Abstract
BackgroundThe relationship between undernutrition and HIV is bidirectional, ultimately contributing to quality of life and survival of affected individuals. Ethiopia is a sub-Saharan nation influenced by both undernutrition and HIV. In Ethiopia, although individuals are often dually impacted, the effect of undernutrition on the survival of HIV positive children on anti-retroviral therapy (ART) has not been well investigated. Therefore, this study assessed the effect of undernutrition on survival rates of HIV positive children on ART in Amhara Regional State of Ethiopia.MethodsAn institution-based retrospective cohort study was conducted among 390 HIV positive children on ART from the 1st of January, 2012 to the 28th of February, 2017 in Amhara Regional State Referral Hospitals. A simple random sampling technique was used to select the study participants. Data were extracted by reviewing patients’ ART intake and follow-up forms. Data were entered into Epi-Data Version 3.1, and analysis was done using STATA Version 13. The Kaplan-Meier survival curve was used to estimate the cumulative survival time of the sample. Log rank tests were employed to compare the survival time between different categories of explanatory variables. Bivariable and multivariable Cox proportional hazards models were fitted to identify predictors of mortality.ResultsAmong the 390 records included in the final analysis, 9.7% of the individuals died within the follow-up period. In this study, the overall mortality rate was found to be 4.4 per 100 child-years (95% CI: 3.2, 6.0) while undernourished children had a lower survival time than well-nourished children. Low hemoglobin level (AHR: 3.2, 95% CI: 1.4, 7.4), CD4 cell count or percent below the threshold (AHR: 5.2, 95% CI: 1.9, 14.1), severe stunting (AHR: 3.9, 95% CI: 1.7, 9.4), severe wasting (AHR: 3.0, 95% CI: 1.3, 6.9) and advanced disease stage (III and IV) (AHR: 2.6, 95% CI: 1.1, 6.6) were found to be predictors of mortality.ConclusionThere was a high rate of mortality. A significant difference was observed in the survival rate of undernourished and well-nourished children. Low hemoglobin level, CD4 count or percent below the threshold, severe wasting, severe stunting, and advanced disease stage were found to be predictors of mortality.
Highlights
The relationship between undernutrition and Human Immunodeficiency Virus (HIV) is bidirectional, contributing to quality of life and survival of affected individuals
HIV develops very rapidly among infants and children, unless early initiation of anti-retroviral therapy (ART), almost 33% of infants living with HIV die before their first birthday, and almost 50% die before the age of two years [2]
The results showed that there was a significant difference in the survival function of different categorical variables; nutritional status, hemoglobin (< 10 g/dl and ≥10 g/dl), CD4 count or percent, and World Health Organization (WHO) HIV clinical disease staging.The mean survival time for children who were undernourished at the time of ART initiation was 50.6 months (SD±1.7), but 61.1 months (SD ± 0.6) for those who were well nourished
Summary
The relationship between undernutrition and HIV is bidirectional, contributing to quality of life and survival of affected individuals. Ethiopia is a sub-Saharan nation influenced by both undernutrition and HIV. In Ethiopia, individuals are often dually impacted, the effect of undernutrition on the survival of HIV positive children on anti-retroviral therapy (ART) has not been well investigated. This study assessed the effect of undernutrition on survival rates of HIV positive children on ART in Amhara Regional State of Ethiopia. Independent of HIV, sub-Saharan Africa is the region of the world most seriously affected by malnutrition, reporting 21% of children under-five-year as underweight, 39% as stunted, and 9% as wasted [8]. Ethiopia is one of the sub-Saharan African nations largely affected by malnutrition and HIV. Despite significant progress in the reduction of child malnutrition, it remains widespread and a serious public health problem of Ethiopian children. As indicated by the 2016 Ethiopian Demographic and Health Survey report, 38%, 24% and 10% of under-five children were stunted, underweight and wasted respectively [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
