A guidebook on nutritional care and support for people ... · Chapter 1 – Nutrition for people...

A guidebook on nutritional care and support for people living with HIV

and AIDS in Eritrea

Guide for home based care service providers and people living with HIV and AIDS and their families

A guidebook on nutritional care and support for people living with HIV

and AIDS in Eritrea

Guide for home based care service providers, and

people living with HIV and AIDS and their families

© 2005, Ministry of Health of the State of Eritrea, World Food Programme Eritrea, UNAIDS Eritrea This material may be copied, translated, and disseminated (as long as no profit is derived from and reference is given to this book). This booklet was compiled by Iskinder Berhane and Piet Vochten with the assistance of the NATCO (National HIV/AIDS/STI and Tuberculosis Control Division) and the Nutrition Unit of the Ministry of Health of Eritrea; WFP Eritrea; UNAIDS Eritrea; WHO Eritrea; FAO Eritrea; The Eritrean Association of People Living With HIV and AIDS (BIDHO); The Evangelical Church of Eritrea’s HIV and AIDS Programme; The Orthodox Church of Eritrea HIV andAIDS Programme, The Eritrean Mufti HIV and AIDS Programme, The Eritrean Catholic Secretariat (ErCS) HIV and AIDS Programme; and received funding through the UNAIDS Programme Acceleration Fund (PAF). Comments and observations, including possible other beneficial recipes and care practices can be sent to the UNAIDS and WFP offices in Asmara, where they will be collected and used for an update of this booklet in the future. UNAIDS, No. 5 Warsay Street, Asmara, Eritrea, email: [email protected] http://eritrea.unaids.org WFP, Saba Building, Warsay Street, Asmara, Eritrea www.wfp.org

Foreword Eritrea is probably the most blessed among the sub-Saharan African countries with an overall HIV prevalence that appears to be stabilizing at 2.4% (2003 round of HIV sentinel Surveillance,Ministry of Health). However, infection levels vary considerably, highlighting a need to intensify and to refine the focus of prevention efforts. Prevalence reached 7.2% along the southerncoastal strip, and was more than three times as high in urbanthan in rural areas.

Home-based care and socio-economic support services are nowreaching thousands of families. Access to antiretroviral therapy(ARV) will be initiated in 2005. Therefore, we welcome thisinitiative to produce a guidebook on nutrition for people livingwith HIV and AIDS in Eritrea.

Unfortunately, Eritrea is a poor country with limited naturalresources. That is why we highly appreciate that the traditional food of the different groups of the Eritrean people were incorporated in the guide book, and that cleat attention wasgiven to the economic capacity of the poorest among thoseaffected by HIV and AIDS. It is important to note that goodnutrition does not have to be expensive as is shown by many ofthe recipes proposed in this guidebook.

Food, appropriate nutrition and proper care are indeed crucialfactors in prolonging and improving the quality of life of people living with HIV and AIDS.

We encourage all people affected by HIV and AIDS as well as service providers, from home-based care volunteers to allcategories of health workers, to make good use of thisguidebook and make it available to all those that might need it.

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Contents Contents vAcronyms ixIntroduction xiWho is this guide for? xiHow can this guide be used? xi Chapter 1 – Nutrition for people living with HIV and AIDS 1

1.1 Why is malnutrition more common among people living with HIV and AIDS?

3

1.2 The importance of healthy food for people living with HIV and AIDS

3

1.3 Guidelines for healthy food 41.4 What to consider when selecting food on a daily basis 91.5 Names of common food products in Eritrean languages 11Mini-poster: What to eat and do to help the body fight HIV and AIDS 13 Chapter 2 – Common nutritional problems related to

symptoms and illnesses associated with HIV and AIDS and some dietary advice

15

2.1 Tuberculosis 182.2 Herpes zoster 182.3 Sore throat 202.4 Sore mouth 202.5 Thrush/Candida 212.6 Haemorrhoids /constipation 232.7 Anaemia 232.8 Loss of appetite 242.9 Diarrhoea 242.10 Weight loss 262.11 Nausea and vomiting 282.12 Fever 292.13 Headache 29

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2.14 Colds and influenza (flu) 302.15 Cough 30Mini-poster: Common illnesses associated with HIV and AIDS

and some dietary advice 31

Chapter 3 – Food recommended to better fight HIV and AIDS 33

3.1 Foods rich in selenium 353.2 Foods rich in zinc 363.3 Foods rich in vitamin A/beta-carotene 383.4 Foods rich in vitamin B12 383.5 Foods rich in vitamin C 393.6 Garlic 403.7 Cabbage 40Mini-poster: Healthy food 41

Chapter 4 – Safe hygienic practices when dealing with food 43

Mini-poster: Safe hygienic practises 49

Chapter 5 – Herbal and heat treatments 51

5.1 Keeping the body temperature warm to better fightHIV and AIDS

53

5.2 Herbs, their benefits and how to use them 545.3 Common Eritrean herbs 58

Chapter 6 – Eritrean recipes for foods and drinks 61

6.1 Common dishes 636.2 Soups 706.3 Teas and drinks 726.4 Snacks and other useful recipes 77

Endnotes 81

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Annexes 83

Annex 1. Cross reference tables of Eritrean recipes and their respective usefulness

85

Annex 2. Ways to sprout grains for eating 91 Annex 3. Recommended Daily Allowance for an adult

person or child older than four years living with HIV and AIDS

93

Annex 4. Suggested vitamin and mineral supplements for people living with HIV and AIDS

94

Annex 5. Foods rich in selenium 95 Annex 6. Possible adverse effects of excessive intake of

nutrient supplements 96

Annex 7. Role and source of selected micronutrients 97 Annex 8. Form to monitor food intake over one week 99 Annex 9. Form to monitor weight changes over time 100 Annex 10. Bibliography and sources 103 Annex 11. Glossary 105

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Acronyms AIDS Acquired Immune Deficiency Syndrome

ARV Antiretroviral

CSB Corn Soya Blend

DMK Dura Milk Kebkebe

FANTA Food and Nutrition Technical Assistance Project

FAO Food and Agriculture Organization

HIV Human Immunodeficiency Virus

MoH Ministry of Health

RDA Recommended Daily Allowance

UNAIDS Joint United Nations Programme on HIV and AIDS

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

WFP World Food Programme

WHO World Health Organization

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Introduction HIV and AIDS weaken a person’s immune system and increase the chance of contracting opportunistic infections, as well as worsening their severity. These opportunistic infections may cause symptoms such as loss of appetite, fever and diarrhoea that, in turn, reduce food intake, nutrient utilisation and increase the requirements for nutrients. As a result, the person becomes malnourished, loses weight and is weakened, which can speed up the progression from HIV to full blown AIDS.

The bodies of people living with HIV and AIDS require more nutrients (carbohydrates, protein, fats, vitamins and minerals) in order to fight infections and slow down the advancement of the HIV infection. Who is this guide intended for?

This guidebook attempts to address a number of key issues related to nutrition for people living with HIV and AIDS. It is primarily intended for use by:

• HIV and AIDS home-based care providers • People living with HIV and AIDS • The family members of people living with HIV and AIDS.

It may also serve as a reference for other interested individuals interacting with people living with HIV and AIDS and their families. At the same time the advice given on healthy eating and food, handling practices can easily help and direct healthy eating for most people in Eritrea. How can this guide be used?

This guidebook highlights thematic issues related to HIV and AIDS and nutrition. It provides a general approach to the diverse conditions existing in Eritrea. It is best read as a whole, but each chapter can also be read separately. The annexes

xi

include recipes of a number of dishes, foods and drinks that can be beneficial to people living with HIV and AIDS. The recommendations given in this booklet will need to be adapted to the person who will be eating the food, also keeping in mind the local context where they live. Whenever reference is made to a recipe that is mentioned in the annexes, it will be written in the following way: ginger tea .

Page 13 and 14 have an overview of photographs of lesscommon or region-specific Eritrean food ingredients and listtheir local names in the nine Eritrean languages. Photographs ofuseful herbs are given on page 58 and 59. This guidebook consists of five chapters plus annexes:

Chapter One – Nutrition for People Living with HIV and AIDS –describes the causes of malnutrition, the importance ofhealthy food for people living with HIV and AIDS and gives some guidelines for healthy food consumption.

Chapter Two – Common Nutritional Problems Related toSymptoms and Illnesses Associated with HIV and AIDS –provides dietary advice for people who are coping with HIV and AIDS-related symptoms and illnesses.

Chapter Three – Foods Recommended to Better Fight HIV and AIDS – provides basic information on the selection ofimportant nutrients from cheap and locally available foodproducts.

Chapter Four – Safe Hygienic Practices – provides information on the proper hygienic practices for handling and preparing food.

Chapter Five – Herbal and Heat Treatment – provides information on the use of herbs and food as alternative ways tomanage HIV and AIDS related symptoms and illnesses. It also gives a number of techniques for keeping the body temperature high enough in order to fight better HIV and AIDS.

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Chapter Six – Eritrean recipes for foods and drinks – provides recipes for common dishes, soups and drinks that can be prepared using cheap and locally available ingredients.

The Annexes provide additional information on nutrition andfood preparation. They also include two forms that can be used for monitoring the daily food intake and weight change. An overview of the different measurements used in this guidebook is given below:

Measurement Weight (gram)

Volume (millimetre)

Remarks

1 teaspoon 5 5 1 tablespoon 15 15 3 teaspoon 1 fengal 50 50 10 teaspoon 1 chelfa 100 100 refers to the medium

sized chelfa used for stews (sauce). 1 chelfa = 2 fengal

1 cup 250 250 1 cup = 2½ chelfa or 5 fengal

1 injera 300 average weight of injera

1 bread 100 a small bread roll (the cost of the bread in 2004 was 0.35 nakfa)

1 melekia 25 1 litre (l) 1000 1000 1 litre = 4 cups or

10 chelfa 1 kilogram (kg) 1000 1000 1 melelik 700 700 1 melelik = 2 4/5 cups

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CHAPTER ONE

Nutrition for people living with HIV and AIDS

Good nutrition cannot cure AIDS or prevent HIV infection, butit can help to maintain and improve the nutritional status of aperson with HIV and AIDS and delay the progression from HIVto AIDS.

1. Nutrition for people living with HIV and AIDS

1.1 Why is malnutrition more common among

people living with HIV and AIDS?

• Loss of appetite – when not eating enough, the body does notgain weight.

• Diarrhoea – makes the body lose minerals and water (dehydration).

• Fever – makes the body reduce the utilisation of food. • Depression (e.g., caused by loneliness, isolation, or

discrimination) – makes a person lose his or her appetite. • Nausea and frequent vomiting – reduces a person’s appetite

and results in poor utilisation of food by the body. • Sore mouth (thrush) – results in poor food intake and loss of

appetite.

HIV-positive people taking antiretroviral (ARV) medicinesshould always follow the instructions of their doctor, sincetaking ARVs incorrectly might result in some of the symptomsmentioned above.

Many of the diseases and symptoms described above increasethe need for food and its nutrients. Therefore, for a person livingwith HIV AND AIDS, malnutrition is both a cause and an effect of weight loss and worsening health status. 1.2 The importance of healthy food for people living

with HIV and AIDS

• Helps to maintain health and quality of life. • Strengthens the immune system and reduces vulnerability to

opportunistic infections such as tuberculosis and other bacterial and fungal infections.

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• Delays progression from HIV to AIDS. • Provides the body with the essential nutrients for tissue

growth and repair of the body. • Reduces the severity of infections, contributes to weight gain,

and prevents malnutrition. • Improves the effectiveness of drug treatments. 1.3 Guidelines for healthy food

Food is made up of nutrients such as carbohydrates, proteins, fats, vitamins and minerals. The body cannot work properly ifone or more nutrients are missing. A healthy, nutritious diet iscomposed of a variety of foods, which provide the essential foodcomponents and nutrients on a daily basis.

No single food contains all the necessary nutrients in the rightquantities and combinations. A mix of different foods cansupply the nutrients the body needs. Therefore, one should:

a. Eat staples with every meal

Staples such as injera, porridge, teheni, wheat, rice, barley, sorghum, millet, maize and teff (used to make injera) provide the body with energy. They are relatively cheap and easy to find.

