Survival and Predictors of Mortality among HIV Positive Children on Antiretroviral Therapy at Public Hospitals in East Gojjam, Ethiopia, 2019
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Date
2019-07
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Addis Abeba University
Abstract
Background: Human immunodeficiency virus and acquired immunodeficiency syndrome had created enormous challenges worldwide, continued to be the world’s serious health and development challenge.Globally, at the end 2017, there were 1.8 million children (<15 years) living with human immunodeficiencyvirus. The goal of antiretroviral therapy is to maintain maximal suppression of viral replication, to restoreimmune function, to reduce human immunodeficiency virus -related morbidity and mortality, and improvequality of life and prolong survival. The survival of HIV positive children treated with ART depends on avariety of factors, which might vary greatly with economic, socio- demographic, behavioral risk and healthfactor.
Objectives: To assess Survival status and predictors of mortality among human immunodeficiencyvirus Positive Children on Antiretroviral Therapy at East Gojjam Zone Public hospitals, Amhara RegionalState, Ethiopia 2019.Methods: An institution based retrospective cohort study was conducted in selectedhospitals of East Gojjam zones among children aged less than 15years who were newly enrolled in humanimmunodeficiency virus care clinic from January1st 2014 to December 31, 2018. Data was collected usingstandardized check list. The charts were reviewed during March 1 to 22,2019. Data was entered Epi-Dataversion 3.1 and then exported to SPSS version 24 for statistical analysis. A Kaplan Meier curve and long ranktest were used to estimate the survival time and compare survival curves between variables. Multivariable Coxproportional hazards model was fitted to identify predictors of survival status and variables having p value <0.05 were considered as statistically significant.
Result: In this study, a total of 251 HIV positive children onART were followed up for a total of 60 months, with a mean (SD) survival time of 55.54(+ 0.83), (95%CI:53.90-57.17) months. The overall mortality incidence rate in the cohort during the 626 Child-year-observation (CYO) was 2.56/100 CYO. Kaplan- estimation Meier survival showed that overall estimatedsurvival probability after starting ART was 0 .90 at 60 months of follow up. In this study age, hemoglobinlevel, CD4 count, cotrimoxazole preventive therapy (CPT), weight for height were statistically significantpredictors of survival status (P <0.05).
Conclusion and Recommendation: Age < 5 years, CD4 count, Hgb<10gm/dl, WFH (z<-3), not taking cotrimoxazole preventive therapy were an independent predictor of mortality. Therefore, concerned stakeholders should focus on above mentioned predictors of mortality andnutritional interventions to enhance survival of HIV-infected children on antiretroviral therapy.
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Keywords
Children, antiretroviral therapy, Human immunodeficiency virus, survival, Ethiopia