% of the
fathers HIV status was known, of which 117 (65.0%) were
positive and 9 (5.0%) of them were negative. Whereas 85%
of the mothers HIV status was known, of which 148 (82.2%)
of them were positive and 5 (2.8%) of them were negative.
Among HIV positives, 42 (23.3%) of the fathers and 107
(59.4%) of the mothers were on ART.

The prevalence of malnutrition in this study was 78.4%.
Under nutrition was more common in boys 89 (63.1%) than
girls 52 (36.9%). Among children aged 0-10years old, under-
weight was seen in 17 (27.8%) of them. Among children aged
0-14 years old, wasting was seen in 35 (19.4%) and stunting
was seen in 124 (68.8%) of them as shown in table 3. Acute,
chronic and mixed malnutrition was seen in 17 (9.4%), 106
(58.9%), 18 (10.0%) of the study participants respectively as
shown in graph 1. The mean CD4 count of the study partici-
pants was 735.14532.2 cells/mm3. According to WHO im-
munological classification, 105 (58.3%) of the study partici-
pants did not have immunodeficiency. Whereas 28 (15.6%)
of them had mild, 26 (14.4%) of them had advanced and 21
(11.7%) of them had severe immunodeficiency as shown in
graph 2. There was significant association between malnutri-

tion and presence of immunodeficiency among stud partici-
pants as mentioned in table 4.

DISCUSSION

This present study included HIV infected children of age
0-14years old. Of which, more than half of them 66.2% were
of 11-14years of age group. Similar finding was seen in a
study by Meenal Gupta et.al.? The mean age (in years) of
study participants was 11.114 2.87 SD. Which was slightly
high compared to other studies!®!!. Boys to Girls ratio was
1.65:1 which was similar to other studies.*!*""* More than
half of the study participants (63.9%) belonged to rural area.
This was the same as seen in a study done in Punjab’ and sev-
eral other studies.*'* More than 3/4th of study participants
(79.4%) belonged to class V socioeconomic status, whereas
several other studies*>'° showed that majority of them were
in Class IV. The prevalence of orphan-hood was 73.3%,
which was very high compared to studies conducted in Ni-
geria (36.4%)! and North India (39.15%).!!

The prevalence of under nutrition was 78.3%. Nearly same
result was seen in a study done in Nigeria.'S Whereas this
was very high compared to studies done in Cotonou (27.1%)
(61 and Central and West Africa (42%).° More than half of
the study participants (58.9%) had chronic malnutrition fol-
lowed by mixed malnutrition (10.0%) and acute malnutrition
(9.4%). Similar findings were seen in studies conducted in
Central and West Africa’ and in India.'’ Majority of the chil-
dren had stunting (68.8%) followed by underweight (27.8%)
and wasting (19.4%). Similar results were seen in several
studies.*!5

Majority of the study participants had mild immunodefi-
ciency (15.6%) followed by advanced (14.4%) and severe
immunodeficiency (11.7%). Similar result was seen in many
studies.*!*!6 Whereas in few other studies®*!? majority of the
study participants had severe immunodeficiency. The mean
CD4 count of the study participants was 735.1+532.2 cells/
mm?. Similar result was seen in few studies done in North
India” and Bengaluru.”!

CONCLUSION AND LIMITATIONS:

There was high prevalence of malnutrition among the HIV
infected children. HIV acts as an independent risk factor for
malnutrition. Malnutrition should be targeted to ensure opti-
mal response to ART and reduce early mortality.

ACKNOLEDGEMENTS

The authors would like to thank the Director, Dr. S.T. Kalsad
for granting permission to do the study, Dr. A B Halappa-

Int J Cur Res Rev | Vol 11 - Issue 09 » May 2019

Raghavendra et.al.: Assessment of nutritional status of the hiv infected children attending art centre and its relation...

navar and Mrs. SunandaHalki (statistician) for their guid-
ance and support.Authors acknowledge the immense help
received from the scholars whose articles are cited and in-
cluded in references of this manuscript. The authors are also
grateful to authors / editors / publishers of all those articles,
journals and books from where the literature for this article
has been reviewed and discussed.

