A cross national analysis of the household and community HIV AIDS determinants of child malnutrition in sub Saharan Africa Evidence from the DHS
The HIV/AIDS epidemic in sub Saharan Africa is believed to have retarded progress in the reduction of under five mortality in the region through its impoverishing effects which impinge on the health and nutrition of children, and through illness of the parent and/or the child. The WHO consultation on nutrition and HIV/AIDS in Africa recognized that far reaching steps need to be taken to reverse current trends in malnutrition, HIV infection and food insecurity in most countries in the region, in order to achieve the Millennium Development Goals" An improved understanding of HIV/AIDS determinants of malnutrition in the worst affected regions will help inform such efforts. In this paper, we examine the extent to which children whose mothers are infected with HIV, or in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected households or communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003 2008 from 18 countries in sub Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual household/community/country level HIV/AIDS factors on child malnutrition. The results suggest that across countries in sub Saharan Africa, the nutritional status of children who are paternal orphans or in households with HIV positive adult(s) is not significantly different from other children. However, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio economic background. The disadvantage of children whose mothers" are infected with HIV becomes particularly apparent when urban/rural residence and household wealth index are controlled for. Other adult household members being HIV positive is associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers" HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. An examination of the risk factors of undernutrition among children whose mothers are infected suggests that the overall higher risk among those from the poorest households is amplified for this particularly vulnerable group of children. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub groups of the population made vulnerable by HIV/AIDS.