Abstract:
Introduction Despite documentation on injection drug use (IDU) in Kenya, the nutritional status of people who
inject drugs (PWIDs) is under-explored. Elsewhere studies report under-nutrition among PWIDs which is attributed
to food insecurity; competing priorities between drugs and food supply; chaotic lifestyle; reduced food intake;
substance use induced malnutrition due to inflammation and comorbidities.
Methods This was a cross-sectional study that sought to assess the nutritional status of PWIDs in Coastal Kenya.
We recruited 752 participants of whom 371(49%) were on IDUs and 75 non-IDUs and 306 non-drug users using
respondent driven sampling, traditional snowball, makeshift outreach and purposive sampling methods.
Results More than one half of the participants (56%) had BMI classified as normal while 35% had BMI < 18.5. The
proportion with BMI < 18.5 was higher among IDUs (46%) compared to the non-IDUs (33%) and non-drug users (23%)
at P < 0.001. Using the mid upper arm circumference (MUAC), 17% were classified as underweight and the proportion
was lowest (11%) among non- drugs users compared to 22% among IDUs (P < 0.001). However, the IDUs had lower
proportion of overweight (8.1%) compared to 55% among the non- drug users. The proportion with low waist-for-hip
ratio was highest among the IDUs (74%) while high waist-for-hip ratio was lowest in the same group of IDUs (11%)
at P < 0.001. One half (50%), of the participants had no signs of anaemia, (47%) had mild/moderate anaemia while
21 (2.8%) had severe anaemia. However, IDUs were more likely to be overweight based on waist circumference as a
parameter. The IDUs had the highest proportion (54%) of mild to moderate anaemia compared to non-IDUs (37%)
and 40% non- drug users (P < 0.001). In the multivariable models, IDUs (aRRR 2.83 (95%CI 1.84‒4.35)) and non-IDUs
(aRRR 1.42 (95%CI 1.07‒1.88)) compared to non- drug users were positively associated with BMI < 18.5. Being an
IDU was positively associated with mild or moderate anaemia (aRRR 1.65 (95%CI 1.13‒2.41)) while non-IDUs were
positively associated with severe anaemia (aRRR 1.69 (95%CI 1.16‒2.48)).
Conclusion A significant proportion of the participants were under-nourished with those injecting drugs bearing
the heaviest brunt. Being an IDU was positively associated with the low BMI, MUAC, waist for hip ratio and mild or
moderate anaemia but high waist circumference. People who inject drugs have high risk for under-nutrition and
should be targeted with appropriate interventions.
Keywords Under nutrition, Injection drug use, BMI, MUAC and anaemia