Eritrean Staples

Injera with tsebhi (stew) Porridge

b. Eat sufficient fibre and starchy foods

Fibre helps to prevent constipation and is good for the functioning of the gut and intestines. Cereals, pulses (also called legumes), vegetables and fruits provide fibre while also

4

supplying the body with energy, proteins, vitamins and minerals. Animal products contain no fibre.

The skins of cereals and pulses contain fibre as well as vitamins.Therefore, cereals and pulses should be eaten with their skin;when eaten as flour, it should be whole-grain flour.

Foods rich in fibre and starch

Barley Millet Maize Sorghum

Faba beans Chickpeas peanuts

Cabbage Wild spinach Pumpkin carrot

Orange Apple Banana

c. Eat less sugar

Sweet tea or coffee, biscuits, cookies, cakes, sweets, sugar, soft drinks (such as Coca Cola, Fanta, Sprite), jam, and honey provide

5

energy, but their consumption should be limited. Too much sugar affects the appetite, removes the important mineral magnesium, and negatively affects the functioning of the immune system. It also encourages the growth of fungus

Remember The daily intake of sugar should not be more than 10 tea-spoons (50 gram).

(e.g. thrush/Candida) in the mouth, in the stomach and in the vagina. Sugar should be avoided when a person has a Candidainfection (thrush).

People taking antiretroviral drugs (ARVs) – used to slow down the progression of the disease in an HIV-positive person – need to be particularly careful about their sugar consumption. This is because some of these medicines affect the body’s ability to produce the enzyme insulin, which is needed to digest the sugar1. d. Eat animal products regularly

Animal products have a high content of good proteins. They build and repair the body and help to fight infections. If the body does not get enough protein, the immune system will not function properly. Having HIV, the body needs

Remember When the body does not get enough food, it becomes weak and cannot fight infections.

more proteins. Therefore, HIV-infected people need to eat more protein-rich foods. Animal protein is found in milk, cheese, yoghurt, fish, meat, poultry and eggs.

Foods rich in animal protein

Fish Meat Eggs Milk

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e . Eat pulses, beans, peas and lentils every day

P (e.g. helbet, teteko bqulto – sprouted beans), ccpplpp

WAq

ulses, beans
hickpeas (e.g. shiro, kolo) or lentils (adese) provide arbohydrates, proteins, fibre, minerals and vitamins. The roteins in pulses are not quite as good as the proteins in animalroducts. Legume proteins can be improved though by mixing entils, beans, chickpeas with small amounts of cereals oreanuts. This avoids underutilisation of the proteins in theulses.
Food rich in plant protein

Chickpeas Kidney beans Peanuts

ays of improving protein quality

combination of the following foods in the diet improves theuality of these proteins:

Example Combination of ingredients

Teteko beans + wheat Kolo chickpeas + barley Helbet helbet + sauce Ministroni pasta/rice + lentils Fetfet bread (henbasha) + yoghurt Porridge flour (millet, wheat) + butter (yoghurt, linseed) Injera tsebehi injera (millet, sorghum) + tsebehi (adese, shiro) Snack pumpkin seeds + milk Bqulto bqulto + peanut Sandwich bread + peanut butter DMK wheat + peanut + chick peas Alicha carrot, potato, wild spinach + lentils

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f. Eat a variety of fresh fruits and vegetables every day

Fruits and vegetables are a good source of vitamins andminerals. Vitamins and minerals protect the body againstdisease.

Fruits and vegetables

Orange Papaya Banana

Wild spinach Cabbage Garlic Carrots

Remember – When cooking vegetables: • they should be washed before cutting and peeling; • they should be cooked for a short time to prevent loss of nutrients; • only sufficient water should be used for cooking – using excess

water wastes energy; copper utensils should • be avoided as these destroy vitamin C; water from cooked vegetables can be taken as soup and should not •

be thrown away.

g.

at

Limit the consumption of fatty or oily food s and oils are a good source of energy, and they are imF portant

for maintaining weight and helping in the absorption of the fat-soluble vitamins A, D, E and K. They add flavour and texture to food, and thereby stimulate the appetite. However, highconsumption of fatty or oily food causes obesity, high bloodpressure, high cholesterol and heart disease. Using too much oil

8

can also cause diarrhoea, and it can negatively affect digestion.

Foods rich in fats

Oil Butter

Foods rich in fats

Margarine

h. Drink a lot of water and make sure it is clean and safe

cups (1.5 litres) of fluid per day to be

. Avoid alcoholic beverages nal value. They prevent the

aW ter assists body processes (e.g. digestion), excretions (e.g.urine and sweat) and is a medium for the transport of vitalmaterials to the different parts of the body. It makes up about 70% of the human body.

sixA person needs at leasthealthy. Lack of enough water causes dehydration. Water needs to be clean and safe, and therefore should be boiled for at leastten minutes, filtered and stored in a clean container with a lid. i

lcA oholic beverages have no nutritiobody from properly using the nutrients in food, stop the immunesystem from working appropriately, cause dehydration and can affect how medicines work. 1.4 What to consider when selecting food on a daily basis

• Nutrient value and variety of the available foods such as staples, animal foods, fruits, vegetables, nuts and pulses.

• andMeals that are adequate, attractive, stimulate the appetitesatisfy the needs of the body.

• The costs of the food.

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Some examples of healthy meals

lthy meals spread over

The following are a few examples of heaa whole day. They have an average composition of 50% staplefoods, 30% vegetables and fruits, 15% pulses and 5% animal products. Drink water with each meal and at least six cups per day. Healthy meals for a whole day

Meal What the meal could include

1 Breakfast 2 bread rolls and coffee with 2 teaspoons (10 g) of sugar. Half an Lunch jerain (150 g) with 3 chelfa tsebehi (stew) made of hamili adegi.

Dinner 6 chelfa ministroni (made of rice, potato, carrot and lentils).

2 Breakfast Porridge with butter and yoghurt.

Lunch 00 g pasta and half a chelfa adese. 2

Dinner alf an injera (150 g) with 3 chelfa shiro. H

3 Breakfast bread (100 g), 1 egg and 1 cup tea with 2 1 teaspoons of sugar.

Lunch p of boiled beans (fule) and 1 bread (100 g), 1 cu150 g salad.

Dinner with 2 chelfa alicha1 cup of rice .

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Names of common food products in Eritrean languages 1.5

Colour-key to

languages

Tigringa Arabic Tigre Afar Bilen Saho

Kunama Nara Hedareb English

bunnahe

deqwala emra bunnaahe sukufa tefe (noone)

----- wild spinach

ceero (cuureyta) cheber cuure

----- keevvo (mir) ----- aloe

kawlo

kawlo kawlo kawlo kawlo

----- cabbage

carrot karott karrot karotta karot

----- carrot

-----

dubbari feden dubbo daro dubba oja dubba tii

pumpkin seeds

cebo

----- cilbo afo-kina ootia

maize

----- bultug bultug borta bartuu ----- millet

xaffali ----- cadeelaw

sigem shiir

barley

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sirraya

----- sinar sirnay sirnay

wheat

elba

kina maseela cas-doro xaffali

sorghum

ruddi rusa ruuz ruz ruz

rice

-----

----- catir ataro atar

chickpeas

full ----- ful fula ful

peanut

leemuun ----- lemuun

lemuna lemuun lemon

basala

besel shuggurti sungurita bashal

onion

cado basal

toma cado shuggurti sungutitaara bashal- tum

garlic

----- babaayo ----- papaya

papaya babayo

papaya

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CHAPTER TWO

Common nutritional problems related to illnesses and symptoms associated with HIV and AIDS and some dietary advice

Dietary practices may assist in managing illnesses associatedwith HIV and AIDS. However when severe diarrhoea; loss ofappetite due to illness; fever; abdominal pain; vomiting orbloody stools persist for three days or more, it is important toseek medical advice to prevent the illness from becoming moreserious.

2. Common nutritional problems related toillnesses and symptoms associated withHIV and AIDS, and some dietary advice

Illnesses and symptoms often associated with HIV andAIDS are loss of appetite, weight loss, diarrhoea, fever,headaches, nausea, vomiting, sores in the mouth, thrush, herpes zoster and anaemia. The chances of experiencing these symptoms can be reduced by eating the right foods. This is especially important when taking ARV medicines. When experiencing any of the above symptoms, eating the right foods might help to reduce the seriousness of the symptoms. However, it is still important to get medical advice and the necessary medical treatment to prevent the illness from becoming more serious, especially when any of the above symptoms persist for three days or more.

Everyone gets sick at times. Colds, flu, allergies, diarrhoea, vomiting, fever, food poisoning, upset stomach and fatigue are not necessarily HIV -related. Anyone can suffer from these ailments. However, if a person is infected with HIV, the body needs to be given additional help (by eating the right foods) to fight any ailments experienced.

If frequently experiencing one of the above symptoms, the cause might be food related. Experiment with the diet to figure out what is causing the symptoms. For example, try to remove one food item at a time from the diet, to see whether it makes adifference. Once the food at the origin of the problem has been identified, it should be avoided. What affects one person maynot affect others. Everyone will have to find out what suits him/her best.

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2.1 Tuberculosis (TB)

Because of their weakened immune system, people living withHIV AND AIDS can experience opportunistic infections.Tuberculosis is one of the most common opportunisticinfections. The major symptoms of tuberculosis are cough,spitting blood and weight loss. The dietary advice mentionedbelow will not cure TB, but it can help to strengthen the immunesystem to fight the TB infection.

Dietary advice: • Eat staple foods like injera and porridge made of millet,

wheat, maize and sorghum. • Eat protein rich foods like chickpeas, beans, fish, meat and

eggs. • Eat easily digestible food like fermented food (yoghurt,

injera). • Eat dark green, leafy vegetables such as wild spinach

(hameli), as well as greens, okra or spinach. • Eat fruits such as banana, watermelons and lemons.

Medical advice: When suffering from TB, always seek medical advice. 2.2 Herpes zoster

Herpes zoster is a skin condition causedby a virus that leads to severe burning painand a rash of painful blisters that usuallyappear on one side of the body (such as the chest, back, neck or face). People, who are HIV-infected, are susceptible to repeatedepisodes of herpes zoster because of theirdamaged immune system. Before blistersappear, the person may feel fatigue, chills,

fever and/or stomach problems. The area where the blisters willappear will feel sensitive 3-4 days before the blisters actually emerge.

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Normally the blisters and the pain will go away after 2-3 weeks. The following are some suggestions on how to manage thesymptoms associated with herpes zoster through good nutrition. Remember, it is always best to get advice from a nurse or doctorto make sure that the illness is properly treated.

Dietary advice: • Include foods rich in protein, vitamins

and minerals in the diet such as; lean meat, poultry, fresh fish and vegetables;

• Pumpkin seeds are a rich source of zinc, a mineral that can help to stop the spread of the herpes virus.

Warning! 1. Eating too many

peanuts can stimulate herpes infections because they contain a substance called arginine. To prevent this, eat peanuts with

Caution: • Avoid alcohol and coffee, because

alcohol can damage the body’s ability to fight infection and too much coffee can cause a runny stomach.

either milk or wild spinach2.

2. Never touch the eyes after you have touched the sores; wash hands immediately.

Care: • Crush one Aspirin and mix it with two teaspoonfuls of

Vaseline. Gently rub the mixture onto the affected area. Repeat this 3-4 times a day (Note that you should use Aspirinand not, for instance, Panadol);

• Place a clean cloth in a cooled mixture of eucalyptus leavesand water, then place the cloth on top of the affected part of the body. After use, the cloth should be washed in boilingwater before using it again. This will prevent cross infection;

• Put a few drops of pure lemon juice directly on the affectedarea (a short stinging sensation might be felt). Repeat several times a day until the sores are gone.

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Medical advice: • If the blisters lead to other infections of the skin, seek medical

advice immediately. 2.3 Sore throat

A sore throat is usually caused by colds or flu and is normally not serious.

Dietary advice: • Crush a lemon and mix the juice with honey. Gargle and drink

a large spoonful as often as necessary. • Drink tea and plant extracts that help with a sore throat. Take

them for as long as the symptoms last.

Care: • Gargle a strong solution of salt and water several times a day.

Medical advice: Consult a health worker when: • fever develops and persists; • the patient cannot swallow or breathe; • the sore throat lasts more than two weeks; • the pain causes a complete loss of appetite. 2.4 Sore mouth

A sore mouth is a symptom of infections associated with aweakened immune system.

