Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia, 2009–2019

Abstract

Objective: This study aimed to assess Severe Acute Malnutrition (SAM) associated mortality rate of children attending HIV/AIDS care in North West Ethiopia 2009–2019. Methods: Institutional-based retrospective cohort study was employed among 721 on antiretroviral therapy care seropositive children since 2009–2019. Data were entered using EpiData version 4.2 and exported to STATA (SE) R-14 version statistical software for further analysis. Beside, Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. Bivariable and multivariable Cox regression analyses were conducted to identify the predictors of mortality. Finally, variables with p-value less than 0.05 were considered significant predictors of mortality. Result: Overall, 721 (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. A median time of death was reported at 19.5 months (interquartile range = ±8.5). The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% confidence interval: 3.6–5.8). Severe stunting (height for age Z-score <−3) (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4), admission with septic shock (hazard ratio = 2.3, 95% confidence interval: 1.2–4.3, p < 0.008), CD4+ count below threshold (hazard ratio = 1.6, 95% confidence interval: 1.19–7.9), and World Health Organization Stages III and IV (hazard ratio = 2.9, 95% confidence interval: 1.8–6.4) were at high risk of mortality. Conclusion: A high rate of SAM associated mortality rate within short median (±SD) time to death was reported as compared with previous finding in Ethiopia. Seropositive children presenting with CD4 counts being below a threshold, World Health Organization Stages III and IV, and being nutritionally stunted during antiretroviral therapy initiation were at high risk of early mortality.

Rate, risk factors and estimations of time to develop severe acute malnutrition after children receiving antiretroviral therapy at selected health facilities in northwest Ethiopia

“…This might be due to the difference in quality care, cut-off point for SAM diagnosis and ability of healthcare providers to screen in different health institutions (24) . Likewise, the overall incidence density rate in our study was found to be 5⋅64 per 100 PPY (95 % CI 4⋅68, 6⋅94) and is comparable with previously reported studies in 5⋅4 per 100 PPY at Debre Tabor (7) and 5⋅42 per 100 PPY in Pawe hospitals (5) . This might be due to the difference in socio-demographic characteristics, study population and study design (7) .…”

“…deficiencies. What is more, the proinflammatory cytokines like interleukin-1 (IL-1), interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) for a long time cause anoxia and lack of interest in feeding (3,5,6) , this might expose for metabolic derangement due to oxidative stress and hasten viral replication in progressions of AIDS disease (16,30) .…”

“…According to the Health and Health-Related Indicators (HHRIs) of 2014, SAM was the third leading cause of mortality (accounting for 8⋅1 % of deaths) and 20 % of hospital admissions for children in Ethiopia (17)(18)(19) and mortality rate in HIV children undergoing SAM treatment is found to be 5⋅4 per 100 child-years in northwest Ethiopia (20) . A major contribution to the excess mortality due to malnutrition in HIV-positive children is the inaccessibility of timely and appropriate medical services, which are plentiful and vary at regional and district levels (21) .…”

“…Rationally, the HIV disintegrates the primary physical defense barriers of collagen levels in skin cells and alters intracellular neovascularisation (3,4) . Evidence suggested that inadequate calorie intake due to elevated levels of proinflammatory cytokines like interleukin-1(IL-1), interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) can cause anorexia and oxidatively stressed derangements of metabolites (3,5,6) .…”

Incidence and predictors of attrition rate after children started inpatient treatments for complicated severe acute malnutrition in North West Ethiopia

“…This might be due to the number of families in a house can cause interruptions from treatment observation. This may be a cause fear for care on transportation and feeding of schoolchildren at home [ 25 , 26 ]. Consistent to this narration, our report confirmed that majority 49 (69.1%) of interrupted cases were lived with ≥ 5 number of families in a house.…”