The methods were performed in accordance with the relevant guidelines and regulations in this section. In conducting and reporting this research, we adopted the “Strengthening reporting on observational studies in epidemiology” (STROBE) checklist.
frame
The study was conducted in 2019 at a public hospital in the Ho community in the Volta region, Ghana. Ho has four hospitals and three clinics, with the Ho Teaching Hospital, popularly known as Trafalgar, being the general and referral center [18]. The hospital has a HAART unit where PLWHA usually visits monthly for access to immunity and medication. The department has an advisory department that usually takes on the mandate to advise customers on their maintenance. The community has a central market and three universities.
Study design
We adopted a descriptive cross-sectional design in conducting this study. This design allowed the collection of quantitative data at a specific point in time using questionnaires to describe an existing phenomenon of interest, nutritional status. This was appropriate as the study attempted to examine the nutritional knowledge, attitudes and nutritional status of PLWHA who have access to HAART in a public hospital in Ghana.
Study population and sampling
The study included people living with HIV / AIDS, who have access to HAART in a public hospital, and who are at least 18 years old. This population was chosen because it is experiencing a service designed to affect the phenomena of this study. Nutritional knowledge and practices in people with HIV. However, health professionals and foreigners were excluded.
The study used Yamanes [19] Sample size formula, (n = frac { mathrm {N}} {1+ mathrm {N} { left ( mathrm {e} right)} ^ 2} ) to determine the sample size based on the population of PLWHA accessing HAART in the facility, 210. With a 95% confidence interval, the margin of error is e = 0.05. With a 10% non-response rate, the study used a sample size of 152 PLWHA who participated in HAART in the public hospital. These respondents were selected using a simple random sampling method. Using the HAART register as a sampling frame, the numbers corresponding to each customer in the register were written on pieces of paper, rolled into balls, and placed in a container. The container was shaken and a rolled paper selected at random until the sample size was obtained. Customers, whose number was selected, were included in the study to form the required sample.
Procedure
A person living with HIV / AIDS whose registration number was selected and willing to participate was interviewed by a trained research assistant. Before entering the study, the study processes were explained and ethical concerns as well as any other concerns were considered. The data was collected using a semi-structured questionnaire with the support of two trained research assistants. The instrument was developed based on the literature itself (largely adapted by Abgaryan) [5]) and pre-tested under 40 PLWHA in the Hohoe Municipal Hospital and given a reliability coefficient, ∝ of 0.742. Due to the different contexts of the previous studies and this study, the validity of the tool was ensured by giving it to two experts in HIV / AIDS studies for review, which resulted in some parts being discarded or redesigned for use. It consisted of four sections AD; Section A on socio-demographic characteristics, B on nutritional knowledge and healthy eating, C on PLWHA’s attitudes towards healthy eating, and D on nutritional status. The respondents who could not read or understand the questionnaire were supported and the questions explained. In order to minimize the introduction of distortions in the translation, the data collectors were trained to explain all questions together. The completed questionnaires were checked for completeness and validity of the answers.
Study variables
The outcome variable was nutritional status, which was determined using the body mass index (BMI). The explanatory variables were age, gender, marital status, highest level of education, employment status, household size, monthly expenses and the proportion of expenses for food, nutrition-related knowledge and attitude to nutrition. Nutritional knowledge included understanding nutritional needs for PLWHA and the need for a specific diet, while attitudes towards nutrition included questions about evaluating behavior and perception of a specific diet for PLWHA.
Data analysis
The collected data was entered, cleaned and analyzed with the Statistical Package for the Social Sciences (SPSS) Version 22.0. The analyzes were performed using descriptive statistics, which included mean, frequency, and percentage, and inferential statistics, which consisted of binary logistic regression. All statistical analyzes were considered significant with p-values <0.05 in 95% confidence intervals (CI). We performed two binary logistic regression models. We first ran a bivariate model (Model I) using all of the explanatory variables. Significant variables were then included in our multivariable model (Model II).
There were 20 nutritional knowledge assessment questions, and the correct answers were scored 1 and the wrong answers were scored 0, resulting in a maximum total score of 20. Therefore, the respondents had index values of more than half, ie 11 or more (which indicates correct answers for more than 10 of the 20 knowledge questions) were classified as having sufficient nutrition-related knowledge. The setting variable consisted of five [5] Questions and used a Likert scale of 0-disagree and 1-agree to rate, giving a maximum index score of 5. Thus, respondents with attitude ratings of more than half, ie 3 or more (which represents positive answers for 3 or more of the 5 statements of attitude) were rated as good to their diet.
Ethical issues
Ethical approval for this study was obtained from the Research Ethics Committee of the University of Health and Allied Sciences. Approval was also obtained from the Ho City Health Department and public hospital management. Before the study participants were included, a written declaration of consent was obtained after an optimal level of anonymity and confidentiality of the information provided had been ensured. Printouts of the data were kept under lock and key, while soft copies with password and security were saved on a PC.