Dietary advice: • Chew raw garlic every few hours. • Eat mashed, soft/smooth or moist foods such as pumpkins,

yoghurt, papaya and banana. • When eating, dip dry and hard foods in liquid to soften them.

Caution: For as long as the symptoms persist, it is best to avoid eating the

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following: • acidic foods such as lemons and oranges; • foods that are difficult to swallow; • foods that contain too much salt or spices; • foods that are too hot or too cold; • all forms of sugar (including honey), as they help the infection

in the mouth to grow.

Care: • Rinse the mouth every 3 hours with warm water mixed with

salt, or with a mixture of baking soda and water. • Maintain proper mouth hygiene such as brushing teeth and

cleaning the mouth after meals and before bedtime. 2.5 Thrush/Candida

Thrush is a common fungal(candida) infection in people living with HIV and AIDS. It causes white patches on thegums and on the sides of thetongue, burning, swelling andredness in the mouth, sore throat, difficulty in swallow-ing, chest pains and vaginal infections in women.

Thrush sores in the mouth can result in difficulty in eating andloss of appetite. Because of the reduced food intake, this usually leads to weight loss. Treatment of thrush is necessary to ensure sufficient and diverse food intake.

Dietary advice: • Eat unsweetened foods such as yoghurt - this will help to

prevent the fungus from growing. • Eat soft, mashed foods such as carrots, scrambled eggs,

mashed potatoes, bananas, soups and porridge.

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• Eat food cold or at room tempera-ture.

• Eat 1-2 cloves of raw garlic every 3-4 hours. If the raw garlic is too strong, crush the cloves and mix with a small amount of clean (boiled) water. Rinse the mouth with this mixture and then swallow the rest. Repeat every 3-4 hours.

Caution: • Strong citrus fruits and juices

should be avoided – they may irritate the mouth sores.

Remember: 1. With oral thrush,

maintain good mouth hygiene, including brushing teeth and cleaning the mouth after meals and before bedtime

2. For vaginal thrush, always ensure that underwear is well washed, thoroughly dried, and ironed.

• Spicy and salty food may also irritate the mouth sores.

• Sugar, honey, very sweet fruits, sweet foods and sweet drinks (including carbonated soft drinks such as Coca Cola, Fanta and Sprite) increase the soreness and help the fungus to grow.

• Alcohol will also increase the soreness.

Care:

Warning! 1. People taking ARVs

anti-HIV medicines Ritonavir or Saquinavir should not take garlic at the same time, as these substances do not work well with garlic3.

2. People with diabetes who are taking insulin should only use garlic in small amounts4.

• Gargle with slightly salty, warm, clean water. • If the thrush is in the anus or vagina, insert raw garlic in the

anus or vagina. Before inserting make sure that the garlic has been properly washed, peeled, has small cuts and applied oil over it 5.

Medical advice: When experiencing any of the following symptoms, a nurse ordoctor should be consulted: • the thrush going together with fever;

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• no improvement occurs after a few days; • pain causes a complete loss of appetite. 2.6 Haemorrhoids/Constipation

Haemorrhoids are itchy or swollen veins in the anal tissue. Theirmain causes are long periods of constipation, sitting for too long(which restricts blood flow to the abdomen), coughing andobesity.

Dietary advice: • Eat fibre-rich foods such as fruit, cereals, pulses, kolo, teteko,

bqulto, DMK, CSB and green, leafy vegetables.

Caution: • Avoid highly spiced foods. 2.7 Anaemia

Anaemia is an inadequate number, or low quality, of red blood cells in the body. It is caused usually by a poor diet and a lack of iron in the diet. Infections such as malaria and other parasites can also lead to anaemia. Headaches, tiredness, irritability, paleskin colour and dizziness are all signs of anaemia.

Dietary advice: • Eat foods that are rich in iron such

as spinach, wild spinach (hameli), pumpkin, beans, peas, helbet, bqulto, lentils, peanut, pumpkin seeds, fish, meat, liver and eggs.

• Eat foods rich in vitamin C such as oranges, lemon, guava, green leafy vegetables and tomatoes.

Warning! Do not drink tea or coffee with a meal or right after a meal. It is best to wait at least two hours in order to allow the iron in the food to be absorbed by the body.

Medical advice: If it is not possible to get enough iron through a normal diet, ahealth care provider can recommend other ways to treat anaemia

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(such as taking iron pills). If an HIV-positive person experiencesheadaches, tiredness, irritability, pale skin colour, or dizziness, itis best to check first with a health provider to make sure that it isanaemia and not another illness. 2.8 Loss of appetite

Loss of appetite occurs during different infections. It leads togeneral weight loss, and is common when individuals aredepressed or living in socially and emotionally unfavourableenvironments.

Dietary advice: • Eat small meals frequently. • Keep favourite foods nearby to encourage eating.

Care: • Avoid emotional stress before and during meal times. • Do some gentle exercise before meals to stimulate appetite. 2.9 Diarrhoea

Diarrhoea is common among people living with HIV and AIDS. It results in loss of water and essential nutrients, and leaves a person at greater risk of dehydration. Diarrhoea also reducesappetite and causes weight loss because the food does not stay long enough in the digestive tract to be properly absorbed.

The main causes of diarrhoea are infections (by bacteria,parasites or a virus) due to the drinking of unclean water orother forms of poor hygiene. Diarrhoea may also be a side-effect of medication or the result of malabsorption, when the food is not absorbed in the intestine. A person might also experiencediarrhoea if he or she takes ARV medicines incorrectly.Therefore, it is important to follow whatever instructions givenby the health care provider and tell him or her about any symptoms that one is experiencing.

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Dietary advice: • Take plenty of fluids such as clean (boiled) water, fruit juices,

soups, rice water, light porridges made of maize or OralRehydration Salts (ORS) to prevent dehydration.

• Eat fruits such as papaya, ripe bananas and mangoes. • Prepare and eat rice soup. • Drink fermented milk (yoghurt) 3-4 times a day. • Drink garlic tea. • Eat small meals frequently, as well as snacks. • Eat slowly. • Eat food warm, rather than very hot or cold. • Eat bananas and rice, which can slow the progress of

diarrhoea.

Caution: • Try to avoid raw and cold foods. • Do not eat foods that are too high in fibre (e.g. kolo, teteko). • Be careful with fresh milk. • Avoid foods that are too sugary. • Foods high in fat, such as fried foods, margarine, butter and

oils sustain diarrhoea. • Coffee, tea and alcohol can worsen dehydration. • Very spicy foods such as chillies and pepper can cause

diarrhoea. • Foods that produce gases, such as beans, broccoli, cauliflower,

cabbage, onions and green pepper are to be avoided. • Do not eat food, which might be contaminated or infected.

Care: • Get plenty of rest. • Try remaining quiet and rest a bit after meals.

Medical advice: Most diarrhoea goes away after a few days with proper care.However, seek medical advice when any of the following occur: • there is blood in the diarrhoea;

25

• the diarrhoea is accompanied by fever; • the patient is too weak to eat or very dehydrated and efforts to

rehydrate are not working; • the diarrhoea does not go away after 2-3 days. Preparing oral rehydration drink6

From ORS packets Follow the instructions and dissolve the contents of the packet in the amount of clean (boiled) water stated on the packet. (ORS = Oral Rehydration Salts)

With powdered cereals Take one litre of clean (boiled) water, add half a teaspoon of salt and eight teaspoons of powdered cereals. Rice is best, but finely ground wheat flour, maize, sorghum or cooked mashed potatoes can also be used. Boil for 5-`````7 minutes to make a liquid soup (broth) or watery porridge. Cool the drink quickly.

2.10 Weight loss

The body needs extra nutrients to fight off infections. Seriousweight loss is a common problem among people with HIV andAIDS. It may be caused by a loss of appetite due to illness or use of medicines, increased nutrient need during periods ofinfection, possibly combined with the difficulties of the body toabsorb nutrients or parasite infections. Symptoms such as soremouth, diarrhoea, nausea and vomiting may make it hard to eat, thus lowering food intake. Isolation and depression tend to

26

affect the appetite, as does the lack of variety in food, oftencaused by economic hardship. When a person living with HIV and AIDS loses weight, he or she needs to take action to return his or her body weight to its normal level.

Dietary advice: • Eat a variety of foods on a daily basis. Foods good for weight

gain are rice, maize, millet, sorghum, injera, porridge, wheat and barley (tehni), peas (kolo, teteko), peanuts, beans (helbet, bqulto) lentils, DMK, potatoes, meat, fish, chicken, eggs, full-cream milk, banana and fermented foods.

• Eat small amounts of food more frequently (eat less, but moreoften), at least 5 times per day (minimum every 3 hours).

• To help digestion and absorption, squeeze fresh lemon juice over fatty foods or add the grated skin of oranges and lemons (be sure to wash the skin well before grating) to fatty foods like meat, chicken and nuts.

• Eat the inner part of the skin of a lemon or orange with meals.This contains pectin, which holds the food longer in the stomach, allowing better absorption.

• Eat garlic, seeds and leaves of papaya, pumpkin seeds andcarrots to help the stomach stay clean.

• Eat protein-rich foods such as meat with papaya fruit or (crushed) seeds to help the stomach digest the protein.

• Eat food that contains selenium every day (see Chapter 3). Thebody needs selenium to build muscles. Examples of foods withselenium include aloe juice, sunflower seeds, nuts and sea fish.

Caution: • Avoid eating too much fatty and fried food.

Care: • Exercise regularly because it improves the appetite while also

improving the functioning of the digestive system. Exercise alsohelps to increase energy and strength while building muscles. Do not exaggerate and stay within the body’s capacities.

27

• Daily activities such as cleaning, working in the field,walking, jogging, swimming and aerobics are good ways toexercise. They also help to relieve stress.

2.11 Nausea and vomiting

Nausea and frequent vomiting can be the result of drugs used to treat HIV and AIDS – especially when those drugs are taken atthe wrong time of the day or with the wrong combination offoods – or from opportunistic infections. Nausea also leads toreduced appetite and poor utilisation of the food consumed.

Dietary advice: • Eat small and frequent meals and avoid having an empty

stomach (nausea is worse when the stomach is empty). • Drink plenty of fluids after meals. • Eat foods such as soups and fruits (bananas). • Eat lightly dried and salty foods like crackers and cereals to

calm the stomach. • Drink lemon juice in hot water or herbal tea. • Drink ginger tea.

Caution: • Avoid foods that make you feel ill. • Reduce consumption of fatty, spicy and very sweet foods. • Caffeine (found in coffee, tea, and chocolate) and alcohol can

increase the feeling of nausea.

Care: • Do not lie down immediately after eating. Wait at least 20

minutes to avoid vomiting. • Sometimes the smell of food while cooking may worsen the

feeling of nausea. Therefore, try to avoid preparing food while experiencing nausea.

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2.12 Fever

People with fever may have chills or sweat more. They may also experience muscle and joint aches or fatigue. Fever is common in people with HIV and AIDS, and it does not necessarily indicate another serious illness. Fever may result in increased nutrient requirements, as the body utilizes more

nutrients to fight fever.

Dietary advice: • Drink citrus (lemon and orange) juice several times a day. • Drink tea from lemon and guava. • Drink neem tea. • Eat soups that are rich in energy and nutrients, like soups of

maize, potatoes and carrots. • Drink plenty of fluids.

Care: • Pound eucalyptus leaves in a mortar with a small amount of

cooking oil. Rub the oil onto the patient’s chest. Leave the potin the patient’s room so the vapours can be inhaled.

• Cool down the body by sponging with a wet cloth.

Medical advice: Consult a nurse or doctor if the fever: • persists; • gets too high and the patient is very hot; or • is accompanied by other signs of serious illness. 2.13 Headache

People with HIV and AIDS may experience headaches for a variety of reasons. Headaches may also be caused by many illnesses other than infection with HIV.

29

Dietary advice: • Drink garlic and onion tea.

Care: • Take Aspirin or Panadol with a cup of clean (boiled) water.

Please note that taking Aspirin while having a high fever might be dangerous.

• Take sufficient rest. 2.14 Colds and influenza (flu)

Colds and influenza (flu) are common infections caused byviruses.

