Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

Animut Alebel,Mamaru Wubale Melkamu,Pammla Petrucka,Setegn Eshetie,Yitbarek Tenaw Hibstie,Fasil Wagnew,Getnet Asmare,Eshetu Haileselassie Engeda,Daniel Bekele Ketema,Getnet Gedif,Zebenay Workneh Bitew,Belisty Temesgen,Mengistu Mekonnen Kelkay,Getiye Dejenu Kibret

doi:10.1186/s12889-020-09418-6

Abstract

BackgroundThough highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region.MethodsA multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables.ResultsThe cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5, 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality.ConclusionA higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIV-positive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality.

Highlights

Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce
This study identified the predictors of mortality among HIV-positive children receiving ART using a multicenter facility-based historical cohort study
This study found a high rate of mortality when compared to studies reported from Adama Referral Hospital and Medical College, Ethiopia (2.1 deaths per 100 child-years) [23], Zambia (1.6 deaths per 100 childyears) [24], and Malawi, Lesotho, and Swaziland (2.25 deaths per 100 child-years) [25]

Summary

Introduction

Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. This study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region. The use of anti-retroviral therapy (ART) has been effective in reducing mortality markedly among infected children and adolescents [5]. In this regard, the World Health Organization (WHO) exceeded its target of 15 million ART users by the end of 2015. According to the recent Ethiopian Demographic and Health Survey (EDHS, 2016), child mortality in Ethiopia was reported as 67 per 1, 000 live births. In our study area (Amhara Region), child mortality rate was reported as 85 per 1, 000 live births [8]

Methods

Results

Conclusion