- 學位論文
史瓦濟蘭曼齊尼地區感染人類免疫缺乏病毒之孕產婦女的 營養知識、態度、行為
Nutrition Knowledge, Attitude and Practices of Maternal Women Living with HIV in the Manzini Region of Swaziland
摘要
背景：感染人類免疫缺乏病毒(Human Immuno-deficiency Virus, HIV)或罹患後天免疫缺乏症候群(Acquired Immune Deficiency Syndrome, AIDS)是全球性的危機，其嚴重程度對撒哈拉以南的非洲國家影響甚鉅。史瓦濟蘭感染HIV的盛行率為26 %，為世界之最。且女性盛行率較男性高，分別為31 % 與20 %。根據2010年於產前檢查診所就診情形發現：感染HIV的盛行率從1992年的3.9 % 增加到41.1 %。鑑於HIV週期與營養之間的關係，營養介入為減輕HIV造成之影響的新選擇。然而，有效的營養介入需要有知識、態度與行為方面的調查，史瓦濟蘭在營養知識、態度與行為的資料卻非常有限。 目的：調查史瓦濟蘭曼齊尼地區受HIV感染的孕婦與產婦的社會人口因子對營養知識、態度、行為的影響。 方法：於兩間區域醫院、一間健康中心與四間診所進行招募。使用結構式問卷以面談方式完成資料收集，最後一共收集到324位感染HIV的孕婦與產婦的資料。問卷包含下列四部份：社會人口資料(22題)、營養知識(15題)、營養態度(12題)、營養行為(14題)。 結果：營養知識、態度、行為的平均得分，分別為8±2.06分(滿分12分，答對率67 %)、24±3.84分(滿分36分，答對率67 %)、21±6.52分(滿分41分，答對率51 %)。知識、態度、行為之間有顯著的正相關，知識與態度(r= 0.155, p= 0.005)，知識與行為(r= 0.456, p= 0.001)，態度與行為(r= 0.230, p= 0.001)。教育程度(p= 0.040)與身體質量指數(body mass index, BMI) (p=0.014)與營養知識有顯著相關性；衛生設施(p= 0.001)、宗教(p= 0.001)、主要收入來源(p= 0.031)、有情緒不安感的天數(p= 0.031) 與營養態度有顯著相關性；社會人口因素例如：教育程度(p= 0.002)、就業情形(p= 0.009)、收入(p= 0.008)、宗教(p= 0.007)、住宿類型(p= 0.006)、購物時使用的運輸工具類型(p= 0.001)、身體質量指數(BMI) (p= 0.015)與營養行為有顯著相關性。迴歸分析顯示：購物時使用的運輸工具類型(p= 0.002)、平盤的食物分配比例知識(p= 0.001)、高纖維飲食的積極程度(p= 0.004)、攝取多樣化食物(p=0.006)等是有良好的營養行為之決定因素。 結論：在324位受試者中，營養知識、行為、態度的表現，三者之間具有相關性。營養知識無法完全影響使其有良好的營養行為；教育程度、身體質量指數與營養知識有關，與營養態度有關；社會人口因素例如：教育程度、就業情形、收入、住宿類型等與營養行為有關。
並列摘要
Background: Swaziland has the highest Human Immuno-deficiency Virus (HIV) prevalence rate in the world at 26% while women have a higher prevalence rate than men at 31% and 20%, respectively. Trends in HIV prevalence among pregnant women attending antenatal clinics (ANC) increased from 3.9% in 1992 to 41.1% in 2010. The cyclical relationship between HIV and nutrition makes nutritional interventions a novel option to mitigate the impact of HIV. However, planning of effective nutrition interventions require adequate information on nutrition knowledge, attitude and practices. In Swaziland, there is limited data on nutrition KAP. Objective: To investigate nutrition KAP and the influence of socio-demographic factors among maternal women living with HIV in the Manzini region of Swaziland. Methods: Cross sectional face-to-face interviews using a structured questionnaire were conducted to collect data from 324 HIV infected maternal women at 2 regional hospitals, 1 health center and 4 clinics. The questionnaire consisted of four parts: 1. Socio-demographic information (22 questions) 2. Nutrition knowledge (15 questions) 3. Scale on nutrition attitude (12 questions) and 4. Nutrition practices (14 questions). Results: The results showed mean scores of nutrition knowledge (8±2.06 points out of 12 points 67%); nutrition attitude (24±3.84 points out of 36 points 67%) and nutrition practices (21±6.52 points out of 41 points 51%). Significant positive correlations among nutrition KAP were observed: Nutrition K and A (r= 0.155, p= 0.005), nutrition K and P (r= 0.456, p= 0.001), nutrition A and P (r= 0.230, p= 0.001). Education level (p= 0.003) and BMI (p= 0.002) were significantly associated with nutrition knowledge while health facility (p= 0.001), religion (p= 0.001), principal wage earner (p= 0.031), and no. of days of emotionally ill-feeling (p= 0.030) were significantly associated with nutrition attitude. Socio-demographic factors that were significantly associated with nutrition practice include education level (p= 0.002), employment status (p= 0.009), income (p= 0.008), religion (p= 0.007), type of accommodation (p=0.006), type of transport used when going for shopping (p= 0.001) and body mass index (BMI) (p= 0.015). Multiple linear regression identified type of transport used when going for shopping (p= 0.002), education level (p= 0.001), income (p= 0.001), employment status (p= 0.038), knowledge of food proportion in a plate (p= 0.000), a positive attitude towards high fiber diet (p= 0.004) and eating a variety of foods (p= 0.006) as predictors of good nutrition practice. Conclusion: Nutrition knowledge, attitude and practices were positively and significantly correlated with each other. The level of education and BMI were significantly associated with nutrition knowledge and practices. The level of education was also identified as a predictor of nutrition practice, suggesting that formal education system is a potential target for influencing dietary behavior among people living with HIV (PLWHA).
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