| dc.description.abstract | Background: HIV infection and exposure is still a significant contributor to morbidity and mortality in children. PMTCT interventions have greatly reduced the number of HIV-infected children and together with a stable adult HIV prevalence, led to an increase in the number of HIV-exposed uninfected (HEU) children. Studies done in the pre-ART and post-ART era have shown that HEU children may be at an increased risk of mortality compared to HIV unexposed uninfected (HUU) children. However, there remains a knowledge gap in understanding whether nutritional status, the severity of illness during hospitalization, and length of hospital stay differ between the HEU children compared to the HUU children. This knowledge would be critical in improving the outcomes of these children.
Objective: The overall objective was to determine whether nutritional status, illness severity during hospitalization, and length of hospital stay differ among the HEU children compared to the HUU children less than two years of age in Uganda, Kenya, and Malawi.
Methods: I did a secondary analysis of data from a cohort study (CHAIN prospective cohort study) which was conducted between November 2016 and January 2020 in 4 African and 2 Asian countries. I used data for hospitalized children in 3 countries (Uganda, Kenya, and Malawi). The main exposure variable was the child’s HIV exposure group (HEU and HUU). Other covariates included: child characteristics, caregiver characteristics, and household characteristics. The dependent variables were: nutritional status, illness severity at admission, and length of hospital stay. I used logistic regression to assess for differences in nutritional status, illness severity, and hospital length of stay between the HIV exposure categories. Multivariable analysis was conducted to take into account potential confounding.
Results: In this analysis, 1343 children were included, out of which 1144 children were HEU and 199 were HUU. HIV exposure was significantly associated with the children’s nutritional status. In the adjusted model, the odds of having malnutrition among the HEU children were 41 % higher than the odds among the HUU children (OR=1.41, CI 1.01-1.97, p=0.044). The association between HIV exposure and illness severity at admission was not significant in the adjusted model. (OR=1.34, CI 0.96-1.87, p=0.09). There was a significant relationship between HIV exposure and length of hospital stay. In the adjusted model the odds of having a long duration of hospital stay among the HEU children were almost twice as the odds among the HUU children (OR= 1.90, CI 1.01- 3.56, p=0.044). There was significant interaction between HIV exposure and nutritional status with length of hospital stay as the outcome.
Conclusion:
In this study, HIV exposure was significantly associated with poor nutritional status at admission and prolonged length of hospital stay. HIV exposure was not associated with high illness severity at admission
Recommendations:
Health workers should be vigilant to screen HEU children for malnutrition as they are more likely to be malnourished compared to their HUU counterparts. More research should be done to identify the specific mechanisms that put HEU children at a higher risk of poor clinical outcomes. | en_US |