Dietary advice: • Drink plenty of water or other fluids. • Drink sibko. • Prepare special teas for colds and drink them for as long as

the symptoms last.

Care: • Have plenty of rest. 2.15 Cough

Coughing is not a sickness by itself but a sign of severaldifferent sicknesses that affect the throat or lungs.

Dietary advice: • Drink lots of warm water or other warm fluids.

Care: • Take a bowl or pot filled with very hot water with eucalyptus

or mint leaves. Cover the head with a towel while bendingover the bowl and pot, allowing the vapours to concentratearound the head. Breathe in the hot vapours deeply for tenminutes. Do this twice a day.

• Use onion tea or cough syrup to ease the symptoms.

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CHAPTER THREE

Food recommended to better fight HIV and AIDS


35

3.

Food recommended to better fight HIV and AIDS

3.1 Foods rich in selenium

Selenium is a mineral, which is very important to keep people living with HIV and AIDS healthy. The progression from HIVto AIDS can be slowed down when sufficient amounts of selenium are consumed on a daily basis. One or a combination of the foods listed below should be eaten every day.

Food rich in selenium

Aloe leaves Pumpkin seeds Peanuts

Fish Chicken Eggs Meat

Examples of food containing a full day’s requirement of selenium :7 - 150 g canned sardine in oil. - 3 melekia (25 ml) of aloe juice daily (one melekia with every meal breakfast, lunch and dinner). - one cup of shelled sunflower seeds.

Selenium supplement pills

When taking selenium supplement pills, ensure that they either contain vitamin E or combine them with food rich in vitamin E such as leafy vegetables, vegetable oil, peanuts, egg yolks and whole-grain cereals.

Warning! Do not consume more than 450 µg per day. This total could be achieved through a combination of selenium pills and food8.

A cheap, easily available and efficient source of selenium is thejuice of aloe. Aloe juice (Ere)

Aloe juice is made from the inner soft white parts of aloe leaves. • It is a good source of selenium. • Helps the body in fighting HIV and AIDS. • Strengthens the immune system. • Helps the stomach to better digest

protein because it contains pectin. • Helps the body to maintain and gain we

A teaspoon of aloe juice wit

ight.

h a meal

is commended to drink some aloe

can help people experiencing weight loss keep their weight stable.

It rejuice every day.

3.2 Foods rich in zinc the leaf if you want to gain weight.

Zinc is a mineral, which is very important in fighting infec

Warning! The outer green secof the aloe leaf is very bitter and causes diarrhoea. Do not use the outer gree

tion

n parts of

tions, cluding HIV. Ensuring they have sufficient zinc in their diet is

therefore important for people living with HIV and AIDS.

in

Foods rich in zinc

Wild spinach Pumpkin seeds Peanuts

Foods rich in zinc should be eaten in com

in A such as carrots and mbination with food that

ango. contains vitam

36

37

Preparation of aloe juice9

1.g each), which are

Get two medium-sized aloe leaves (about 25 cm lonsufficient for one month’s supply for one person.

2.pletely and keep only

Remove the green skins of the leaves comthe inner, white parts for making the juice.

3. The inner white part of the two leaves is quite soft, like jelly. Chop it up finely in a bowl while being careful not to lose any of the liquid.

4. e aloe juic e

Add th e to one litr of

clean (boiled) water and pour in a bottle.

5.y) in

Add two tablespoons of alcohol (zebib, congac, gin or whiskorder to ensure that the mixture does not ferment and go bad.

6.

lways

though it will have to be prepared more often.

A small amount (about one-third of a small cup) should be taken every day. One litre should last for one month, for one person. A

If religion does not allthe use of alcohol, thejuice can be prepared without alcohol and stored in a freezer to avoid fermentation. A smaller quantity could also be made,

ow

mix the contents of the bottle thoroughly before pouring.

7. Add some sugar or honey to taste, as aloe juice tastes bitter.

Examples of food containing a full day’s requirement of zinc10: - two-and-a-half (2 ½) cups of wild spinach (hameli adegi),

including the leafstalks. - one-and-a-half (1 ½) cups of pumpkin seeds. - two cups of shelled sunflower seeds. - three cups of roasted peanuts.

3.3 Foods rich in vitamin A/beta-carotene

Vitamin A keeps the body strong and helps it to fight HIV.

Foods rich in vitamin A

Carrots Wild spinach Cabbage

Examples of food containing a full day’s requirement of vitamin A11: - one-and-a-half (1 ½), medium sized raw carrots. - one-and-three-quarter (1 ¾), medium sized boiled carrot. - seven cups boiled wild spinach leaves.

3.4 Foods rich in vitamin B12

Vitamin B12 helps the body to stay strong, and can help to fight HIV and AIDS. Insufficient intake of vitamin B12 is a cause ofanaemia and depression.

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39

Foods rich in Vitamin B12

Beef liver Red meat Poultry Eggs

Sardines Milk Maize Sorghum

Examples of food containing a full day’s requirement of vitamin B1212: - 30 g of beef liver. - 200 g of canned sardines.

3.5 Foods rich in vitamin C

Vitamin C increases resistance to infection and improves the absorption of iron. Insufficient intake of vitamin C may increase the susceptibility to diseases like anaemia.

Foods rich in vitamin C

Tomato Chilli pepper Cabbage

Papaya Lemon Orange

Examples of food containing a full day’s requirement of vitamin C13: - 1 or 2 papayas or guavas per day. - 2 or 3 chili peppers per day. - 2 or 3 cups cauliflower per day. - 3 oranges per day.

Avoid smoking – every cigarette you smoke destroys 25 mg of vitamin C in your body14.

3.6 Garlic

Garlic strengthens the immune system. It helps fight infections caused by viruses, bacteria and fungi. Eat garlic regularly and in sufficient amounts; 2-``3 cloves of garlic per day will prevent many infections. Garlic is best chopped into pieces and eaten raw.

3.7 Cabbage

Cabbage is a rich source of calcium, vitamin A, vitamin C andsulphur. Cabbage: • strengthens the immune system; • works very well to settle an acid stomach; • controls infections, heals ulcers and

inflammation; • sour cabbage water is a remedy for

digestive problems.

Cabbage is best eaten raw.

40

CHAPTER FOUR

Safe hygienic practices when dealing with food

Good nutrition cannot cure AIDS or prevent HIV infection, butit can help to maintain and improve the nutritional status of a person with HIV and AIDS and delay the progression from HIVto AIDS.

4.

Safe hygienic practices when dealingwith food

People living with HIV and AIDS are more vulnerable to foodpoisoning because their immune system has already been weakened. Therefore, people having HIV or people who preparefood for HIV patients need to follow strict hygienic food-handling practises.

1. Use safe and clean water. If the water is not clean, it shouldbe boiled for 10 minutes before drinking or using. Boiled

water needs to be stored in a clean container with a lid.

2. Always wash hands with clean water and soap before, during and after preparing food or eating. Do this also after visiting the toilet. Dry hands with a clean cloth or towel.

3. Cover all wounds to prevent conta-mination of the food during its preparation and handling.

4. Keep food preparation surfaces clean. Use clean dishes and utensils to store,

prepare, serve and eat food. Thoroughly

wash utensils and surfaces where you place uncooked foods, particularly meat and fish.

45

5.

boiled, water before ating, cooking or serving. Peel the

i

Thoroughly wash fruits and vegetables with safe, clean, preferablyeskin and cut off bruised parts, if it is not poss ble to wash them properly.

6. harmful

ll animal products like

Cooking destroysbacteria and germs. Therefore, cook ameat, fish and eggs at high temperatures until well

one. Do not eat soft-d boiled eggs or meat that still has red juice.

Do not eat raw eggs, raw milk, raw meat or homemademayonnaise.

Food should be eaten as soon

7.

8. as it is cooked. Avoid storing

re, to kill possible

. oked foods together. Use containers in order to avoid contact between them.

0. Cover food to prevent insects, flies, rodents and dust from contaminating the food.

leftovers unless they can be kept in a refrigerator or a cool place. Do not store them for more than one or two days and

at them at high temperatualways reheharmful germs, before eating.

Do not store raw and co9

1

46

11. If food products have expirati

meals with those products after the expiration date.

12. Do not keep prepared food in meperiod. It is better to use plastic containers.

12. Do not use ice in drinks, as the water used tomight not have been safe to drink.

on labels, do not eat or prepare

tallic dishes for a long

make the ice

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CHAPTER FIVE

Herbal and heat treatments Good nutrition cannot cure AIDS or prevent HIV infection, butit can help to maintain and improve the nutritional status of aperson with HIV and AIDS and delay the progression from HIVto AIDS.

53

5. Herbal and heat treatments 5.1 Keeping the body temperature warm to better

fight HIV and AIDS15

The normal body temperature of an adult isapproximately 37 degrees Celsius. When thebody is warm, or just a little warmer thannormal, it can better fight HIV (or any other)infection. This is because heat increases thebody’s ability to fight infections.

A body’s temperature is lowered by: • being tired or exhausted – because the

body cannot generate enough energy to staywarm;

• staying outside in the cold, especially when it is windy; • not enough exercise – because the body is not working; • a lack of certain essential nutrients such as calcium and

magnesium; • not having enough energy-rich food components (fats and

carbohydrates) in the diet; • swimming or being wet during rain – as it drains away body

heat.

Dietary advice: • Eat more foods rich in calcium and

magnesium. Milk, yoghurt, cheese, potatoes, peanuts and wild spinach are rich in calcium. Cabbage, wild spinach and ordinary spinach are rich in magnesium. Take either cayenne pepper (kehi gu’u), ginger (powdered/finely chopped), chilli powder (berbere) or raw chillies

For the best effects, calcium-rich foods and magnesium-rich foods are not eaten together but at different times. For example, drink milk in the morning and eat cabbage at lunch.

(finely chopped) three times a day. For the best effects, mix a quarter (1/4) teaspoon ofone of these spices with a glass of water, milk or fruit juice, then stir and drink16.

Warning! Avoid cayenne pepper, ginger, or chilli when having stomach or intestinal problems such as ulcers or gastritis. People who have a heart condition, including high blood pressure, should also be careful when using these spices17.

Care: • Rest properly and do not work when tired. • Exercising keeps the body’s temperature higher, but one

should not exaggerate. 5.2 Herbs: their benefits and how to use them

Herbs can be used to strengthen the body’s immune system, helpto treat common illness such as diarrhoea and nausea, improve digestion, stimulate appetite and preserve foods. These herbsrepresent alternatives to formal medicine; they are locally known and are easily available for many people.

Some herbs are good and safe to use by most people, provided the maximum amounts prescribed are not exceeded. Excessiveuse (in other words, taking more than the prescribed amounts)may cause problems and have toxic effects (and is harmful).

One should always start with small amounts, to ensure that one’s body is not allergic to the specific herb. When experiencing any unexpected reactions, one should immediately stop using thatherb and seek medical advice.

Herbs, like vitamin and mineral supplements, cannot replacehealthy eating and should not be used as a substitute to a healthy and balanced diet.

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55

Herb Benefits How to use18

Aloe

• Has high levels of selenium.• Fights HIV. • Relieves constipation. • Helps to gain weight.

• Use as extract; boil and drink the concentrated water.

• To be used in limited amounts.

• Stop immediately should it cause cramps or diarrhoea.

Basil

• Helps to relieve nausea. • Helps digestion. • Has an antiseptic function

for mouth sores.

• Add to food to treat nausea and digestive problems.

• Use as gargle for mouth sores.

Cardamom

• Helps with digestive problems, pain, diarrhoea, nausea, vomiting.

• Helps with loss of appetite.

• Add to food during cooking.

• Prepare as tea.

Cayenne

• Stimulates appetite. • Helps fight infection. • Heals ulcers and intestinal

inflammation.

• Add a pinch to cooked or raw foods.

• For an energizing drink, add to fruit juice or water.

Camomile

• Helps digestion. • Provides relief from nausea.

• Prepare tea from the leaves and flowers and drink several cups throughout the day.

Cinnamon

• Good for colds and for weakness after colds or flu.

• Use when feeling cold. • Good for diarrhoea and

nausea. • Stimulates appetite. • Gently stimulates digestive

juices. • Encourages bowel

movements.

• Add to meals. • Use in tea, particularly

ginger cinnamon tea for cold or tuberculosis.

