dc.contributor.author | Kibore, Minnie W | |
dc.date.accessioned | 2014-01-22T05:52:05Z | |
dc.date.available | 2014-01-22T05:52:05Z | |
dc.date.issued | 2010 | |
dc.identifier.citation | Master of Medicine (Paediatrics) | en_US |
dc.identifier.uri | http://hdl.handle.net/11295/64153 | |
dc.description | A dissertation submitted in part fulfillment for the degree
of Master of Medicine (Paediatrics) in the University of
Nairobi. | en_US |
dc.description.abstract | Introduction
Pneumonia in the context of Human Immunodeficiency Virus (HIV) and Acquired
Immune Deficiency Syndrome (AIDS) is a problem of high magnitude particularly
among children in sub-Saharan Africa. Studies from Southern African states have
demonstrated children infected with HIV experienced an increased morbidity and
mortality from pneumonia compared to HIV uninfected children.
Study Justification
There is little local data that has been able to clearly demonstrate the magnitude of this
problem in Kenya and particularly at Kenyatta National Hospital (KNH). This
information would be useful in planning health services and developing protocols or
guidelines in the management of these children.
Study Objectives
This study's objective was to determine the prevalence of HIV infection in children aged
two to 59 months with severe or very severe pneumonia admitted to KNH and to describe
the clinical and immunologic staging as well as the short-term in-hospital mortality in
these children.
Methodology
Children aged two to 59 months were recruited from the KNH Paediatric Emergency
Unit (PEV) 24 hours a day, seven days a week for the entire period of the study. This was
conducted jointly with other members of the 'Childhood Pneumonia Study Group'. HJV
testing was offered according to the Provider Initiated Testing and Counselling (PITC)
guidelines. Clinical and immunologic staging was carried out according to the new World
Health Organisation (WHO) guidelines. Outcomes namely mortality and discharge status
were followed for up to five days of in-patient treatment.
Results
342 children were enrolled of whom 158 (46%) had severe pneumonia and 184 (54%)
had very severe pneumonia. The median age of the cohort was 8.6 months (interquartile
range (lQR) 5.1-14.4) with a male to female ratio of 1:1.2. 38/342 (11.1 %) were found to
be HIV antibody positive, 31 (82%) of whom were < 18 months of age. Of these 29/31
(94%) were confirmed positive on DNA PCR giving a total of 36/342 HIV infected
patients and an HIV prevalence of 10.6%. HIV prevalence among those with severe
pneumonia was 8.2% while the prevalence among those with very severe pneumonia was
higher at 12.6%. 23/36 (64%) of the HIV infected patients were male while 26/36 (74%)
of the HIV infected patients were infants two to 11 months of age.
22(61%) of the 36 HIV infected patients were in WHO clinical stage 3 and 14(39%) in
clinical stage 4.29/34(85%) of the HIV infected patients were immunosuppressed with
22(63%) having severe depressed CD4 counts. 17/27(63%) infants and 5/7(71 %) children
aged 12-35 months had severe immunosuppression. The in-hospital mortality among HIV
infected patients was 13.9% (5/36) more than double that of HIV uninfected patients
which was 5.3% (16/305). Univariate predictors of early in-hospital mortality included;
female gender Risk Ratio (RR) 6.25, very severe pneumonia RR 9.51, HIV infection RR
2.91, WHO HIV clinical stage 4, previous admission RR 4.35; all with a P value of <
0.05. Adjusted analysis showed HIV infection to be independently predictive of mortality
in this cohort (RR 3.82, 95%CI 1.08 to 13.57, P value=0.038).
Conclusions
Theprevalence of HIV infection among children under five years admitted to KNH with
severe or very severe pneumonia was 10.6%,38.9% of these children were in clinical
stage 4 and 63% had severe depressed CD4 counts. In-hospital mortality among HIV
infected children was 13.9% compared to HIV uninfected children who had a mortality
rate of 5.3%.
Recommendation
Effort is needed to step-up early screening and diagnosis of HIV infection particularly
among children with severe forms of pneumonia. This will assist in instituting early and
aggressive management of both typical and atypical forms of pneumonia. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University Of Nairobi | en_US |
dc.title | Prevalence of human immunodeficiency virus infection among children under five years with severe or very severe pneumonia in Kenyatta National Hospital | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |