Factors associated with short term survival of HIV infected children in Nairobi, Kenya
Abstract
Background and objectives: .
There is limited report on natural history of HIV-1 infection in African children, and
much more so on long-term observational cohort studies. The literature on natural
history may differ from the western world due to lack of anti-retroviral drug use and
other infectious disease burdens in the resource poor sub Saharan Africa. From 1986~
a collaborating team of researchers from the University of Nairobi and the University
of Manitoba, Canada has been conducting a cohort study on mother-to-child HlV-1
transmission. While following up the children, we noted a sub-group of children who
died before reaching 3 years of age. The study objective is to describe the factors
.associated with survival of HlV-1 infected children to <3 years.
Methods:
Data was abstracted from the main study onHlV-1 infected mothers and their
children those who were born between 1992 and 1997. The data included maternal
socio-demographic and clinical factors at delivery of the index child, the clinical and
anthropometrical measurements of the infant at delivery, and clinical and laboratory
follow-up evaluation on scheduled visits.
Results:
There were 52HlV-1 infected children within complete follow-up data from delivery.
Twenty-eight of the 52 children (53.8%) died before age 3 years. The mothers and the
children had no access to anti-retroviral drugs. Significant factors associated with
early mortality included: illnesses during pregnancy with no medical treatment being
sought (p 0.02), low birth weight <2500grams (p=0.02), occurrence of diarrhoeal
disease as early as 6 weeks of life (P=0.06) and failure to thrive by 6 months
(p=0.001). Significantly higher incidences of common signs of HlV-1 infection; fever
(P=0.02), cough (p<0.001),diarrhoea (p=0.002) and thrush (p=0.0002) were seen in
the children who died before 3 years of age.
Conclusion:
There was a high (53.8%) mortality in this cohort in the first three years of life.
Diarrhoeal disease and failure to thrive were the main factors associated with early
mortality in this cohort of children without antiretroviral drug exposture.
Citation
Masters of Medicine (Pediatrics) in the University of Nairobi, 2002Publisher
University of Nairobi, School of Medicine