Herb Benefits How to use Cloves

• Stimulates appetite. • Helps to improve digestion,

diarrhoea, nausea and vomiting.

• Use in soups, stews, warmed fruit juice and tea.

Eucalyptus

• Has antibacterial function, particularly for lungs and during bronchitis.

• Eucalyptus oil from leaves increases the blood flow.

• Eucalyptus oil reduces the symptoms of inflammation.

• Prepare as tea from the leaves.

• Make extract.

Fennel

• Helps to increase appetite. • Combats flatulence and

expels gas. • As mouthwash for gum

disorders.

• Add as spice to foods.• Prepare as tea from

the seeds. • Use in limited

amounts. Fenugreek • Helps to gain weight.

• Reduces effects of herpes zoster.

• Control blood sugar levels.

• Prepare as Helbet. • Used for flavouring

pickles.

Garlic

• Has antibacterial, antiviral and antifungal function, particularly in the gut, intestines, lungs and vagina.

• Helps digestion and feeling of weakness.

• Also good for thrush, throat infections, herpes and diarrhoea.

• Drink as tea. • Eat raw. • Use as energy drink.

Ginger

• Improves digestion. • Energizes. • Relieves diarrhoea. • Stimulates appetite. • Used for treating common

colds and flu. • Used for treating nausea.

• Use as a spice in meals.

• Drink as ginger tea.

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57

Herb Benefits How to use Lemon

• Works as an antibacterial. • Helps digestion.

• Add lemon juice to food.

• Add lemon juice to drinks.

Lemon grass • Has a calming effect on the digestion.

• Alleviating stress.

• Use as tea.

Mint

• Has anti-inflammatory effect. • Helps digestion.

• Use as tea. • Gargle for mouth

sores. • Chew mint leaves to

aid digestion. Neem • Reduces fever. • Cut a fresh twig,

remove the leaves and boil the bark in water; drink as tea.

• The bark can also be chewed.

Parsley • Reduce intestinal colic. • Stimulates stomach secretions

and activities. • Produces a feeling of hunger. • The seed is used to remove

excess water from the body.

• Add raw or cooked to food.

Thyme • Reduces colds and sore throat.• Has antiseptic and antifungal

function. • Stimulates digestion and the

growth of the intestinal flora. • Helps with thrush/Candida infections.

• Use as a spice in meals.

• Use as gargle or mouth wash.

• Drink as thyme tea. • Make thyme extract.

Turmeric/ yellow root

• Digestive aid. • Antiseptic. • Antioxidant.

• Use powdered in rice, cereals, etc.

5.3 Common Eritrean herbs

Cinnamon – ቃርፋ Ginger – ጅንጅብል

Cloves – ቅንፍር Cardamom – ሄል

Thyme – ጠስነ Turmeric – ህሩድ

Camomile – ካማሜላ Basil – ሰሰግ

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59

Garlic – ጻEዳ ሽጉርቲ Lemon – ለሚን Mint – ናEናE

Fenugreek – ኣባEከ Fennel – ፌኔል Lemon grass – ሳEሪ ለሚን

Parsley – ፐርሰሜሎ Neem – ኒም Eucalyptus – ቀላሚጥስ

61

CHAPTER SIX

Eritrean recipes for foods and drinks Good nutrition cannot cure AIDS or prevent HIV infection, butit can help to maintain and improve the nutritional status of aperson with HIV and AIDS and delay the progression from HIVto AIDS.

6. Eritrean recipes for foods and drinks The recipes selected hereafter are suggestions for foods anddrinks that may help to address some of the commoncomplications arising from HIV and AIDS. Recipes should be adapted to locally available foods and preferences and there may even be variations and different ways to prepare these dishesand drinks. When using alternative spices, the recommendationsgiven in the previous chapters of which spices to avoid/usewhen experiencing specific conditions should be kept in mind.

The recipes are grouped to cover common dishes, soups, teasand drinks, snacks and other useful recipes. For each recipe anumber of a conditions or ailments are given in which this mightbe of use, followed by the ingredients – indicating the number of servings this prepares – and a way to prepare the dish.

People living with HIV and AIDS may have problems in digesting fat (particularly when they are suffering fromdiarrhoea). Traditionally the Eritrean kitchen tends to use considerable amounts of oil and fats. Therefore it is best to limitthe amounts of oil and fats used in these recipes, especiallywhen cooking for people living with HIV and AIDS. 6.1 Common dishes Adese (Timtimo)

Indications: weight gain.

Ingredients – serves 4: 2 cups lentils or split beans, 2 onions, 3garlic cloves, 3 tomatoes, 1 tablespoon berbere (chilli powder), oil and salt.

Preparation: Boil the lentils (split beans) in water until soft.When done set aside. Fry the onion in oil. When soft add tomatoes, garlic and berbere. Cook until the mixture (sauce) has

63

a red colour. Add the lentils or split beans, water and stir well. Cook for about 20 minutes. Add salt to taste. Alicha with vegetables

Indications: constipation, haemorrhoids, weight gain.

Ingredients – 3 servings: ½ cabbage chopped, 2-3 potatoes peeled and cubed, 2-3 chilli peppers sliced lengthwise intostrips, 3 carrots chopped, 6-7 leaves of spinach, a pinch of salt, 1teaspoon alicha spice, 1-2 onions chopped, 8 cloves of garlic chopped, water and oil.

Preparation: Sauté onions and garlic in 2 tablespoons of oil.When soft, add all the other ingredients to a large pot. Coverwith water. Add alicha spice and stir. Bring to boil and then let simmer for between 45 minutes to an hour until the liquid isgone. Salt to taste. Alicha with lentils


Ingredients – 5 servings: ½ kg lentils, 2 cups onion chopped, 2cups oil, 1 cup tomato chopped, 1 teaspoon alicha spice, 5cloves of garlic, water and oil, pinch of salt.

Preparation: Similar to the recipe above. Beans and tomatoes (easy and fast to prepare)


Ingredients – 2 servings: 1 medium-sized tin of baked beans, 1medium-sized tin of tomatoes or 5 fresh tomatoes, parsley, basilleaves.

Preparation: Mix the beans and tomatoes together. Bring to boiland simmer slowly for ten minutes. Add freshly chopped herbsand the recipe is ready. One may also add minced meat or

64

65

chopped leafy greens and simmer together with the vegetables. Bean broth

Indications: diarrhoea.

Ingredients – 3 servings: 2 cups beans, 4 cups water, ½teaspoon salt.

Preparation: Boil the beans (using more water than usual) untilthey are well cooked. Drink the broth or use it to make soups. Bean broth is good for people who do not have diarrhoea.

½ a cup of rice, maize meal or millet can also be boiled with thebroth to add carbohydrates, thus increasing the energy content ofthe broth. Cowpea paste

Indications: herpes zoster, tuberculosis, weight gain.

Ingredients – 2 servings: 1½ cups boiled cowpeas, water, salt, 1tablespoon grated onion, 1 teaspoon margarine, 1 tablespoonlemon juice.

Preparation: Boil the peas in water with a little salt until very soft. Mash to make a smooth paste. Add onion, margarine and lemon juice and mix. Green vegetables stew

Indications: haemorrhoids, constipation, weight gain.

Ingredients – 3 servings: 3 cups greens or other vegetables(such as cabbage, pumpkin, green beans and peas), 2 onions, garlic, 1 teaspoon ginger, 1 teaspoon cinnamon, coriander or mild curry powder, 2 pieces cayenne (if you like a hot taste), oil,250 gram chopped meat (optional: use bones or mince), water,3 carrots, 2 tomatoes, 3 potatoes, 1 teaspoon lemon juice.

Preparation: Chop and fry the onions, garlic and spices at a low temperature (small flame) in a little oil. When the onions are brown, addthe meat and water. Cook the meat at high temperature (large flame)until well done and soft. Chop and add the vegetables except the greens.Cover and simmer until the vegetables are soft. Chop and add the greens and let simmer for another ten minutes before the dish is ready.Add lemon juice to help digestion. Hameli adegi (wild spinach)

Indications: haemorrhoids, constipation, herpes zoster,tuberculosis, weight gain. Ingredients – 2 servings: 1 bunch hameli adegi/wild spinach, 1-2 onions chopped, 4-6 cloves garlic, 1-2 chilli peppers, salt, 1-2 teaspoon alicha spice and oil.

Preparation: Wash and chop the wild spinach. In a pot, sautéthe onions, garlic and chilli peppers until the onions are soft.Add wild spinach with half (½) a teacup of water. Add alichaspice and mix well. Cover and cook for 10-20 minutes. Add salt to taste. Helbet

Indications: anaemia, herpes zoster, tuberculosis, weight gain. Ingredients – 15 servings: ½ kg faba beans, 125 g fenugreek, 160 g lentils.

Preparation: Wash all the ingredients. The ingredients aresoaked separately in the water for almost one day. Drain off thewater after one day. Keep covered for almost 3 days so they cansprout. After sprouting, dry in the sun. After drying beans andlentils, have to be stoned in order to remove the fibre. Wash andmix all three ingredients and mill them together. Sieve the flourand store in a clean container.

Mix the flour and water in a dish and bring to a boil. Stir

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67

frequently for 15 minutes. Serve hot with sauce. Henbasha (Bekeo)


Ingredients –5 servings: 4 cups wheat flour, ½ teaspoon salt, 1tablespoon yeast, 1 tablespoon oil (margarine), 2 tablespoonsugar, about 2 cups water.

Preparation: Melt the yeast in lukewarm water. Sift the flourand salt into a bowl. Add sugar, melted yeast and ½-cup water. Mix the mixture by adding ½-cup water at a time. Leave themixture in a warm place for about 20 minutes to rise. When themixture has raised, knead and wait for 10 minutes. Subsequently bake the dough in mogogo (or pan with cover) at a temperature of 150 - 180 0C for about 15 to 20 minutes. To increase theprotein quality of the product bqulto flour (flour of sprouted beans) can be added. Injera


Ingredients – 5 pieces: 5 cups sorghum (or maize) flour, 2½cups millet flour, 2½ cups wheat flour, 4 cups starter, 14 cups water.

Preparation: Place flour, starter and 1 cup water in a melesi (bowl). Mix the mixture by adding ½-cup water at a time. Knead the mixture as much as possible up to when it reaches the rightconsistency (water to the flour ratio). Cover the melesi with a cloth or hard cover and place at room temperature (20 – 22 0C) for 2 to 3 days in order to ferment.

After fermentation a portion of the batter is mixed with threeparts of water and boiled (this is called lafa). The boiled batter is returned to the main part of the batter and the mixture is allowed to ferment for another 2 hours during which time the batter

becomes thoroughly leavened and acidic.

The batter is then steam-baked in a mogogo with a tight cover at150 - 180 0C temperature for about 2 to 3 minutes. When not mogogo is available, a traditional pan with cover can also be used. Minestrone

Indications: constipation

Ingredients – 3 servings: 4 tablespoon oil (margarine), 2tomatos chopped, 2 onions chopped, 1 chilli pepper, 2 carrotsgrated, 1 cup lentils, 2 potatoes chopped, 2 cups macaroni, salt,about 6 cups water.

Preparation: Fry onions in oil. When soft, add tomatoes, grated carrots, potatoes, parsley, lentils and chilli pepper. Add water little by little and let boil until well done and soft. Add macaroni and let cook for another 10 minutes. Add salt to taste. Mixed beans with spinach


Ingredients – 4 servings: 2 cups mixed beans, 4 water, salt, 2 onions, 2 cloves garlic, 2 tablespoon margarine or oil, 2tomatoes, 1 bunch spinach or other green leaves, 2 pepper.

Preparation: Boil beans. Fry chopped onions and garlic in a little margarine or oil. Add chopped tomatoes, boiled beans andbring to boil. Add chopped spinach or other green leaves andpepper. Cover and simmer slowly until the leaves are soft. Porridge


Ingredients – 3 servings: 3 cups wheat flour, barley flour or millet flour, ½ teaspoon salt, 4 cups water.

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Preparations: Heat-treat the flour for 10-15 minutes on a pan. Boil water. Safe 1 cup hot water for later use. Add the salt andflour, and keep stirring while adding the saved water little bylittle to avoid lump formation. Keep over a flame until the porridge becomes very stiff. Serve with butter, yoghurt orlinseed sauce.

