埃塞俄比亚西北部菲诺特-塞拉姆综合医院接受治疗性喂养计划的成年艾滋病患者的营养恢复情况及其预测因素：一项回顾性队列研究
Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study.
作者信息
Diress Gedefaw, Moges Nurilign Abebe
机构信息
Public Health Department, Health Sciences College, Woldia University, Woldia, Ethiopia.
Public Health Department, Health Sciences College, Debre Markos University, Debre Markos, Ethiopia.
出版信息
AIDS Res Treat. 2020 Dec 28;2020:8861261. doi: 10.1155/2020/8861261. eCollection 2020.
BACKGROUND
Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia.
METHODS
An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients' charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery.
RESULT
From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9-17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22-31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27-0.85), no formal education (ARR = 0.24, 95% CI: 0.13-0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08-0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17-0.59) decrease the probability of nutritional recovery.
CONCLUSION
Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.
背景
营养不良是撒哈拉以南非洲地区艾滋病患者面临的一个主要公共卫生问题。为解决营养不良问题，埃塞俄比亚卫生部实施了一项治疗性喂养计划，即为营养不良者提供营养治疗、护理和支持。然而，对于治疗性喂养计划的结果了解甚少。因此，本研究旨在评估参与埃塞俄比亚西北部治疗性喂养计划的营养不良艾滋病患者的营养恢复情况及其预测因素。
方法
在2010年7月至2017年1月期间，于菲诺特 - 塞拉姆综合医院对376名随机选取的参与治疗性喂养计划的成年营养不良艾滋病患者进行了一项基于机构的回顾性队列研究。通过使用预先测试的结构化检查表查阅患者病历、随访卡和营养不良治疗登记册来收集数据。主要结局变量为营养恢复情况，根据体重指数进行定义。采用双变量和多变量对数二项回归模型来确定营养恢复的预测因素。
结果
在参与治疗性喂养计划的所有营养不良艾滋病患者中，61.2%实现了营养恢复，中度急性营养不良患者的中位恢复时间为12周（四分位间距9 - 17周），重度急性营养不良患者为25周（四分位间距22 - 31周）。农村居住（调整风险比（ARR）= 0.53，95%置信区间：0.27 - 0.85）、未接受正规教育（ARR = 0.24，95%置信区间：[0.13 - 0.54]）、抗逆转录病毒治疗依从性差（ARR = 0.14，95%置信区间；0.08 - 0.32）以及世界卫生组织临床分期为III期或IV期（ARR = 0.38，95%置信区间；0.17 - 0.59）会降低营养恢复的概率。
结论
营养补充在营养不良患者的营养护理和治疗中起着关键作用。医疗服务提供者应更加关注依从性差、世界卫生组织临床分期较晚、农村居住以及教育程度低的人群。未来应开展前瞻性随访研究，以评估家庭收入、家庭层面的食物分享以及到医疗机构的距离等重要变量。
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