Assessment of the effect of malnutrition on survival of HIV infected children after initiation of antiretroviral treatment in Wolaita zone health facilities, SNNPR, Ethiopia
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Date
2014-06
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Addis Abeba Universty
Abstract
BACKGROUND: Nutrition and HIV are closely interlinked creating a vicious cycle.
Malnutrition is a common condition in HIV-infected children; however, its effect on survival of
HIV infected children after initiation of antiretroviral therapy is not well understood.
OBJECTIVE: To assess the effect of malnutrition on survival of HIV infected children after
initiation of antiretroviral treatment.
METHODS: A retrospective cohort study was conducted in HIV infected children starting
antiretroviral treatment at Wolaita zone selected health facilities, Ethiopia. Demographic,
nutritional, clinical and immunological data were extracted from the existing ART logbook and
patient follow up records. Nutritional statuses of children were determined using the
International Reference Population defined by the WHO. Height-for-age (HAZ), weight-forheight
(WHZ), and weight-for-age (WAZ) Z-scores were calculated. Survival was defined as the
time from nutritional and immunologic evaluation at the starting of ART to death. Data were
analyzed by bivariate and multivariate analysis using Cox regression proportional hazard model.
Survival were calculated and compared with the Kaplan Meier and log rank test.
RESULT: A total of 228 records of children were taken from ART registry from February, 2006
to March 2014 in 2 Hospitals and 3 Health centers in Wolaita zone. The mean survival time for
this cohort using Kaplan Meier analysis was 89.34 months (95% CI 85.707-92.97). The
cumulative proportion of survival was 98%, 97%, 94%, 92% and 84% at 6,12,24,60 and 96
months respectively. The incidence of mortality rate 21.02 per 1000 person years of observation
(95% CI 12.8-34.3). Overall nutritional status, 62.5% were stunted, 43.0% were underweight and
44.7% were wasted at baseline. In our study residence living in rural AHR 4.30 (95% CI, 1.25-
14.8), fair/poor of the first three month ART adherence AHR 8.95(95% CI 2.624-33.72) and
Severe wasted children at baseline AHR 7.040 (95 % CI, 1.27-39.13) were predictors of reduce
survival of children on ART. Age of children at starting ART also predictor for survival, children
age as < 18 months than age 18 month-5 year, 5-14 years of age with AHR0.047 (95% CI, 0.006-
0.368 ), 0.145(95% CI 0.032-0.663) respectively. Incidences of mortality rate for severe wasted
children were 3.77 (95% CI 1.2-13.8).
CONCLUSION AND RECOMMENDATION: Our data analysis showed that Children on ART
at initiation had high prevalence of malnutrition and malnutrition was found to be an important
predictor of survival with residence, age of the children and first three month ART adherence.
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Keywords
Assessment of the effect of malnutrition