Treatment outcomes of severely malnourished HIV infected and uninfected children admitted to Mwanamugimu Nutrition Unit, Kampala, Uganda
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Introduction and Background: Under-five mortality in Sub Saharan Africa is twice as high as in any other region of the world. In Uganda, SAM affects 2% of children and more than 40% of acutely malnourished children are considered HIV positive. At Mwanamugimu Nutrition Unit, the discharge indicators are not reached: about 40 % of the children who are admitted there end up dying. It is therefore important to realize this study which will determine the anthropometry status, the clinical care, the dietary intake and the discharge outcomes for severely malnourished infected and uninfected children admitted and treated at MNU. This result will be used to generate information that will help policies makers to add interventions in order to recommend the best practices in improving the prognosis of HIV infected severely malnourished children Objective: To assess of the treatment outcomes of severely malnourished HIV infected and uninfected children admitted to Mwanamugimu Nutrition Unit. Methodology: A retrospective cohort study design was used. 171 medical patients files of under five severely malnourished HIV-infected children and 512 medical patients files of under five severely malnourished HIV-uninfected children were collected at MNU using consecutive sampling from January to August 2012. After consulting patient’s files, data were recorded on a research form which had provision for: baseline information, longitudinal data (socio-demographic information, anthropometric measurements, clinical reports and dietary intake assessments), discharge information. Weight and height values were transformed to weight for age z-score (WAZ) and weight for height z-score (WHZ) using Epi-Info. For categorical variables, the differences between factors (age, sex, location, type of malnutrition, HIV status) and outcome variables/ status of child (alive or dead), the Chisquare statistic were used. For continuous variables like days of stay, weights, heights, weight gain, mean differences, the independent sample t-test was used. Relative Risk (RR) was used to quantify the increased risk of mortality in children with HIV infection to those without HIV infection. Multivariate logistic regression analysis was used for association between mortality as the dependant variable and including HIV status, presence of oedema, age of child, residence as covariates and strength of association was determined using OR and cut off points were pvalue less than 0.05 and 95%. xii Results: The mean (SD) age was 15 (11.36) months and a higher proportion of males (52.3%) compared to females were noticed. The residence was observed to be statistically significant; children from urban and peri-urban areas of Kampala were more likely HIV infected with Chi square value 6.585. (p= 0.010).At admission, 322 children (47.1%) presented W/H≤70, 257 children had W/H<84 (37.6%) while 104 children had W/H ≥85% (15.2%). At discharge, 475 were discharged upon reaching the target W/H of 85% (69.5%).48% of children were marasmic and the majority of them were HIV-infected compared to HIV-uninfected group (114/171, 66.7% vs. 215/512, 42%) (p< 0.05). 24% of HIV- infected children reported 1 or 2 previous hospital admission compared to 7% in uninfected group and both groups reported diarrhea, respiratory infections and fever to be the major causes of hospital admission during the 12 last months prior to admission. Marasmic children gained weight more quickly (6.35g/kg/day, N=338) than oedematous children (4.89g/kg/day, N=345) (p=<0.05). 69.5% (475/683) survived and achieved nutritional recovery and 17% (116/683) died during nutrition rehabilitation. HIV-infected children had a long recovery time (22 days, N=171 vs. 18 days, N=512) compared to the uninfected group. HIV-infected children were significantly more likely to die than HIVuninfected children: 21.6 percent (37/171) vs. 15.4 percent (79/512) (p=0.061) RR=1.35(CI 1.0 – 1.83) and mortality was higher among marasmic, 26/114 (22.8%) than among those with oedema 11/57 (19.2%) Conclusion: Severely malnourished HIV-infected children admitted in Nutrition Rehabilitation Program recovered and reached the discharge weight in spite of a long stay in hospitalization due to stagnation periods compared to the HIV-uninfected counterparts. Although the highest mortality was observed in marasmic HIV-infected children, they gained weight more quickly than oedematous children. Recommendation: In Nutrition Rehabilitation Program, HIV specific activities should complement previous WHO 10 steps and CMAM attempts at outcome improvement. There is a need for a further study assessing mortality of HIV-infected severely malnourished children admitted and treated in Nutrition Rehabilitation Program.