Number/percent of women of reproductive age with HIV who were assessed with anthropometric measurement and who also received therapeutic or supplementary food during the reporting period
The number or proportion of women of reproductive age (WRA, i.e., ages 15 to 49 years) who were assessed using anthropometric assessments, found to be undernourished, and received therapeutic foods or supplementary foods during the reporting period. The recommended measurements and respective cutoffs for undernutrition in WRA include body mass index (BMI) <18.5 kg/m2 for non-pregnant women; mid-upper arm circumference (MUAC) <22 cm for pregnant women; and MUAC < 21 cm for postpartum women with infants under six months of age.
This indicator is calculated as:
(Number women ages 15 to 49 with HIV who were undernourished based on anthropometric assessment and received therapeutic /supplementary foods/ Total number women ages 15 to 49 anthropometrically assessed as undernourished during reporting period) x 100
The numerator is the number of WRA with HIV who were nutritionally assessed using anthropometric measurements, found to be undernourished, and received therapeutic or supplementary foods during the reporting period. The denominator is the number of WRA with HIV who were nutritionally assessed using anthropometric assessment and found to be undernourished during the same period. Each woman who was assessed at least once during the reporting period is counted once in the denominator (and once in the numerator if she also received therapeutic or supplementary foods at least once during the reporting period), irrespective of whether she received services once or several times during the reporting period. The duration of the reporting period is determined by the facility/program gathering the data.
Therapeutic foods are defined as foods for the management of severe undernutrition and include ready-to-use therapeutic food (RUTF) products such as PlumpyNut, an energy dense, fortified peanut butter/milk powder-based paste, or other locally produced RUTFs (FANTA, 2010; 2007). Supplementary foods for continued treatment of severe undernutrition after an initial stabilization and weight recovery period and for patients who are mild-to-moderately undernourished at entry are primarily fortified, blended flours (e.g. corn-soya blend). Basic food commodities provided for household use or as a safety net do not meet the definition of therapeutic and supplementary food for this indicator (i.e., distribution of these foods is not based on anthropometric assessment of clinical undernutrition).
Note: This indicator measures the subpopulation of WRA that can be disaggregated from the corresponding outcome indicator in the linked set of ‘Harmonized Indicators on Nutrition Care and HIV’ (FANTA, 2009), which have been developed to measure undernutrition in people living with HIV (PLHIV) and orphaned and vulnerable children (OVC) (See FANTA 2008; 2009; 2010 for more details on these indicators.)
The number of women with HIV who were nutritionally assessed with anthropometry, found to be undernourished, and those who received therapeutic and supplementary foods during the reporting period can be tabulated by program staff reviewing individual client and/or clinic records. Data can be collected continuously at the facility/community level and information should be documented on program records each time a client is nutritionally assessed and/or provided foods. Tools for the measures mentioned above may include weight scales, MUAC measurement tapes, and stadiometers/height measuring devices. Data can be disaggregated by reproductive status (pregnant, postpartum up to six months, and non-pregnant, non-lactating), by treatment status for opportunistic infections and antiretroviral treatment, and by age groups, parity, and other relevant factors such as education, income, and urban/rural residence.
Program and site records that document women’s HIV status and whether clients who have received anthropometric assessment and were found to be undernourished received therapeutic or supplemental foods.
This indicator monitors the number and proportion of clinically undernourished women with HIV receiving therapeutic or supplementary food within a facility or geographic area. Provision of therapeutic and supplementary feeding to PLHIV who are nutritionally assessed as undernourished is a key component of treatment, care and support for HIV-infected individuals. Several national programs provide food support to clinically undernourished clients, including therapeutic food products for the severely undernourished and supplementary food products for the moderately and mildly undernourished. This indicator is part of the linked set of ‘Harmonized Indicators for Nutrition and HIV Care’ (FANTA, 2009), which track and provide comparative and trend data on the number and proportion of undernourished individuals receiving various program services.