=

Ne

p

e

m

D

a

oe

©

REFERENCES

WHO: Summary of the global HIV epidemic. Available at:
http://www.who.int/hiv/data/2017_summary-global-hiv-epi-
demic.png?ua=1. Retrieved on: 12/08/2018

India HIV estimations 2015. Technical report. NACO & NIMS
ICMR, Ministry of Health & Family Welfare. Gov't of In-
dia. Available at: http://www.naco.gov.in/sites/default/files/
India%20HIV%20Estimations%202015.pdf Retrieved on:
12/08/2018.

Nutrition Guidelines for HIV-Exposed and Infected Children (0-
14 Years Of Age) NACO. Ministry of Health & Family Welfare.
Gov't of India. Available at: http://www.naco.gov.in/sites/de-
fault/files/Paedia%20Nutrition%20national%20guidelines%20
NACO.pdf Retrieved on: 02/08/18

Dundigalla C, Chidugulla SK, Ashwani N, Divya BP, Dundi-
galla P. Study of Prevalence Of Malnutrition In HIV Positive
Children and Its Correlation With Cd4 Count. IOSR J of Denl
and Med Sci. 2015; 14(12):50-57.

Ambey R, Sahu S, Sharma A, Gupta R, Goyal B. Assessment
of Nutritional Status of HIV Positive Children in Antiretroviral
Therapy Center: A Study from Central India. Int J of Pediatr Res
and Pract. 2015; 1(1):7-11.

Jesson J, Masson D, Adonon A, Tran C, Habarugira C, Zio R
et.al. Prevalence of malnutrition among HIV-infected children
in Central and West-African HIV-care programmes supported
by the Growing up Programme in 2011: A cross-sectional study.
BMC Infectious Dis. 2015; 15(216):1-12.

Kishore J. National Health Programs of India, National Policies
and Legislations related to Health. 11" ed. Century Publications.
2014: 289-343.

WHO case definitions of HIV for surveillance and revised clini-
cal staging and immunological classification of HIV-related
disease in adults and children. WHO 2007. Available at: http://
www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf Re-
trieved on: 16/08/18

Gupta M, K.J.P.S. Puril, Singh K, Malhotra S. The road less
travelled: A social and demographic profile of HIV- infected

children accessing care at tertiary care centre in North India.
Egyptian Dermatology Online Journal. 2013; 9(4):1-10.

. Madiba S, Mokwena K. Profile and HIV diagnosis disclosure

status of children enrolled in a pediatric antiretroviral program
in Gauteng province, South Africa. Southeast Asian J Trop Med
Pub Health. 2013; 44(6):1010-1020.

. Chauhan RC, Singh N. Socio-demographic profile of HIV in-

fected children accessing care at pediatric clinic of a tertiary lev-
el hospital in North India. Int J ContempPediatr. 2014; 1(1):20-
23.

. S. Rajasekaran, L. Jeyaseelan, K. Raja, N. Ravichandran. De-

mographic & clinical profile of HIV infected children access-
ing care at Tambaram, Chennai, India. Indian J Med Res. 2009;
129:42-49.

. Bhattacharya M, Rajeshwari K, Saxena R. Demographic and

Clinical Features of Orphans and Nonorphans at a Pediatric HIV
Centre in North India. Ind J Ped. 2010; 77:627-631.

. Solunke VN, Kamble MB, Suryawanshi AR, Saple P, Tiwari

MM, Bhete SB et.al, Clinical Profile and Prevalence of Oppor-
tunistic Infection in HIV Patients Attending Pediatric Depart-
ment. Int Med J. 2014; 1(2):69-74.

. Oladokun R, Brown B, Aiyetan P, Ayodele O, Osinusi K. Com-

parison of socio-demographic and clinical characteristics of or-
phans and non-orphans among HIV-positive children in Ibadan,
Nigeria. Int J Inf Dis. 2009; 13:462-468.

. Adedemy JD, Zohoun L, Alihonou F, d’Almeida M, Couringa

Y, Agossou J et.al. Screening for malnutrition and nutritional
care in HIV-infected children followed up in the pediatric unit of
CNHU-HKM in Cotonou. MaternPediatrNutr. 2016; 2(2):1-7.

