Relapse into undernutrition in a nutritional program in HIV care and the impact of food insecurity: A mixed-methods study in Tigray Region, Ethiopia

Fisaha Tesfay, Anna Ziersch, Sara Javanparast, Lillian Mwanri

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The relapse into undernutrition after nutritional recovery among those enrolled in a nutritional program is a common challenge of nutritional programs in HIV care settings, but there is little evidence on the determinants of the relapse. Nutritional programs in HIV care settings in many countries are not well designed to sustain the gains obtained from enrolment in a nutritional program. This study examined relapse into undernutrition and associated factors among people living with HIV in the Tigray region of Ethiopia. The study employed a mixed-methods approach, involving quantitative and qualitative studies. Among those who graduated from the nutritional program, 18% of adults and 7% of children relapsed into undernutrition. The mean time to relapse for adults was 68.5 months (95% CI, 67.0-69.9). Various sociodemographic, clinical, and nutritional characteristics were associated with a relapse into undernutrition. A considerable proportion of adults and children relapsed after nutritional recovery. Food insecurity and poor socioeconomic status were a common experience among those enrolled in the nutritional program. Hence, nutritional programs should design strategies to sustain the nutritional gains of those enrolled in the nutritional programs and address the food insecurity which was reported as one of the contributors to relapse into undernutrition among the program participants.

Original languageEnglish
Article number732
Pages (from-to)1-15
Number of pages15
JournalInternational Journal of Environmental Research and Public Health
Issue number2
Publication statusPublished - 16 Jan 2021

Bibliographical note

Funding Information:
This study was part of a PhD thesis of the first author and the Flinders University of South Australia covered the tuition fee, data collection, and overseas travel expenses during the PhD candidature. Flinders University had no involvement in the design, collection, analysis, interpretation, writing and the publication of this manuscript. This manuscript is taken from PhD thesis of the first author. We would like to acknowledge the Australian Government Research Training program and Flinders University for covering the tuition fee, living expenses, and fieldwork, and overseas travel costs during the PhD candidature. We would also like to express our gratitude to Mekelle University, Tigray Regional Health Bureau, and the study hospitals (Mekelle, Shul, and Lemlem Karl) for providing administrative support and facilitating the data collection process, and also the quantitative data collectors in these hospitals. The qualitative study participants also deserve special thanks for sharing their personal experiences.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Food insecurity
  • Mixed methods
  • Poor livelihood
  • Poverty
  • Relapse


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