Women with HIV are a critical population for health and nutrition assessment and intervention. According to UNAIDS data from 2009, women account for over 50 percent of global HIV infections and over 19.2 million women live with HIV. The nutritional status of HIV-infected women before or during pregnancy and during lactation influences both the women’s health and the health and survival of their infants. For women who are under- to normal weight pre-pregnancy, adequate weight gain during pregnancy reduces the risks for low birth weight, stillbirth and perinatal mortality. In addition, sufficient energy and nutrient intakes are necessary postpartum to support the demands of breastfeeding and for women to replenish their nutrient stores. HIV infection increases energy requirements due to higher resting energy expenditures and increased nutritional needs from HIV-related infections and illnesses, thereby placing pregnant and lactating women at greater nutritional risk than their HIV-uninfected counterparts (WHO, 2004; Papathakis and Rollins, 2005; FANTA, 2010). This indicator relates to four of the Millennium Development Goals: #1. Reduce poverty and hunger; #4. Reduce child mortality; #5. Improve maternal health; and #6. Combat HIV/AIDs.
The information provided by this indicator can be used at many levels and for a variety of purposes. At the global level, this indicator can be used by donors and international organizations to track the extent to which program nutrition interventions are reaching women with HIV and to identify countries or regions where more focused efforts may be required. This information can be used similarly by national governments to track efforts, identify gaps in service delivery, and prioritize needs within countries. Programs can use the information to assess the reach of their services, to inform resource allocation and program management, to plan resource needs (e.g., commodities and staff training), and to report data to donors. Data collected by this indicator would likely be reviewed annually at the national and global level and could be reviewed more frequently at the program level as needed.
Many countries are integrating nutrition assessment, counseling and provision of therapeutic and supplemental foods into national HIV programs. Acquiring tools for conducting anthropometric measures, training counseling staff, and developing systems for collecting, recording, and reporting data are becoming priorities for national governments as well as international donors making collection and utilization of this indicator increasingly feasible.
There are some possible constraints in comparing this indicator across countries. It is important to note that different countries and programs may use different types of food products and possibly even different entry and exit criteria for food eligibility. Also, the indicator provides information about coverage, but not about the duration of food support provided, drop-out rates, quality of the foods, or existence of complementary interventions with the food.
Accurate collection of data relies largely on flow of services at the clinic/program level and requires availability of standardized anthropometric measurement equipment, trained staff, and accurate record keeping within a program. The indicator may underestimate the number of HIV-infected women in an area and should not be used for these purposes. Not all women with HIV will be able access to services, especially in remote areas or where women’s mobility is limited by cultural norms.
access, nutrition, quality, HIV/AIDS, adolescent
Women’s ability to access HIV programs and services may be more limited than men’s in settings where women are particularly stigmatized for being HIV-positive or where cultural norms limit women’s ability to travel outside the home.
FANTA (Food and Nutrition Technical Assistance) Project. 2010. A Guide to Screening for Food and Nutrition Services Among Adolescents and Adults Living With HIV . Washington, D.C.: Academy for Educational Development.
FANTA (Food and Nutrition Technical Assistance) Project. 2009. A Guide to Screening for Food and Nutrition Services Among People Living With HIV (Draft). Washington, D.C.: Academy for Educational Development.
FANTA (Food and Nutrition Technical Assistance) Project. 2008. A Guide To Monitoring and Evaluation of Nutrition Assessment, Education and Counseling of People Living with HIV. Washington, D.C.: Academy for Educational Development.
FANTA (Food and Nutrition Technical Assistance) Project. 2007, Nutrition and HIV/AIDS: A Toolkit for Service Providers in the Comprehensive Care Centres. Washington, D.C.: Academy for Educational Development.
FANTA (Food and Nutrition Technical Assistance Project. 2006. Compilation of Monitoring and Evaluation (M&E) Indicators Used for Food and Nutrition Interventions Addressing HIV/AIDS. Washington, D.C.: Academy for Educational Development.
FANTA (Food and Nutrition Technical Assistance) Project. 2004. Food and Nutrition Implications of Antiretroviral Therapy in Resource Limited Settings, T. Castleman, E. Seumo-Fosso,and B. Cogill. Washington, D.C.: Academy for Educational Development.
FANTA (Food and Nutrition Technical Assistance) Project. 2004, HIV/AIDS: A Guide for Nutritional Care and Support. Washington, D.C.: Academy for Educational Development.
WHO, 2004, Nutrition Counseling, Care and Support for HIV-infected Women, Geneva, Switzerland: World Health Organization. HIV regnant and lactating women
Papathakis P. and Rollins N., ‘HIV and Nutrition: Pregnant and Lactating Women,’ Consultation on Nutrition and HIV/AIDS in Africa: Evidence, lessons and recommendations for action, Durban, South Africa, April 2005, Department of Nutrition for Health and Development, World Health Organization.