Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province, Kenya

Abstract

Low body mass index (BMI) at the time of enrollment into HIV care has been shown to be a strong predictor of mortality independent of CD4 count. This study investigated socio-demographic associations with underweight (BMI < 18.5) among adults in Nyanza Province, Kenya, upon enrollment into HIV care. BMI, socio-demographic, and health data from a cross-sectional sample of 8254 women and 3533 men were gathered upon enrollment in the Family AIDS Care and Education Services (FACES) program in Nyanza Province, Kenya, between January 2005 and March 2010. Overall, 27.4% of adults were underweight upon enrollment in HIV care. Among each women [W] and men [M], being underweight was associated with younger age (W: adjusted odds ratio [AOR], 2.90; 95% confidence interval [CI], 1.85–4.55; M: AOR, 5.87; 95% CI, 2.80–12.32 for those aged 15–19 compared to ≥50 years old), less education (W: AOR, 2.92; 95% CI, 1.83–4.65; M: AOR, 1.55; 95% CI, 1.04–2.31 for primary education compared to some college/university), low CD4 count (W: AOR, 2.13; 95% CI, 1.50–3.03; M: AOR, 1.43; 95% CI, 0.76–2.70 for 0–250 compared to ≥750 cells/mm³), and poor self-reported health status (W: AOR, 1.72; 95% CI, 0.89–3.33; M: AOR, 9.78; 95% CI, 1.26–75.73 for poor compared to excellent). Among all enrollees to HIV care, low BMI was associated with male gender, lower educational attainment, younger age, and poor self-reported health. HIV care and treatment programs should consider using socio-demographic and health risk factors associated with low BMI to target and recruit patients with the goal of preventing late enrollment into care.

Keywords:

• HIV/AIDS
• socio-economic status
• anthropometry
• body mass index
• Kenya
• Africa

Acknowledgments

The authors thank Paul Awange, Benard Otieno, Cinthia Blat, Stephen Okite, Millicent Ogalo, Starley Shade, Jayne Kulzer, Judith Oayu, and the Family AIDS Care and Education Services (FACES) staff for their assistance with data collection and the UCSF/UCB Global Health Frameworks Program and Organic Health Response/Ekialo Kiona Center for their support of this study. This study is published with the permission of the Director, KEMRI. This study was supported by grant 5R25TW7512-3 from the National Institutes of Health (NIH)/Fogarty International Center as well as a Dean's Research Fellowship from the University of California, San Francisco to J.M.N.; NSF GRFP, Sigma Xi Grants-in-Aid of Research, Andrew and Mary Thompson Rocca Pre-Dissertation Research Award in African Studies and Sara's Wish Foundation Fellowship to K.J.F.; and grants K01MH098902 and T32AI065388 from the NIH/National Institute of Allergy and Infectious Diseases to S.L.Y.