title: The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi.
abstract: A study was undertaken in a central nutritional rehabilitation unit in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. HIV seroprevalence in 250 severely malnourished children over 1 year of age was 34.4% and overall mortality was 28%. HIV infection was associated significantly more frequently with marasmus (62.2%) than with kwashiorkor (21.7%) (p < 0.0001). Breastfed children presenting with severe malnutrition were significantly more likely to be HIV-seropositive (p < 0.001). Clinical and radiological features were generally not helpful in distinguishing HIV-seropositive from HIV-seronegative children. The case fatality rate was significantly higher for HIV-seropositive children (RR 1.6 [95% CI 1.14-2.24]). The increasing difficulties of managing the growing impact of HIV infection on severely malnourished children in Malawi are discussed in the context of reduced support for nutritional rehabilitation units.
authors.affiliation: Department of Paediatrics, College of Medicine, Blantyre, Malawi.
authors.forename: L
authors.initials: L
authors.lastname: Kessler
authors.forename: H
authors.initials: H
authors.lastname: Daley
authors.forename: G
authors.initials: G
authors.lastname: Malenga
authors.forename: S
authors.initials: S
authors.lastname: Graham
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000401:mortality; D015528:HIV Seroprevalence; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007223:Infant; D007732:Kwashiorkor / Q000401:mortality / Q000628:therapy / Q000821:virology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011502:Protein-Energy Malnutrition / Q000401:mortality / Q000628:therapy / Q000821:virology*; D015996:Survival Rate