Add sprouted cereals or legumes flour to make the product morenutritious. Pumpkin stew


Ingredients – 4 servings: 3 cups chopped pumpkin, 250 g beef.

Preparation: Boil beef with chopped pumpkin until very soft. Mash the pumpkin. Cut the beef into small pieces and add to the pumpkin. Rice, maize or millet can also be boiled with the stew to addcarbohydrates for more energy. Shiro


Ingredients – 4 servings: 4 tablespoon oil, 3 tomatoes chopped, 1 onion chopped, 1 chilli pepper, 1 cup shiro powder (the quantity added depends on the thickness desired), salt, about 5 cups water.

Preparation: Fry onions in oil. When soft, add tomatoes andchilli pepper. Fry until tomatoes are cooked. Add water and let boil. When the water is boiled, add the shiro little by little. Stir continuously for about 2-3 minutes to prevent lump formation.Turn heat down and let simmer for 20-30 minutes. Tihni (Tihini, tehni)

Indications: constipation, haemorrhoids.

Ingredients – 3 servings: 2 cups tihni (also called tehen, tehni) flour, ½-teaspoon salt, 1 tablespoon oil or butter, 6 cups water.

Preparation: Boil water. Add the salt and oil. Remove the hot water from the fire and add the flour. Let simmer over a small fire until the tihni becomes stiff. Serve with tea, milk or coffee.

It is also possible to use DMK or CSB instead of tihni. Vegetable stew with meat


Ingredients – 4 servings: 250 g meat, 2 onions, 3 carrots, 5potatoes, oil, water, 2 cloves garlic, salt, pepper.

Preparation: Cut meat and vegetables in small pieces. Fry meatuntil brown, add onion and fry together. Add the othervegetables, water and chopped garlic and cook until tender. Season to taste with salt and pepper.

6.2 Soups Carrot soup

Indications: diarrhoea, sore mouth, sore throat.

Ingredients – 2 servings: 4 carrots, pinch of salt, 1 teaspoonground cinnamon, 4 cups water.

Preparation: Chop carrots finely. Steam until soft. Strainthrough a fine strainer. Add water to form a soup. Add a pinchof salt and ground cinnamon. Carrot and onion soup

Indications: diarrhoea.

Ingredients – 2 servings: 3 tablespoons margarine, 6-8 medium-

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sized carrots, 1-2 medium-sized onions, 1 teaspoon of salt, ½cup rice (uncooked), 4 cups water and 1¼ cups hot milk.

Preparation: Heat margarine in a heavy pot and gently sauté carrots, onions and salt for about 5 minutes. Add rice and stir into mixture. Add water and cook until rice is very well done;about 45 minutes. Return soup to the pot and add hot milk to thepreferred consistency. Do not let it boil. Keep hot until serving time. Lentil or split pea soup

Indications: herpes zoster, weight gain.

Ingredients – 2 servings: 1½ cups dried lentils or split peas, 4cups water, 2 cups vegetables (carrots, potatoes, greens orother), salt, garlic.

Preparation: Soak lentils or split peas in water overnight. Cookuntil soft. Add chopped vegetables and cook until the vegetables are soft. Add salt and garlic to taste. Pumpkin soup

Indications: diarrhoea, sore mouth, sore throat, thrush.

Ingredients – 2 servings: 3 cups pumpkin, 1 onion, 2 clovesgarlic, 1 teaspoon cinnamon, oil, water.

Preparation: Chop the pumpkin, onion and garlic. Fry the onion, garlic and cinnamon in a little oil. Add the choppedpumpkin. Add water and bring to boil. Simmer until thepumpkin is very soft. Rice soup

Indications: diarrhoea, sore mouth, sore throat, thrush.

Ingredients – 2 servings: 1 cup rice, 4 cups water, salt.

Preparation: Add one cup of rice to four cups of salted water.Cover the pot, bring to boil and cook until soft (about 40minutes). Drink the soup while it is warm.

Other ingredients can be added according to taste and tolerance, e.g. grated carrots or pumpkin and finely chopped garlic.

6.3 Teas and drinks To allow these teas and drinks to have the best effect on one’s health, it is best to prepare them fresh three times a day anddrink them hot. If this is not possible, prepare them in themorning and heat them before drinking. They can even be drunkcold. Cough syrup for adults

Indications: cold, cough.

Ingredients – lasts about 10 days: 1 fengal honey, 1 fengallemon juice, 1 fengal alcohol (zebib) or 1 garlic.

Preparation: Mix one part honey with one part lemon juice andone part alcohol (zebib). Shake or stir well. Take one teaspoon three times a day.

An alternative is to mix one part honey with one part lemonjuice. Add two finely chopped garlic cloves. Shake or stir well.Take one teaspoon three times a day. Cough syrup for children

Indications: cold, cough.

Ingredients – lasts about 10 days: 1 fengal honey, 1 fengallemon, 1 fengal water.

Preparation: Mix one part honey with one part lemon juice and

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add one part water. Shake or stir well. Give children oneteaspoon three times a day. The syrup is best stored in a refrigerator as it otherwise might ferment. Energy drink


Ingredients – 1 serving: 1 large clove of garlic, ½ teaspoon turmeric, fresh or grounded ginger, 1 cup of milk or water.

Preparation: Boil all the ingredients together. Simmer for tenminutes. Cool slightly. Add a teaspoon of honey or sugar tosweeten the drink if desired.

When having diarrhoea or difficulty digesting milk, replace themilk with water. Eucalyptus extract

Indications: herpes zoster, sore throat.

Ingredients: bunch of eucalyptus leaves, 1 bottle alcohol (40percent proof).

Preparation: Fill a clean empty bottle with eucalyptus leaves.Press them well down with a knitting needle or stick to pack inas many leaves as possible. Fill up with alcohol. Press again torelease any air. Close the bottle. Leave in a dark place for twoweeks. Strain before using.

Use of the extract for sore throat: Put three drops of the extract onthe back of the tongue. This will disinfect the throat. Start using the extract as soon as feeling a sore throat coming up. Continueusing the drops every two to three hours until no more pain is felt. Garlic tea

Indications: cold, diarrhoea, thrush.

Ingredients – 1 serving: 3-4 cloves of garlic, honey, sugar, 1

cup water.

Preparation: Boil one cup of water. Chop 3-4 cloves of garlic. Add to the boiling water. Boil together for ten minutes. Cover and allow cooling. Add honey or sugar to taste. Drink one cupthree times a day. Garlic and onion tea

Indications: sore throat.

Ingredients – 1 serving: 2-3 cloves garlic, ½ bulb onion, 1 cup water.

Preparation: Chop 2-3 cloves of garlic and ½ bulb of onion. Put the chopped garlic and onion into a cup of hot water. Allow thewater to simmer for ten minutes. Let the tea cool slightly beforedrinking. Ginger tea

Indications: nausea and vomiting.

Ingredients – 1 serving: 1 piece of dry ginger, 1 cup water.

Preparation: Crush one piece of medium sized ginger in coldwater and boil in water for ten minutes. Place in a coveredcontainer, strain the ginger and drink three cups of the liquid perday before meals. Ginger and cinnamon tea

Indications: cold.

Ingredients – 1 serving: ½ teaspoon fresh ginger, ¼ teaspoon cinnamon, 1 cup water.

Preparation: Add ½ teaspoon chopped fresh ginger to 1 cup of boiling water. Boil slowly for ten minutes. Add ¼ teaspoon ground cinnamon. Cover and allow standing for five minutes.

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Strain. Drink one cup three times a day. Start drinking the tea assoon as you feel the symptoms of a cold. Guava tea

Indications: cold, fever.

Ingredients – 1 serving: 2 guava leaves, 2 tablespoons lemonjuice, eucalyptus leaves, 1 cup water.

Preparation: Add 2 guava leaves, a squeezed lemon, and a eucalyptus leaf to 1 cup of boiling water. Cover and allow standing for five minutes. Drink three times a day. Immune strengthening combination drink

Indications: immune strengthening.

Ingredients – 1 serving: ¼ teaspoon cayenne pepper, 2teaspoons lemon juice, 2 tablespoons aloe juice, 1 cup water.

Preparation: Mix ¼ teaspoon cayenne pepper, 2 teaspoonslemon juice and 2 tablespoons aloe juice in 1 cup of boiledwater. Drink three times per day. Lemon tea

Indications: cold, flu.

Ingredients – 1 serving: 2 teaspoons lemon juice, sugar or honey, 1 cup water.

Preparation: Squeeze a lemon. Add the juice to ½ cup waterthat has boiled and cooled slightly. Add sugar or honey to taste.Drink one cup as hot as possible three times a day. Neem tea

Indications: fever.

Ingredients – 1 serving: 1 fresh neem twig, 1 cup water.

Preparation: Cut a fresh twig from a neem tree. Remove theleaves and boil the bark in water.

The bark can also be chewed. Onion tea

Indications: cold.

Ingredients – 1 serving: ¼ onion bulb, 1 cup water.

Preparation: Put ¼ onion bulb into a cup of boiling water.Cover and leave for five minutes. Strain. Throw the onion away.Drink one cup three times a day. Sour cabbage water

Indications: digestion problems.

Ingredients – 2 servings: 1 cup chopped raw cabbage, 3 cups water.

Preparation: Wash the cabbage and soak 1 cup cabbage in 3cups water. Cover tightly and leave to stand for two to three days. Strain the water from the cabbage, throw the cabbage away and store the water in a cool place or refrigerator. It isready to drink when it starts to bubble (fermentation). Drink ½ cup three times a day for all digestive problems.

A second/following batch can be made by pouring ½ cup of thefirst batch into the second batch, replacing some of the water,and letting it stand for one day only. Thyme extract

Indications: sore throat.

Ingredients – 1 serving: 20 gram dried thyme leaves, 100 mlalcohol (40 percent proof).

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Preparation: Use 20 g dried thyme leaves. Add 100 ml alcohol. Keep in a closed bottle in a dark place for two weeks. Strain before using.

Use of the extract for sore throat: Use three drops of the extract on the back of the tongue. This will disinfect the throat. Start using the extract as soon as feeling a sore throat emerging. Continue using the drops every two to three hours until no more pain is felt. Thyme tea

Indications: cold, sore throat, thrush.

Ingredients – 1 serving: ¼ teaspoon dried thyme leaves, water.

Preparation: Add ¼ teaspoon dried thyme leaves to 1 cup of boiling water. Cover and leave for five minutes. Strain. Drinkone cup three times a day.

6.4 Snacks and other useful recipes BP-5


Composition: wheat flour, hydrogenated oil, sugar, soya proteinconcentrate, malt extract, minerals, amino acids, vitamins.

Ways to eat BP-5: it can be eaten as a bar straight from thepackage, crumbled into water and eaten as porridge. • To make porridge use 2 dl of boiled lukewarm drinking water

per food bar; • If eaten dry, make sure drinking water is available. Garlic ointment

Indications: herpes zoster.

Ingredients: 2 tablespoons crushed garlic, ½ cup Vaseline.

Preparation: Warm ½ cup of Vaseline, until it has melted. Grind 2 tablespoons raw skinless pieces of garlic into a fine paste. Add the garlic to the melted Vaseline and stir to mix well. Take a clean glass jar. Place a metal spoon in the jar to stop theheat from cracking the jar, and pour the mixture into the jar. Place the lid on the jar. Store the ointment in a refrigerator or in another cool place. Pumpkin seeds

Indications: anaemia, cleans stomach/intestines.

Ingredients: Pumpkin seeds can be collected when using pumpkin for other recipes.

Preparation: Place the seeds that still have the pulp aroundthem in a bowl of hot water. Separate the seeds from the pulp.Dry the seeds in a warm place. Roast the seeds with the skin in amenkeshkesh (or a pan) with a pinch of salt. The seeds can beeaten with the skin. Sibko

Indications: cold, constipation, diarrhoea, haemorrhoids, flu.

Ingredients – 1 serving: 1 fengal tihni, DMK or CSB, 5 fengal water.

Preparation: Boil 5 fengal of water in a pot; add 1 fengal of tihni, DMK or CSB; keep stirring to avoid lump formation andboil for ten minutes. Then add sugar, honey or butter. Serve hot.

