HIV exacerbates malnutrition among infants in drought-prone Turkana

A high incidence of HIV has worsened the condition of hungry children in drought-prone Turkana region, in northern Kenya.

Over the past month, seven of the 10 children admitted to a nutritional rehabilitation centre at the hospital in Lodwar, Turkana's largest town, were found to be HIV positive. Turkana has a high HIV prevalence rate of 11.4 percent, almost double the national rate of 6.7 percent estimated by UNAIDS.

"HIV is an increasing problem in Turkana, the rate here is high," said Seife K-Yohannes, nutrition coordinator for Merlin, a UK-based healthcare NGO. "Most of the HIV-positive children have a poor appetite, nausea and vomiting and frequent uncontrolled diarrhea, so they become very dehydrated and lose a lot of nutrients."

The problems associated with HIV start early, according to Mary Anne Macharia, a nurse at the Merlin-run stabilisation (rehabilitation) centre. "If the mother is infected, she gives birth to a child with a weak constitution and then she struggles to provide enough milk to the already weak child".

The pastoral and farming communities of Turkana have been especially vulnerable to the severe year-long drought afflicting the Horn of Africa. A recent survey by Unicef, the UN children's agency, found that acute malnutrition rates were dangerously elevated in all parts of Turkana. It recorded a global acute malnourished rate of 20 per cent, above the World Health Organization critical point, which is 15 percent.

Severely malnourished children admitted to the centre are given Plumpy’nut, a peanut-based therapeutic food paste. The meal requires no additional preparation and leads to rapid weight gain provided there are no other health complications.

But poverty and chronic food insecurity often forces the entire family to share the supplement. For HIV-positive children, even a sufficient quantity of the Plumpy’nut supplement is not always enough. Merlin refers these children to a local church-run programme that provides paediatric ARVs.

Besides the stabilisation centre, Merlin operates an infant feeding outpatient service that visits 100 different villages every week.

Despite the availability of treatment, fear and stigma associated with HIV means that few people in Turkana volunteer for HIV testing. Only four out of 19 mothers who were offered testing during a seven-week period at the stabilisation centre accepted it - three of them tested positive.

The few women who know they are infected, receive drugs to lower their chances of transmitting the virus during childbirth, but lack of access to formula milk means there is still a chance their babies will become infected: "Because of the drought here, there is no supplementary feeding [to replace breast milk] and no reliable sources to get food or even water," Macharia said.

Additionally, food insecurity makes HIV infected mothers particularly vulnerable to other health problems. "Often they survive on one meal a day, this is not satisfying or balanced," said Ewoi Bengunn, the supervising clinical officer at the stabilisation centre. "When the immunity is low, there is nothing to fight the infections. We see many respiratory infections, kala-azar [also known as leishmaniasis, a tropical infection spread by sand flies] and recently severe skin infections, measles and, of course, lots of diarrhea and vomiting."

Yakish Eyapan, the district's HIV/AIDS and sexually transmitted infections coordinator, explained that the pandemic had to compete for attention with many other pressing issues.

According to Eyapan: "The problem with Turkana is that it has many neglected issues that are more important to people than HIV... like food insecurity, water, education and poverty. If people have no water and are hungry, how can you talk to them about HIV?"

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