Multi-micronutrient supplementation in HIV-infected South African children : effect on nutritional s tatus, diarrhoea and respiratory infections

S. Mda

Research output: Thesisinternal PhD, WU



Background: The nutritional status of HIV-infected children is reported to be poor. Diarrhoea and acute respiratory infections tend to be more common and severe in HIV-infected children than in uninfected ones. Deficiencies of micronutrients may result in poor growth and increased risk of diarrhoea and respiratory infections. Micronutrient deficiencies are common in HIV-infected children. The poor growth, diarrhoea and respiratory infections seen in HIV-infected children may be partly due to micronutrient deficiencies. The studies in this thesis had two main objectives: (1) to evaluate the effect of short-term (during hospitalization) and long-term (6 months) multi-micronutrient supplementation on episodes of diarrhoea and respiratory infections in HIV-infected children who are not yet on antiretroviral therapy (ART), and (2) to assess the effects of long-term multi-micronutrient supplementation on appetite and growth performance of HIV-infected who are not on ART.

Methods and results: Four studies were conducted. Initially a cross-sectional study was performed in which the duration of hospitalization, weight, length, micronutrient status and appetite of HIV-infected children admitted with diarrhoea or pneumonia was compared with the results of HIV-uninfected children. Duration of hospitalization was 2.8 days (52%) longer in HIV-infected children. Appetite as measured by amount of test food eaten (g per kg body weight) was 26% poorer in HIV-infected children. Mean length-for-age Z-scores were lower in HIV-infected children; there was no difference in level of wasting.

       Subsequently multi-micronutrient supplementation studies were performed, one short-term and two long-term studies. The effect of supplementation on the duration of hospitalization in HIV-infected children with diarrhoea or pneumonia was assessed in the short-term study. One long-term study assessed the supplement’s impact on growth and frequency of episodes of diarrhoea and of pneumonia in HIV-infected children. The other evaluated the effect of the supplement on the appetite of these children. The supplement contained vitamins A, B complex, C, D, E and folic acid, and the minerals copper, iron, selenium and zinc at levels based on recommended dietary allowances.

       In the short-term supplementation study HIV-infected children aged 4-24 months who were hospitalized with pneumonia or diarrhoea received the supplement or a placebo until discharge from hospital. The duration of hospitalization was 1.7 days (19%) shorter in the supplement group.

       Long-term multi-micronutrient supplementation improved the weight-for-age and weight-for-height Z-scores of HIV-infected children aged 4-24 months by 0.4 over the 6-month period. There was no improvement in stunting. Children in the supplement group had substantially fewer episodes of respiratory symptoms per month than the placebo group (0.66 ± 0.51) per month vs (1.01 ± 0.67) (P < 0.05) and marginally fewer episodes of diarrhoea per month (0.25 ± 0.31) vs (0.36 ± 0.36) (P = 0.09). There was no effect on CD4 lymphocytes. Long-term supplementation with micronutrients had benefits on the appetite of HIV-infected children aged 6-24 months as well. Improvements in amount of test food eaten over the 6-month period were much higher among children who received the supplement (4.7 ± 14.7 g/kg body weight) than the changes in those who received the placebo (-1.4 ± 11.6 g/kg body weight).

Conclusion: Multi-micronutrient supplementation reduces the duration of diarrhoea and of pneumonia and incidence of diarrhoea and of respiratory symptoms in HIV-infected children who are not yet on ART. Multi-micronutrient supplementation also improves appetite and weight in these children but not height. The results of these studies indicate that multi-micronutrient supplementation should be considered in HIV-infected infant and young children who have not commenced ART.


Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Wageningen University
  • Kok, Frans, Promotor
  • van Raaij, Joop, Co-promotor
  • de Villiers, F.P.R., Co-promotor, External person
Award date23 May 2011
Place of Publication[S.l.]
Print ISBNs9789085858577
Publication statusPublished - 2011


  • food supplements
  • mineral supplements
  • vitamin supplements
  • human immunodeficiency viruses
  • hiv infections
  • nutritional state
  • diarrhoea
  • respiratory diseases
  • children
  • south africa


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