. Rakholia R, Bano M, Rawat V. Malnutrition among HIV- in-

fected Children by Anthropometric Measures in Poor Outreach
Area of a Developing Country and its Relationship with CD4
Counts. Int J Pediatr. 2016; 4(4):1643-1654.

. Gomber S, Kaushik JS, Chandra J, Anand R. Profile of HIV in-

fected children from Delhi and their response to antiretroviral
treatment. Indian Pediatrics. 2011; 48:703-707.

. Agarwal D, Chakravarty J, Sundar S, Gupta V, Bhatia BD. Cor-

relation between Clinical Features and Degree of Immunosup-
pression in HIV Infected Children. Indian Pediatrics. 2008;
45(17): 140-143.

. Lodha R, Upadhyay A, Kapoor V, Kabra SK. Clinical Profile

and Natural History of Children with HIV Infection. Ind J of
Ped. 2006; 73: 201-204.

. Sanjeeva GN, Sukanya V, Govindaraj M, Shivananda. Clinical

profile, treatment response, and outcome of HIV-TB co-infected
children. Pediatric Infectious Dis. 2013(5):3-8.

Table 1: Socio-demographic profile of the study participants.

AGE GROUP 0-5 year 8 (5.7%)
6-10 years 39 (27.7%)
u- 14 years 94 (66.7%)

GENDER Boys 89 (63.1%)
Girls 52 (36.9%)

o 8 (4.4%) X= 2.947
14 (35.9%) 53 (29.4%) p>0-05
25 (64.1%) 119 (66.1%)
23 (59.0%) 112 (62.2%) X= 0.223
16 (41.0%) 68 (37.8%) P2O0

Int J Cur Res Rev | Vol 11 + Issue 09 • May 2019

Raghavendra et.al.: Assessment of nutritional status of the hiv infected children attending art centre and its relation...

Table 1: (Continued)

RELIGION

TYPE OF AREA

EDUCATIONAL
STATUS

SOCIO-ECONOM-
IC STATUS

ORPHAN STATUS

Hindu
Muslim
Christian
Rural

Urban
Pre-primary
Primary
Secondary
Drop out
Not enrolled
Class 2

Class 3

Class 4

Class 5
Orphans
Non-Orphans

130 (92.2%)
10 (7.1%)
1 (0.7%)

go (63.8%)

51 (36.2%)
4 (2.8%)

74 (52.5%)

57 (40.4%)
2 (1.4%)
4 (2.8%)
2 (1.4%)
5 (3.5%)

25 (17.7%)

109 (77.3%)

105 (74.5%)

36 (25.5%)

37 (94.9%)
2 (5.1%)
o
25 (64.1%)
14 (35.9%)
o
27 (69.2%)
12 (30.8%)
o
o
o
o
5 (12.8%)
34 (87.2%)
27 (69.2%)
12 (30.8%)

167 (92.8%)
12 (6.7%)
1 (0.6%)

115 (63.9%)

65 (36.1%)

4 (2.2%)
101 (56.1%)
69 (38.3%)

2 (1.1%)

4 (2.2%)

2 (1.1%)

5 (2.8%)
30 (16.7%)
143 (79.4%)
132 (73.3%)
48 (26.7%)

X= 0.477
p>0.05

X= 0.001
p>0.05

X= 5.036
p>0.05

X= 2.753
p>0.05

X=0.429
p>0.05

Table 2: Distribution of the parents of the study participants according to demographic and HIV infection

related variables

EDUCATION OF
FATHER

EDUCATION OF
MOTHER

OCCUPATION OF
FATHER

OCCUPATION OF
MOTHER

Illiterate

Primary

Secondary

College and above
Illiterate

Primary

Secondary

College and above
Farmers

Drivers

Laborers

Own Business
Service Occupation
Others

House Wives
Farmers

Laborers

Service Occupation
Others

42 (29.8%)
38 (27.0%)
42 (29.8%)
19 (13.5%)
76 (53.9%)
29 (20.6%)
32 (22.7%)
4 (2.8%)
55 (39.0%)
22 (15.6%)
27 (19.1%)
10 (7.1%)
14 (9.9%)
13 (9.2%)
74 (52.5%)
38 (27.0%)
14 (9.9%)
7 (5.0%)
8 (5.7%)

