Under-nutrition and Associated Factors Among Children on ART in Southern Ethiopia: a Multicenter Facility Based Cross-sectional Study

Abstract Background: Malnutrition is very common in HIV infected individual due to decreased food intake, altering digestion, absorption and altering metabolism and by increasing energy need. Even though data from different settings are necessary to tackle it, evidences are limited especially in case of nutritional status of HIV-infected children. Hence, this study aims to assess the nutritional status and associated factors among children on antiretroviral therapy. Methods: An institutional-based cross-sectional study was conducted among 383 HIV-positive children in Southern Ethiopia. Data were collected using interviewer administered questionnaire and anthropometry measurement. Data were coded and entered into Epi-Data Version 3.1, and analyzed using SPSS Version 25. Bivariable and multivariable binary logistic regression models were used to identify factors associated with nutritional status and variables with p-values ˂0.05 in multivariable logistic regression were considered as statistically significant factors.Results: The prevalence of wasting among HIV positive children in Southern Ethiopia selected Hospitals was 36.3% (95% CI: 31.6, 41.0), while stunting on the same study population was 5.5% (95% CI: 3.4, 7.8). Rural residence (AOR = 4.1, CI: 2.0, 8.4), lack of maternal education (AOR =9.3, CI: 5.0, 17.3), low CD4 counts (<500) (AOR =4.9, CI: 2.3, 10.4), using unprotected water source (AOR = 3.2, CI: 1.8, 5.8), having non-biological mother (AOR =4.2, CI: 1.9, 9.2) and recurrent oral lesion (AOR =2.2, CI:1.2, 4.2) were significantly associated with wasting. Furthermore, history of hospital admission (AOR =4.9, CI: 1.6, 15.0), recurrent oral lesion (AOR =3.9, CI: 1.1, 14.1), low CD4 counts (< 500) (AOR =3.5, CI: 1.0-12.0), advanced WHO clinical stage III (AOR =4.0, CI: 1.1, 14.2) were statically associated with stunting. Conclusion: This study found that the prevalence of under-nutrition among HIV-positive children in Ethiopia was significantly high. Rural residence, lack of maternal education, low CD4 count, recurrent oral lesion, having none-biological caretakers and unprotected source of water were significantly associated with childhood wasting. On the other hand, history of hospital admission, recurrent oral lesion, advanced WHO clinical stage and low CD4 counts were significantly associated with stunting of HIV positive children. Therefore, timely identification and monitoring of nutritional problems should be necessary to enhance the effectiveness of ART treatment and to prevent further related complications.