Number/percent of women (15-49) with HIV who were nutritionally assessed with anthropometric measurement during reporting period

Number/percent of women (15-49) with HIV who were nutritionally assessed with anthropometric measurement during reporting period

Number/percent of women (15-49) with HIV who were nutritionally assessed with anthropometric measurement during reporting period

The number or proportion of women of reproductive age (WRA, i.e., ages 15 to 49 years) who are HIV positive and who were nutritionally assessed using anthropometric measurements during a specified reporting period.  These measurements include body mass index (BMI) for non-pregnant women and mid-upper arm circumference (MUAC) for pregnant women and 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 nutritionally assessed using anthropometric measurements/Total number women ages 15 to 49 with HIV who received programs services during reporting period ) x 100

The numerator is the number of WRA with HIV who received nutrition assessment at some time during the reporting period using anthropometric measurement. The denominator is the number of WRA with HIV receiving program services during the same period.  Each woman who received program services at least once during the reporting period is counted once in the denominator (and once in the numerator if she received nutrition assessment 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.

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.)

Data Requirement(s):

The number of women with HIV who received anthropometric assessment at some time 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.  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 urban/rural residence.

Program/site records that document whether nutrition assessment of clients receiving program services has taken place.

This indicator monitors coverage for the number and proportion of WRA with HIV who are nutritionally assessed within a facility or geographic area.  Nutrition assessment including anthropometric measurements provides information on individual nutrition status and is an essential component of treatment, care and support for PLHIV and OVC.  It is important for women with HIV to be nutritionally assessed at regular intervals.  This indicator is a basic 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 nutritionally assessed 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 including the use of anthropometric measurements into national HIV programs and this indicator directly measures the coverage of these nutrition assessment services.  Acquiring tools for conducting anthropometric measures and developing systems for collecting, recording, and reporting such data are becoming priorities for national governments as well as international donors making collection and utilization of this indicator increasingly feasible.

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 does not provide information about the quality of the nutritional assessment, and accordingly quality assurance systems should be established and indicators of quality collected to assess how effectively these services are being implemented.  The indicator may underestimate the number of HIV-infected women in an area and should not be used for this purpose.  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.

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. 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.  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.

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.

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