Add sugar, honey or butter to taste. Teteko


Ingredients – 3 servings: 2 cups kidney beans, 1 cup wheat, 5 cups water, ½ teaspoon salt.

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Preparation: Wash the kidney beans and wheat first and then put into a pot. Add the water and boil until they are well cooked.Serve hot or cold.

Maize instead of the wheat and faba beans or chickpeas toreplace the kidney beans can also be used. Kolo


Ingredients – 3 servings: 3 cups barley, 1 cup chickpeas.

Preparations: Roast the barley and chickpeas together in a menkeshkesh. Serve hot or cold.

Wheat can be used instead of barley.

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Endnotes 1. Orr & Patient. 2004. Positive Living – Train-The-Trainer

Manual. page 72.

2. Orr & Patient. 2004. Positive Living – Train-The-Trainer Manual. page 84.



5. NZP+. 1995. Food for People Living with HIV/AIDS. page 30.

6. WHO/FAO. 2002. Living Well with HIV/AIDS: A Manual on Nutritional Care and Support for People Living withHIV/AIDS. page 37-38.

7. Orr & Patient. 2004. Positive Living – Train-The-Trainer Manual. page 79-80.




11 Orr & Patient. 2004. Positive Living – Train-The-Trainer Manual. page 86.







18. WHO/FAO. 2002. Living Well with HIV/AIDS: A Manual on Nutritional Care and Support for People Living with HIV AND AIDS. page 65-67.


20. FANTA Project. 2001. HIV/AIDS: A Guide for Nutrition, Care and Support. page 30.

21 Orr & Patient. 2004. Positive Living – Train-The-Trainer Manual. page 79.

22 FANTA Project. 2003. Nutrition and HIV/AIDS. A Training Manual. Session 3. Powerpoint presentation slide 27.

23. WHO/FAO. 2002. Living Well with HIV/AIDS: A Manual on Nutritional Care and Support for People Living with HIV AND AIDS. page 87 - 88 .

24. WHO/FAO. 2002. Living Well with HIV/AIDS: A Manual on Nutritional Care and Support for People Living with HIV/AIDS. page 85-86.

25 WHO/FAO. 2002. Living Well with HIV/AIDS: A Manual on Nutritional Care and Support for People Living with HIV/AIDS. page 89.

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ANNEXES


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Annex 1 – Cross reference tables of Eritrean recipes and their respective usefulness

Recipe Ailment/condition Page

Adese (Timtimo) Weight gain 63 Alicha with lentils Weight gain 64 Alicha with vegetables Haemorrhoids/constipation 64 Weight gain Bean broth Diarrhoea 65 Beans and tomatoes Weight gain 64 BP 5 Weight gain 77 Bqulto Anaemia 91 Haemorrhoids/constipation Tuberculosis Carrot and onion soup Diarrhoea 70 Carrot soup Diarrhoea 70 Sore mouth Sore throat Thrush Combination drink Immune strengthening 75 Cowpea paste Herpes zoster 65 Tuberculosis Weight gain Energy drink Weight gain 73 Eucalyptus extract Herpes zoster 73 Sore throat Garlic ointment Herpes zoster 78 Garlic tea Cold 74 Diarrhoea Thrush Garlic and onion tea Sore throat 74


Ginger tea Nausea and vomiting 74

Ginger and cinnamon tea Cold 74 Green vegetables stew Haemorrhoids/constipation 65 Weight gain Guava tea Cold 75 Fever Hameli adegi (wild spinach) Haemorrhoids/constipation 66 Herpes zoster Tuberculosis Weight gain Helbet Anaemia 66 Herpes zoster Tuberculosis Weight gain Henbasha (Bekeo) Weight gain 67 Injera Weight gain 67 Kolo Haemorrhoids/constipation 79 Weight gain Lemon tea Cold 75 Fever Flu Lentil or split peas soup Herpes zoster 71 Weight gain Minestrone Diarrhoea 68 Sore throat Thrush Mixed beans with spinach Weight gain 68 Neem tea Fever 76 Onion tea Cold 76 Pumpkin seeds Anaemia 78 Clean stomach/intestine

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Pumpkin soup Diarrhoea 71 Sore mouth Sore throat Thrush Pumpkin stew Diarrhoea 69 Herpes zoster Rice soup Diarrhoea 71 Sore mouth Sore throat Thrush Shiro Weight gain 69 Sibko Cold 78 Diarrhoea Flu Haemorrhoids/constipation Sour cabbage water Improve digestion 76 Teteko Haemorrhoids/constipation 79 Weight gain Tihni Haemorrhoids/constipation 70 Thyme extract Sore throat 77 Thyme tea Cold 77 Sore throat Thrush

Ailment/Condition Recipe Page

Anemia Bqulto 91 Helbet 66 Pumpkin seeds 78 Clean stomach/intestine Pumpkin seeds 78 Cold Sibko 78 Cough syrup for adults 72 Cough syrup for children 72 Garlic tea 74 Ginger and cinnamon tea 74 Guava tea 75 Lemon tea 75 Onion tea 76 Thyme tea 77 Cough Cough syrup for adults 72 Cough syrup for children 72 Constipation Alicha with vegetables 64 Bqulto 91 Green vegetables stew 65 Hameli adgi (wild spinach) 66 Kolo 79 Teteko 79 Tihni 70 Diarrhoea Bean broth 65 Carrot and onion soup 70 Carrot soup 70 Garlic tea 74 Minestrone 68 Pumpkin soup 71 Pumpkin stew 69 Rice soup 71 Sibko 78 Fever Guava tea 75 Lemon tea 75 Neem tea 76

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Flu Lemon tea 75 Sibko 78 Hemorrhoids/constipation Alicha with vegetables 64 Bqulto 91 Hameli adegi 66 Kolo 79 Sibko 78 Teteko 79 Tihni 70 Herpes zoster Cowpea paste 65 Eucalyptus extract 73 Garlic ointment 78 Hameli adgi (wild spinach) 66 Helbet 66 Lentil or split pea soup 71 Pumpkin stew 69 Immune strengthening Combination drink 75 Improve digestion Sour cabbage water 76 Nausea and vomiting Ginger tea 74 Sore mouth Carrot soup 70 Pumpkin soup 71 Rice soup 71 Sore throat Carrot soup 70 Pumpkin soup 71 Eucalyptus extract 73 Garlic and onion tea 74 Minestrone 68 Rice soup 71 Thyme extract 77 Thyme tea 77

Thrush/Candida Carrot soup 70 Pumpkin soup 71 Rice soup 71


Garlic tea 74 Minestrone 68 Tuberculosis Alicha with vegetables 64 Alicha with lentils 64 Bqulto 91 Cowpea paste 65 Hameli adegi, 66 Helbet 66 Thrush/Candida Thyme tea 77 Weight gain Adese (Timtimo) 63 Alicha with lentils 64 Alicha with vegetables 64 Beans and tomatoes 64 BP 5 77 Cowpea paste 65 Energy drink 73 Green vegetables stew 65 Hameli adgi (wild spinach) 66 Helbet 66 Henbasha (Bekeo) 67 Injera 67 Kolo 79 Lentil or split peas soup 71

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Annex 2 – Ways to sprout grains for eating Sprouts are actually grains that are starting to grow into a new plant. Sprouted grains have a number of advantages over the grain itself. Advantages of sprouted food

• Sprouting increases the vitamin, mineral and protein content; • Sprouted food contains many live enzymes that can help the

food to be digested more easily; • Sprouting helps to cut down on the cooking time; • Sprouting is an easy and cheap way to obtain fresh food. Method for sprouting food

1. Put the amount of seeds shown in the chart on the next page in a jar.

2. Fill the jar half full with clean and safe water. 3. Use a tight rubber band to secure a cheesecloth or mesh over

the jar. 4. Soak seeds overnight (or as shown in the chart). 5. Drain the water. 6. Put the jar down at an angle so that the water can drain off (a

dish rack is perfect for this). 7. Keep the jar in the dark until sprouting begins. 8. Rinse the sprouts to remove the shells twice a day – use clean

and safe water –, morning and evening. If it is very hot, rinse more often.

9. Place in a cool place or refrigerator as the seeds are now ready to eat.

10. Eat the sprouts after the length of time shown in the chart on the next page.

One can try to make different kinds of sprouts from seeds such as alfalfa, beans, lentils, peas, sorghum and sunflower. Since they need a different length of time to grow, they cannot be put

in the same jar. All sprouts can be eaten raw – after careful washing with clean water – in salads, sandwiches and, for example, in scrambled eggs. They can also be cooked in stews and soups.

Attentions should be paid to the source of the seeds as sometimes the treatments used to preserve the seeds – e.g. fumigation – may seriously reduce their capacity to germinate.

Sprouting chart Type of grain

Amount of grains per jar

Time to soak the grains

Approximate time until ready to eat

Length of sprout when ready to eat

Alfalfa 3-4 table-spoons

4 hours 4-6 days or until seeds develop green leaves

3 cm

Beans (bqulto)

1 cup Overnight 4-7 days 1 cm

Groundnuts/ peanuts (whole)

1 cup Overnight 1-2 days Swell, do not sprout

Lentils 1 cup Overnight 2-5 days 1/2-1 cm

Maize 1 cup Overnight 3-4 days 1 cm

Peas 1 cup Overnight 2-5 days 1 cm

Sorghum or millet

1 cup Overnight 2-3 days 1/2 cm

Sunflower (without husks)

1 cup Overnight 1-3 days 1/2-1 cm

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Annex 3 – Recommended Daily Allowances (RDA)for an adult person or child older thanfour years living with HIV and AIDS19

Nutrient Daily required HIV- person

Daily required HIV+ person

Example of food providing RDA

Energy

1500 – 2100 kcal/day

10-15% more energy per day (about 400 kcal for men and 300 kcal for women)

• 1 cup teheni -OR- • ¼ injera with 2

chelefa tsebehi lentils -OR-

• 200 g porridge with 3 tablespoons of butter

Protein

57 g/day for men 48 g/day for women

About 50 –100% more protein/day (85 g for men; 72 g for women)

• 1 kg DMK -OR- • ½ kg chickpeas

(kolo) -OR- • or 4 chelfa shiro

Beta-carotene (vitamin A)

25,000 IU (15 mg)

50,000 IU (30 mg)

• 1½ medium raw carrot -OR-

• 3 mangoes Vitamin C 60 mg 120 – 250 mg

• 3 oranges -OR- • 2 guavas

Vitamin B 12 10 mcg (micro-gram)

20 mcg • 30 g liver -OR- • 75 g tinned sardines

Selenium 75 to 200 mcg

• 100 ml aloe juice -OR- • 12 small sardines

Zinc 10 – 12 mg 15 – 45 mg

• 2½ cups boiled wild spinach -OR-

• 1½ cups pumpkin seeds

• 3 cups peanuts

Annex 4 – Suggested vitamin and mineralsupplement or people living with HIV andAIDS20

Vitamin A 13,000-20,000 IU (International Units)

Vitamin E 400-800 IU

Vitamin B High-potency B complex (e.g., B-25 or B-50 with niacin and B6)

Vitamin C 1,500-2,000 milligram (mg)

Selenium 200 microgram (µg)

Zinc 12-19 mg

Note: The amounts given above are for daily intake of food andsupplements combined. The vitamins and minerals in pills work best when taken withoutany food in the stomach. Should this cause pain or discomfort,the pills can also be taken together with some food. One can alsotry taking a pill just before bedtime. Do not forget however toread the specifications enclosed in the packaging of vitamin andmineral supplement pills. It is possible to take excessive amounts of vitamins and minerals through the intake of supplement pills. Therefore annex 6, whichmentions the adverse effects of excessive intakes, can be referredto.

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Annex 5 –

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Foods rich in selenium21

Type of food Weight (in grams) or quantity

Selenium

Canned sardine in oil 100 gram 52.7 µg

Sunflower seeds 1 cup 86 µg

Chicken meat (¼ roasted)

100 to 120 gram

24 µg

Beef meat (cooked) 100 gram 17 µg

Goat meat 100 gram 12 µg

Eggs 100 gram 15 µg

Peanut (dry roasted) 150 gram (1 cup) 11 µg

Rice 1 cup 10 µg

Pumpkin seeds 140 gram (1 cup) 8 µg

Annex 6 – Possible adverse effects of excessiveintake of nutrient supplements22

Intake of too many vitamins and minerals can be harmful. Whentaking supplements under the form of pills, it is very importantto follow the instructions on the label.

