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|Title: ||HIV infection in severely malnourished children in Kumasi, Ghana: a cross-sectional prospective study|
|Authors: ||Asafo-Agyei, Serwah Bonsu|
Nguah, Samuel Blay
|Issue Date: ||2013|
|Publisher: ||BMC Pediatrics|
|Abstract: ||Background: The Human Immunodeficiency Virus (HIV) epidemic has adversely affected the nutritional status and
mortality of children in Africa. This study assessed the disease burden, predictive clinical features and outcomes for
children with severe acute malnutrition (SAM) and concomitant HIV infection.
Methods: This was a cross-sectional prospective study of children with SAM aged between 3 months and 13 years
admitted to the nutritional rehabilitation unit (NRU) of Komfo Anokye Teaching Hospital. Socio-demographic,
anthropometric and clinical data were documented and HIV serostatus established with 2 rapid HIV antibody tests
and Enzyme-linked immunosorbent assay, if indicated. HIV viral polymerase chain reaction testing was not available
at the time of the study. Logistic regression analyses were used to identify significant clinical predictors of
Results: Sixty-seven (27.2%, 95% CI = 21.8-33.3%) of the 246 study children had positive HIV antibody results. Uptake
of provider-initiated HIV testing and counselling was 100%. Amongst children aged 18 months and over, the HIV
seroprevalence was 28.3% (30/106). HIV seropositivity was strongly associated with prolonged fever, cough and
diarrhoea; oral thrush, generalised lymphadenopathy and pulmonary tuberculosis (p value < 0.001 for all parameters).
The presence of ≥ 3 of the first 5 aforementioned parameters was highly specific (98.3-100%) for HIV seropositivity in
study children. HIV seropositivity was also significantly associated with cough, vomiting, lethargy/altered consciousness,
skin rash and hepatomegaly (p value < 0.05 for all parameters). Overall mortality rate was 17.5%, with HIV seropositive
children having a significantly higher mortality rate (37.8% versus 10.1%; p value < 0.001) and a lower rate of weight
gain (2.4 g/kg/day versus 7.0 g/kg/day; p value < 0.001).
Conclusions: HIV testing was well accepted by parents/carers and should be offered in all NRUs. There was a high HIV
seroprevalence among children with SAM and a significantly poorer outcome in mortality and weight gain. Some
clinical features were identified to be predictive of HIV seropositivity and could be useful as indicators to prompt
further investigation and/or referral in resource limited settings where HIV test kits are unavailable. This would aid in
the early detection and comprehensive management of the HIV seropositive child with SAM.|
|Description: ||This article is published in BMC Pediatrics and also available at DOI: 10.1186/1471-2431-13-181|
|Appears in Collections:||College of Agric and Natural Resources|
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