| dc.description.abstract | 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%.
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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. | en_US |
