Bitew, Shimelash (2014) Assessment of the Effect of Malnutrition on Survival of HIV Infected Children after Initiation of Antiretroviral Treatment in Wolaita Zone Health Facilities, SNNPR, Ethiopia. Masters thesis, Addis Ababa University.
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Abstract
BACKGROUND: Nutrition and HIV are closely interlinked creating a vicious cycle. Malnutrition is a common condition in HIV-infected children; however, its effect on survival of HIV infected children after initiation of antiretroviral therapy is not well understood. OBJECTIVE: To assess the effect of malnutrition on survival of HIV infected children after initiation of antiretroviral treatment. METHODS: A retrospective cohort study was conducted in HIV infected children starting antiretroviral treatment at Wolaita zone selected health facilities, Ethiopia. Demographic, nutritional, clinical and immunological data were extracted from the existing ART logbook and patient follow up records. Nutritional statuses of children were determined using the International Reference Population defined by the WHO. Height-for-age (HAZ), weight-forheight (WHZ), and weight-for-age (WAZ) Z-scores were calculated. Survival was defined as the time from nutritional and immunologic evaluation at the starting of ART to death. Data were analyzed by bivariate and multivariate analysis using Cox regression proportional hazard model. Survival were calculated and compared with the Kaplan Meier and log rank test. RESULT: A total of 228 records of children were taken from ART registry from February, 2006 to March 2014 in 2 Hospitals and 3 Health centers in Wolaita zone. The mean survival time for this cohort using Kaplan Meier analysis was 89.34 months (95% CI 85.707-92.97). The cumulative proportion of survival was 98%, 97%, 94%, 92% and 84% at 6,12,24,60 and 96 months respectively. The incidence of mortality rate 21.02 per 1000 person years of observation (95% CI 12.8-34.3). Overall nutritional status, 62.5% were stunted, 43.0% were underweight and 44.7% were wasted at baseline. In our study residence living in rural AHR 4.30 (95% CI, 1.25- 14.8), fair/poor of the first three month ART adherence AHR 8.95(95% CI 2.624-33.72) and Severe wasted children at baseline AHR 7.040 (95 % CI, 1.27-39.13) were predictors of reduce survival of children on ART. Age of children at starting ART also predictor for survival, children age as < 18 months than age 18 month-5 year, 5-14 years of age with AHR0.047 (95% CI, 0.006- 0.368 ), 0.145(95% CI 0.032-0.663) respectively. Incidences of mortality rate for severe wasted children were 3.77 (95% CI 1.2-13.8). CONCLUSION AND RECOMMENDATION: Our data analysis showed that Children on ART at initiation had high prevalence of malnutrition and malnutrition was found to be an important predictor of survival with residence, age of the children and first three month ART adherence.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services |
| Divisions: | Africana |
| Depositing User: | Emmanuel Ndorimana |
| Date Deposited: | 29 Nov 2018 10:03 |
| Last Modified: | 29 Nov 2018 10:03 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/8016 |
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