Nutritional adequacy in rural Limpopo Province, South Africa: Maternal and child dietary diversity in the context of perinatal HIV exposure

Background. Children younger than 5 years old are a vulnerable group whose growth is affected by nutritional intake. However, few studies have evaluated dietary diversity–a proxy measure of dietary adequacy–among HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children in resource-limited settings.Objective. To measure dietary diversity in a cohort of HEU and HUU children in Limpopo. Methods. Data were collected from 305 mother-child dyads enrolled in a cluster-randomised trial in rural Limpopo, South Africa. HIV exposure was based on maternal self-reported status. Height-for-age Z scores (HAZ) and weight-for-age Z scores (WAZ) were calculated using World Health Organization standards. Dietary diversity (DD) was defined as the number of different food groups consumed in the past 24 hours. Mean differences in outcomes between HEU and HUU children were estimated at 7 and 17 months of age. Results. At 7 months, the mean DD was 2.30 (standard deviation 1.63) and showed no differences by sex or HIV exposure (HEU 2.26 (1.63) v. HUU 2.32 (1.63); p=0.08). At 17 months, the mean DD was 3.38 (1.62) and remained similar between HUU and HEU children (3.41 (1.57) v. 3.29 (1.82); p=0.333). No significant association was found between sub-optimal DD score (<5 of 8 food groups) and being underweight or stunted (p>0.05). At 7 months, compared with HUU children (n=234), HEU children (n=71) had a lower median HAZ of −0.54 (interquartile range (IQR) −1.21 - 0.11) v. median −0.1, IQR −0.76 - 0.99 (p<0.0001) and WAZ (median 0.50, IQR −0.27 - 1.24 v. 0.01, IQR −0.69 - 1.02; p<0.018). Conclusion. At 7 months, DD was notable given the prevalence of early weaning. By 17 months, DD had improved, likely reflecting the children’s psychological readiness to try various food combinations and textures at that age.