Nutrient Possible adverse effect of excessive intake

Vitamin B Gastrointestinal upsets.

Vitamin C Gastrointestinal upsets, iron over absorption and abdominal bloating.

Vitamin E Malabsorption of vitamins A and K and gastrointestinal upsets.

Iron Gastrointestinal bleeding (manifested by vomiting and bloody diarrhoea) and possible stimulation of viral replication.

Selenium Skin lesions, nausea and vomiting.

Zinc Gastric distress, nausea, reduced immune function that favours viral replication.

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Annex 7 – Role and food source of selected micro-nutrients23

MINERALS

Micronutrient Role Food source Iron

Essential for transport of oxygen by blood; eliminates old red blood cells, and builds new cells.

Red meat, poultry, shellfish, eggs, peanuts, groundnuts, lentils, beans, some cereals, dried fruit.

Calcium Builds strong bones and teeth; important for the functioning of the heart and muscles, blood clotting and pressure; immune defences.

Milk, green leafy vegetables, shrimp, dried fish, beans, lentils, peas, whole-grain millet, oil seeds, okra.

Zinc

Reinforces immune system; facilitates digestion; transports vitamin A.

Wild spinach, fish, peanuts, chicken, meat, cereals, vegetables.

Iodine

Ensures development and proper functioning of brain and nervous system.

Fish and other seafood, iodized salt.

Magnesium

Strengthens muscles; important for nervous system functions, involved in bone development and maintenance of teeth.

Cereal, dark green vegetables, seafood, nuts, peanuts, legumes.

Selenium Acts as antioxidant together with vitamin E and fights HIV, prevents the impairing of heart muscle.

The inner white flesh of aloe leaves, sea fish, sun flower seeds, meat, eggs, chicken, peanuts, rice, pumpkin seeds.

VITAMINS

Micronutrient Role Food source

Vitamin A (Beta-carotene)

Growth and function of T and B cells of immunity system; maintenance of specific cells, including lining of respiratory and gastrointestinal tracts. Vitamin A deficiency is associated with increased HIV progression, increased adult mortality, increased mother-to-child transmission, higher infant mortality and child growth failure.

Liver and dairy products, dark green leafy vegetables, kidneys, eggs, some fishes, sweet potatoes, pumpkin, palm oil, carrots, fruits such as ripe papaya.

Vitamin B1 (Thiamine)

Important for energy metabolism; supports appetite and nervous system functions.

Whole-grain cereals, beans, meat, fish, chicken, eggs.

Vitamin B2 (Riboflavin)

Important for energy metabolism; supports normal vision, and the health and integrity of skin.

Milk, yoghurt, meat, green leafy vegetables, whole-grain cereals, fish, beans.

Vitamin B3 (Niacin)

Essential for energy metabolism; supports integrity and health of skin, and the nervous and digestive systems.

Milk, eggs, poultry, peanuts, groundnuts, whole-grain cereals, fish.

Vitamin B6 (Pyridoxine)

Facilitates metabolism and absorption of fats and protein; has a role in the productions of red blood cells.

Sweet potatoes, white beans, maize, meat, avocados, cabbage, fish.

Vitamin B12 (Cobalamin)

Important for development of new cell and maintenance of the nerve cells.

Red meat, fish, chicken, shellfish, cheese, eggs, milk, fermented products.

Vitamin C (Ascorbic acid)

Important for the immune functions and iron absorption.

Oranges, guava, tomatoes.

Vitamin E Protects cell structures and makes it easier to resist disease.

Leafy vegetables, vegetable oils, egg yolk, peanuts, liver.

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Annex 8 – Form to monitor food intake over oneweek24

This form can help in monitoring a person’s food intake. Itshould be filled in carefully every day, noting the amount eatenevery time. The form can then be reviewed and discuss with a nutritionist or doctor at the end of one or two weeks. Comparethe sheets from week to week can help to see whether a person is eating less from one week to another. It will also help to seewhether the food intake gradually goes down, even if this is notfelt by the person. In the case a decrease in taking place, thereason(s) should be identified (e.g. diarrhoea, sore mouth,feeling weak) and the guidelines provided followed to increasethe food intake. Example of how to fill in the form

Meal Date

Breakfast7am

Snack 10am

Lunch 1pm

Snack 4pm

Supper 8pm

Monday 19/09 Bread +

tea 1 cake Injera with shiro

bread with tea

Injera with hameli adgi sauce

Tuesday 20/09

Porridge with butter Kicha Rice with

fish Kicha with tea

Porridge with butter

Wednesday 21/09

Tihni with tea 1 bread Injera with

temtemo 1 cup peanut Injera with alicha

Thursday 22/09 Sibko Kicha porridge

with butter 1cup teteko Injera with hameli adgi

Friday 23/09

Kicha with tea Teheni Pasta with

sauce Pumpkin seeds

Pasta with sauce

Saturday 24/09 Bread 1 cake Rice with

fish 1 cup Bekelto Injera with meat sauce

Annex 9 – Form to monitor weight changes overtime25

Each time a patient/person weighed, the weight is written on theform. Since sometimes-different scales may be used, this couldexplain some of the weight variations. The person should beweighed without shoes and each time in similar clothes. Underthe remarks header, causes of changes in eating habits and other reasons, which could explain the weight changes, can be noted. Example of how to fill in the form

Date Where Weight (kg)

Remarks (diarrhoea, fever, food shortage, etc.)

20/08

Pharmacy

65

Normal

10/09

Pharmacy

62

Because of diarrhoea

12/10

Pharmacy

64

Normal

100

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103

Annex 10 – Bibliography and sources Boyle, Marie A. and Diane H. Morris, 2003. CommunityNutrition in Action, and Entrepreneurial Approach, 3 Edition. Wadsworth, Publishing Company, Belmont, CA, USA.

rd

Bijlsma, M. 1997. Living positively: a nutrition guide forpeople with HIV/AIDS. Second ed. Mutare City HealthDepartment, Box 910, Mutare, Zimbabwe.

FANTA Project. 2001. HIV/AIDS: a guide for nutrition, care and support. Food and Nutrition Technical Assistance Project,Academy for Educational Development. Washington DC, USA.www.fantaproject.org

FANTA Project. 2003. Nutrition and HIV/AIDS. A Training Manual. Regional Centre for Quality of Health Care (RCQHC)and Food and Nutrition Techincal Assistance Project, Kampala,Uganda. www.fantaproject.org

NAP+. 1996. Food for people living with HIV/AIDS. Network of African People Living with HIV/AIDS Pretoria, South Africa, Hope Productions. NAP+ Secretariat, PO Box 30218,Nairobi, Kenya.

NAP+. Undated. A healthy diet for better nutrition for people living with HIV/AIDS. Network of African People Living withHIV/AIDS Secretariat, PO Box 30218, Nairobi, Kenya.

NPZ+. 1995. Food for people living with HIV/AIDS. Network of Zambian People Living with HIV/AIDS. Capetown, South Africa, Hope Productions. NZP+ Secretariat, PO Box 32717,Lusaka, Zambia.

MoH Uganda 2004. Nutritional Care and Support for People Living With HIV/AIDS in Uganda. Ministry of Health/Food and Nutrition Technical Assistance Project (FANTA), Kampala,Uganda.

104

Orr, Neil M and Patient, David R. 2004. Positive LivingTrain-The-Trainer Manual. Empowerment Concepts CC.Nelspruit 1200, Republic of South Africa.

WHO/FAO. 2002. Living well with HIV AND AIDS: a manual on nutritional care and support for people living with HIV AND AIDS. FAO, Rome, Italy.

105

Annex 11 – Glossary Absorption The process whereby nutrients from the food pass into the bloodstream for use by the body.

AIDS Acquired Immunodeficiency Syndrome: a group of diseasescaused by HIV.

ARV Antiretroviral: the name given to a group of drugs that act on the HIV virus and prevent it from reproducing itself in the body.

Candida The name of a fungus that causes oral thrush, an infection of themouth. Infection can also happen in other body parts, such asvagina and anus.

Constipation A condition when the bowels, intestines, are not functioningproperly and a person has difficulty in passing stools,defecating. This may be caused by a diet low in fibre, it can be asymptom of illness, or a side effect of medicines.

Carbohydrates A group of nutrients composed of starch, glucose and othersugars. They are normally the body’s main source of energy.

Dehydration The excessive loss of water and salts by the body. This oftenhappens during a case of diarrhoea.

Diarrhoea The frequent passing of watery faeces (stools); at least three in a day.

Digestion The process in the stomach and intestine in which food is broken

down and nutrients are released.

Fetfet A traditional Eritrean dish of bread or injera cut into pieces andmixed with yoghurt or stew.

Healthy and balanced diet A diet is healthy and balanced when there is consumption of anadequate amount and variety of foods as appropriate, sufficientto meet one's energy and nutrient needs. This includes staples,legumes, animal products, fruit, vegetables, nuts, fat and oils, and sugar/sugar-containing foods.

HIV Human Immunodeficiency Virus: a viral infection which affects the immune system and can lead to AIDS.

Immune system All the body’s mechanisms that defend the body against external agents, particularly microbes such as viruses, bacteria, fungi andparasites.

Kolo An Eritrean traditional snack, prepared on special occasions. It is a roasted product prepared from either cereals (e.g. barley, corn or wheat), legumes (e.g. chickpeas) or from a combination of cereals and legumes.

Melesi An Eritrean kind of bowl used to ferment the batter for making injera.

Menkeshkesh An Eritrean traditional – pan shaped – utensil used to roast coffee, kolo, pumpkin seeds and popcorn.

Mineral Nutrients that are required in small amounts by the body, but are nevertheless essential. They have a role in protecting the body from infections.

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107

Malnutrition An abnormal physiological condition caused by deficiencies, excesses or imbalances in the nutrient intake of the body, e.g. energy, protein and/or other nutrients. In this guidebook the term malnutrition is only used for the case of lack of food energy (i.e. under nutrition) and the case of lack of nutrients.

Nausea The state of feeling unwell or sick in the stomach.

Nutrient Nourishing substance contained in foods that is released during digestion. This includes carbohydrates, proteins, fats, minerals and vitamins.

Nutrition The science of food and how it is used by human – and animal –bodies to grow, work, play, maintain health and resist disease.

Opportunistic infection An infection by a micro-organism that does not ordinarily causedisease. In the case of a person whose immune system isweakened, such as by HIV infection, this micro-organism may become pathogenic and result in disease.

Oral Rehydration Salts (ORS) A liquid that can be given to people to restore the fluid that they have lost through diarrhoea. ORS can be made from packets, by mixing salt, sugar and water or by making a watery porridge from powdered cereals such as rice and maize.

Protein Proteins are nutrients that provide the building materials for the body. They are also an essential element of the immune system.

Pulses The edible seeds of various leguminous plants, e.g. chickpeas, lentils, beans, etc.

Refined cereals Cereals like wheat, rice or maize, that have been extensively processed, removing all or part of the bran. They are low in fibre.

Ritonavir Ritonavir is an anti-retroviral drug.

Saquinavir Saquinavir is an anti-retroviral drug.

Staple foods Foods that form the main part of the diet, usually cereals such asmaize, sorghum, wheat and millet, eaten in Eritrea under the form of injera, kicha, haneza and porridge.

Tsebhi A Tigrinya term for stew. It is often used in combination withthe name of a spice/food to typify the type of stew, for exampletsebhi shiro, tsebhi alicha, tsebhi adese.

Virus Infectious agent (microbe) responsible for many diseases in allkinds of living beings. It is an extremely small particle and, in contrast with bacteria, can only survive and multiply within a living cell at the expense of that cell.

Vitamins A group of nutrients needed in small amounts – micronutrients –by the body for it to function normally. An insufficient intake ofvitamins can result in some serious disturbances in the body’sfunctioning and ultimately disease. Vitamins occur naturally infood.

108

Ministry of Health of the State of Eritrea

United Nations World Food Programme

Eritrea

WFP

Food and Agriculture Organization of the United Nations

Eritrea

World Health OrganizationEritrea

Joint United Nations Programme on HIV and AIDS

Eritrea

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