Abstract
BackgroundThe burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa.MethodsA cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2–19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d’Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition.ResultsOverall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7–13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6–12 %), 26 % (95% CI: 23–28 %), and 7 % (95% CI: 5–10 %), respectively. Among those malnourished, more than half of children didn’t receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5 years); and mixed malnutrition with male gender, age (<5 years), severe immunodeficiency and recent ART initiation (<6 months). Orphanhood and Cotrimoxazole prophylaxis were not associated with any type of malnutrition.ConclusionsThe prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes. Anthropometric measurements and appropriate nutritional care of malnourished HIV-infected children remain insufficient and a priority to improve health care of HIV-infected children in Africa.
Highlights
The burden of malnutrition among Human Immunodeficiency Virus (HIV)-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children
The prevalence of malnutrition in HIV-infected children even on antiretroviral treatment (ART) remains high in HIV care programmes
Regardless of HIV, sub-Saharan Africa is the region of the world the most seriously affected by malnutrition, 21 % of children under 5 years are underweight, 39 % are stunted, and 9 % are wasted [2]
Summary
The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. In 2012, 3.3 million children were living with Human Immunodeficiency Virus (HIV) worldwide, with more than 90 % in sub-Saharan Africa [1]. Regardless of HIV, sub-Saharan Africa is the region of the world the most seriously affected by malnutrition, 21 % of children under 5 years are underweight, 39 % are stunted, and 9 % are wasted [2]. HIV infection increases the risk of malnutrition, because of a high pro-inflammatory cytokine activity which can cause growth impairment among children [8]. Poor weaning practices among HIV-infected mothers can have an impact on the child’s nutritional status [11]
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