Abstract
BackgroundApproximately 70% of HIV positive people live in Africa where food insecurity and under nutrition are endemic. However the impact of malnutrition on treatment outcome is not clear. This study assessed the effect of under nutrition on Anti-Retroviral Therapy treatment outcome among pediatric age group living with HIV/AIDS in Public Hospitals, Southwest Ethiopia.MethodA retrospective cohort study was conducted on records of 242 pediatric children in Guraghe zone Public Hospitals. Also median, mean, standard deviation and interquartile range were calculated. Life table, hazard function and survival function were plotted. Log rank test with 95% confidence interval of mean survival time was done. The nutritional status data were managed via WHO Anthros plus and BMI for age Z score was calculated. To assess effects of nutritional status on mortality, both Bivariate and multivariate cox proportional hazard regression was conducted with crude (CHR) and adjusted hazard ratio (AHR) (95% confidence interval and p value). P value of less than 0.05 was used as cut off point to declare statistical significance.ResultsA total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed. About 178 (73.3%) have got therapeutic feeding on the course of ART treatment. Whereas significant number of children, 163 (67.1%) reported to had eating problems. A total of 13 (5.3%) children were dead with incidence density of 11.2 deaths per 1000 person years. There is significantly higher survival time among well nourished (11.1 years with 95% CI: 10.8 to 11.4) as compared to underweight children (9.76 with 95% CI: 9.19 to 10.32 years). Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4). Similarly children with anemia had higher incidence of death than children without anemia (AHR = 1.55; 95% CI: 0.49–4.84).ConclusionsLow nutritional status at the start of ART evidenced by underweight and anemia were found to be predictors of survival among HIV positive children. There should be improved, sustained and focused nutritional screening, care and treatment for children on ART follow up.
Highlights
ResultsA total of 243 records of pediatric Ante retroviral treatment (ART) records with mean age of 11.6 (± 3.8 years) were reviewed
Nutrition is a critical component of treatment, care, and support, for chronic Human Immune Virus (HIV) care especially among children [1]
Underweight children had almost three fold increase incidence of death (AHR = 3.01; 95% CI: 0.80–11.4)
Summary
Socio demographic characteristics A total of 243 records of pediatric ART records with mean age of 11.6 (± 3.8 years) were reviewed and included in the study. Higher hazards of death comparable to study in Iran which showed lower cumuwas observed among advanced stage ART clients (WHO lative proportion surviving among males than in females stage II and above) as compared to WHO stage I (Table (P = 0.0001) [20]. In addition pre ART nutritional (5.3%) children were dead during the course of their status evidenced by low weight increased hazards of chronic HIV care with incidence density of 11.2 deaths death (AHR = 5.4 95% CI 3.03–9.58) [22]. In addition there should be high energy and micronutrient foods locally prepared in the community or some preparations like ready to use therapeutic foods or others should be readily available to the ART clients It estimated that about 3.2 million children living with HIV/AIDS, almost 90% cases were found in sub Saharan African countries in which malnutrition is common problem facing children [23]. The secondary nature of the data makes, the availability of some factors like iron status and other nutritional indices unavailable
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