15 (38.5%)
13 (33.3%)
10 (25.6%)
1 (2.6%)
24 (61.5%)
9 (23.1%)
6 (15.4%)
o
14 (35.9%)
10 (25.6%)
8 (20.5%)
3 (7.7%)
3 (7.7%)
1 (2.6%)
18 (46.2%)
7 (17.9%)
u (28.2%)
2 (5.1%)
1 (2.6%)

57 (31.7%)
51 (28.3%)
52 (28.9%)
20 (11.1%)
100 (55.6%)
38 (21.1%)
38 (21.1%)
4 (2.2%)
69 (38.3%)
32 (17.8%)
35 (19.4%)
13 (7.2%)
17 (9.4%)
14 (7.8%)
92 (51.1%)
45 (25.0%)
25 913.9%)
9 (5.0%)
9 (5.0%)

¥7=4.620
Pp>0.05

¥7=2.292
P>0.05

¥7=3-755
P>0.05

17=9.169
P>0.05

Int J Cur Res Rev | Vol 11

e Issue 09 - May 2019

Raghavendra et.al.: Assessment of nutritional status of the hiv infected children attending art centre and its relation...

Table 2: (Continued)
HIV STATUS OF Positive 89 (63.1%) 28 (71.8%) 117 (65.0%) y2=1.151
FATHER Negative 7 (5.0%) 2 (5.1%) 9 (5.0%) P2005
Unknown 45 (31.9%) 9 (23.1%) 54 (30.0%)
HIV STATUS OF Positive u4 (80.9%) 34 (87.2%) 148 (82.2%) X=0.904
MOTHER Negative 4 (2.8%) 1 (2.6%) 5 (2.8%) P3003
Unknown 23 (16.3%) 4 (10.3%) 27 (15.0%)
IS FATHER ON ART Yes 31 (22.0%) u (28.2%) 42 (23.3%) x% =0.661
No no (78.0%) 28 (71.8%) 138 (76.7%) p=0:05
IS MOTHER ON Yes 83 (58.9%) 24 (61.5%) 107 (59.4%) ¥2=0.091
ART No 58 (41.1%) 15 (38.5%) 73 (40.6%) p20-05

Table 3: Classification of malnutrition of the study participants

Underweight (WAZY u (18.0%) 6 (9.8%) 17/ 61 (27.8%)
Wasting (WHZ or BAZ)” 10 (5.6%) 25 (13.8%) 35/ 180 (19.4%)
Stunting (HAZ) 52 (28.8%) 72 (40.0%) 124/ 180 (68.8%)

*WAZ calculated for children 0-10 years of age, ** WHZ used for children <S5years and BAZ used for children 6- 14years of age

Table 4: Association of the malnutrition with immunological profile of the study participants.

IMMUNODEFICIENCY Normal 6 (3.3%) 71 (39.4%) o 28 (15.6%) 59.531
N=105 (%) df= 9
Mild 5 (2.8%) 17 (9.4%) 5 (2.8%) 1 (0.6%) p<0:05
N=28 (%)
Advanced 3 (1.7%) 12 (6.7%) 3 (1.7%) 8 (4.4%)
N= 26 (%)
Severe 3 (1.7%) 6 (3.3%) 10 (5.6%) 2 (1.1%)
N=21 (%)

59.80%
57.40%

20.50% [23.50%]
14.70% A
6.30%
Acute Chronic Mixed Normal
BBoys H Gins Graph 2: Distribution of study participants according to WHO
+ Acute Malnutrition (VHZ'BAZ < -2 SD and HAZ > -2SD) — Only wasting, Chronic Malnutrition (HAZ < -2 SD and WHZ/BAZ >-2 SD) — cl ss ificati on of | mmun od eficien cy.

Only Stunting, Mixed Malnutrition (WHZ/BAZ < -2 SD and HAZ <-2SD) — Both wasting & stunting.
Graph 1: Distribution of study participants according to de-
grees of malnutrition.

Int J Cur Res Rev | Vol 11 - Issue 09 - May 2019