High malnutrition among Ethiopian adolescents on ART linked to food, infections, mental health

Adolescence is a vital time for growth, and for young people living with HIV/AIDS the right nutrition can make a big difference to health and treatment. A team led by Meless G. Bore set out to understand why many adolescents on antiretroviral therapy (ART) in Ethiopia struggle with their nutritional status. The researchers focused on clinical, lifestyle, environmental and dietary influences on nutrition among adolescents living with HIV (ALHIV). To capture a wide picture, the study worked in ten public hospitals across Addis Ababa and the Oromia regions, recruiting 384 ALHIV who were receiving ART. The work took place between August – December 2023 and used a combination of cross‑sectional surveys, clinical assessments and reviews of clinical records. Participants were chosen with proportionate random sampling, and data were gathered with a pre-tested interviewer-administered structured questionnaire plus standardised assessments carried out by trained healthcare workers. The study aimed to identify which factors are most strongly tied to thinness, stunting and acute malnutrition among this vulnerable group.

The methods and results come from systematic, clinic-based research. The team enrolled 384 ALHIV on ART at ten public hospitals in Addis Ababa and Oromia, using proportionate random sampling to select participants. Data collection combined cross-sectional surveys, clinical assessments and clinical record reviews; tools included a pre-tested interviewer-administered structured questionnaire and standardised assessments by trained healthcare workers. Nutritional screening found that 24.2% of participants were classified as thin, 21.7% as stunted, and 34.9% as acutely malnourished. Statistical analysis identified specific determinants: thinness was associated with male gender, household food insecurity, a history of chronic infections such as tuberculosis, and symptom levels indicative of anxiety and moderate/moderately severe depression. Acute malnutrition was significantly linked to younger adolescence (ages 10–17), male gender, larger household size (four or more members), household food insecurity, delayed disclosure of HIV status, history of chronic infections, generalized anxiety disorder, and low haemoglobin (<11 mg/dL). These patterns point to overlapping clinical, social and psychological drivers of poor nutrition.

The findings underscore that malnutrition in ALHIV is not just about calories or dietary choices: it reflects a mix of social, medical and mental health problems. Household food insecurity and larger family size suggest environmental and economic pressures, while chronic infections like tuberculosis and low haemoglobin show medical vulnerabilities that worsen nutritional status. Mental health signals — anxiety, generalized anxiety disorder, and depression symptoms — also emerged as important, linking emotional wellbeing to physical nutrition. Delayed disclosure of HIV status appeared tied to worse outcomes, highlighting how social and care dynamics affect health. Taken together, the results point toward the need for integrated responses: routine nutritional screening in HIV clinics, attention to household food support, active testing and treatment for chronic infections, screening and care for anxiety and depression, and carefully managed disclosure practices. The study’s authors call for targeted nutrition and mental health interventions tailored to adolescents on ART, aiming to reduce thinness, stunting and acute malnutrition in this high-risk group.