Prevalence, clinical pattern and short term outcomes of HIV infected children admitted at Alsabah Children's Hospital, South Sudan

Abstract

Background: Worldwide, HIV continues to be a major global health issue, having claimed more than 35 million lives so far. According to the Joint United Nations Program on HIV/AIDS (UNAIDS) 2017 report, approximately 36.7 million people are living with HIV, of which 2.1 million are children <15 years. According to the 2016 report from the HIV commission in South Sudan, 200,000 people were living with HIV, of which 190,000 are adults, accounting for a prevalence of 2.7% whereas 18,000 are children below 15 years. Objectives: To determine the prevalence of HIV infection among children, the clinical pattern of the illnesses among children with HIV infection at the time of diagnosis, and the immediate outcomes of the admitted children in AL Sabah Children’s Hospital. Also, the study looked at the associated factors linked to immediate outcomes, specifically prolonged hospital stay. Methods: This was a cross sectional descriptive study, with a longitudinal component for the immediate outcome. Consecutive enrollment of 848 eligible children aged 0-14 years, admitted to the hospital during the study period, was done after obtaining informed consent and assent as appropriate. HIV testing was done using HIV rapid tests to determine HIV exposure for children < 18 months (testing the mother or the child), or confirmation of the diagnosis for children ≥ 18 months. DNA-PCR was done to confirm the HIV diagnoses for children < 18 months found to be HIV exposed, to establish the HIV diagnosis. If a diagnosis of HIV was made in a child by the laboratory test result, the clinical patterns and the short term outcome within 7 days of close follow up was documented. Data was entered into the EpiData version 3.1, exported and analyzed using Stata version 12. Results: Twenty four children tested HIV positive; giving an overall HIV prevalence among the children of 24/848, i.e. 2.8% (95% CI 1.8 – 4.2). Among children diagnosed with HIV, 11 (45.8%) were admitted with severe acute malnutrition, 10 (41.6%) were diagnosed with diarrheal diseases, 9 (37.5%) with malaria and 8 (33.3) had pneumonia. However, in children who were uninfected with HIV, 456 (55.3%) were diagnosed with malaria, 218 (26.4%) with septicemia/bacteremia, 218 (26.4%) with pneumonia, 216 (26.2 %) had diarrheal diseases, 80 (9.7%) with severe acute malnutrition and 40 (4.8%) with severe anemia Among the 24 HIV infected children, 12 (50%) stayed at the hospital for more than 1 week, and 12 (50%) for ≤ 7 days. One child died within the one week of follow-up period. In the HIV uninfected children, 741 (89.9%) stayed at the hospital for less than one week, 83 (10%) stayed more than one week and twenty eight children (3.3%) died. The clinical characteristics associated with HIV infection were: a history of cough (p=0.001), weight loss (p <0.001), oral thrush (p <0.001), lymphadenopathy (p= 0.001), ear discharge (p<0.001), skin lesion (p <0.001), hepatomegaly (p <0.001), splenomegaly (p <0.01). Factors associated with prolonged hospital stay were history of weight loss (OR=4.96, 95% CI 2.68-9.18), skin lesion (OR=3.60, 95% CI 1.36-9.56), and < -3 Z score (OR=8.67, 95% CI 4.70-15.99. Conclusion: The prevalence of HIV among this hospital based population of children less than 15 years was 2.8%, which is relatively low. Children who presented with cough, weight loss, oral thrush, lymphadenopathy, ear discharge, skin lesion, hepatomegaly, and splenomegaly in this setting are likely to have HIV infection, and should therefore raise suspicion for testing and early diagnosis. HIV infection was associated with prolonged hospital stay.