Time to develop severe acute malnutrition and its predictors among children living with HIV in the era of test and treat strategies at South Gondar hospitals, northwest, Ethiopia, 2021: a multicentre retrospective cohort study

Abstract

Background Although severe acute malnutrition is a major public issue among HIV infected children, there is no prior evidence in Ethiopia. Hence, this study aims to assess the time to develop severe acute malnutrition and its predictors among children living with human immunodeficiency virus in Ethiopia, 2012. Methods An institution based retrospective cohort study was conducted in South Gondar hospitals among 363 HIV infected children from February 10, 2014, to January 7, 2021. Epi-data version 3.1 was used to enter data, which was then exported to STATA version 14 for analysis. Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. A standardized data extraction tool was used to collect the data. The Kaplan Meier survival curve was used to estimate the median survival time. The Cox-proportional hazard model assumption was checked via the Schoenfeld residual ph test and a stph plot. Bivariable and multivariable Cox proportional hazard models were employed at 95% confidence intervals (CI). A variable having a p-value < 0.05 was considered a statistically significant predictor of severe acute malnutrition. Results A total of 363 children living with HIV, 97 (26.72%) developed severe acute malnutrition during the follow-up period. The overall incidence rate was 5.4 (95% CI: 4.7–5.9) person per year with a total of 21, 492 months or 1791 years of observation. Moreover, the median survival time was 126 months. Treatment failure [AHR =3.4 (95% CI: 2.05–5.75)], CD4 count below threshold [AHR =2.5 (95% CI: 1.64–3.95)], and WHO stage III & IV [AHR =2.9 (95% CI: 1.74–4.73)] were all significant predictors of severe acute malnutrition. Conclusion The time to develop severe acute malnutrition was found to be very low. Treatment failure, CD4 count below threshold, and WHO stage III were all significant predictors of severe acute malnutrition. Hence, emphasizing those predictor variables is essential for preventing and controlling the occurrence of severe acute malnutrition among HIV infected children.

Severity of malnutrition among underweight children and family‐related factors: A cross‐sectional analysis of data from the 2019 Ethiopian Demographic and Health Survey (EDHS)

“…The results of this study were in line with those of a study conducted in Ethiopia by Teklie et al, which found that children residing in the Afar, Oromia, and Somali areas, respectively, had a 32%, 33%, and 60% lower chance of being underweight than children living in the Tigray region 12 . This result was also similar with the study done in East African districts in Ruanda, Uganda, and Tanzania), and Ghana 15,16 …”

“…12 This result was also similar with the study done in East African districts in Ruanda, Uganda, and Tanzania), and Ghana. 15,16 The study also found that parents' occupation is a very reliable indicator of how severe child malnutrition is in Ethiopia. In Hauzen District, Tigray Region, a similar conclusion was also made, indicating that children of jobless mothers were 2.4 times more likely to be underweight.…”

“… 12 This result was also similar with the study done in East African districts in Ruanda, Uganda, and Tanzania), and Ghana. 15 , 16 …”

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

“…At the end of the study period, 103 (14⋅2 %) participants' children developed SAM with maximum and minimum time to develop between 3 and 98 months. This finding is lower than previously reported studies done in south Gondar hospital (26⋅72 %) (7) , East Africa (24⋅65 %) (10) , sub-Saharan Africa (24⋅5 %) (26) , West Africa (26 %) (27) , Malawi (17⋅5 %) (4) and Burkina Faso (63 %) (2) . 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) .…”

“…The clinical presentation of severe acute malnutrition (SAM) includes severe visible wasting (marasmus), nutritional oedema (kwashiorkor) or marasmus-kwashiorkor. However, Abbreviations: AHR: adjusted hazard ratio; CHR: crude hazard ratio; CI: confidence interval; FMOH: Ethiopian Federal Ministry of Health; MUAC: mid-upper arm circumference; IQR: interquartile range; SAM: severe acute malnutrition; NGT: nasogastric intubation for feeding; WFH: weight for height; SD: standard deviation kwashiorkor and marasmus among HIV-infected children have a higher risk of mortality (7,8) . In sub-Saharan Africa, the epidemiology of SAM has increased among children requiring hospitalisation composed of those who are HIV infected, with case fatality rates reaching as high as 20-50 % (9)(10)(11) .…”