The impact of HIV on mortality during in-patient rehabilitation of severely malnourished children in Malawi.
A prospective cohort study measured mortality during nutritional rehabilitation among HIV-infected and uninfected children, aged 6-59 months, with severe acute malnutrition (SAM). Children were tested for HIV and CD4% on admission to the nutrition rehabilitation unit (NRU). Mortality was assessed by following children to 4 months post discharge from the NRU or death if earlier. Overall mortality was 14.8% (67/454) and HIV prevalence was 17.4% (79/454). HIV-infected children were significantly more likely to die than uninfected children [35.4% (28/79) vs. 10.4% (39/375), P<0.001], and 85.7% of deaths occurred in children with a CD4% less than 20. Forty percent (18/45) of HIV-infected children with a CD4% <20 died, in contrast to 15% (3/20) of HIV-infected children with a CD4% >20 (P=0.05). Routine testing and treatment for HIV among all malnourished children is necessary to improve quality of care and reduce mortality among children with SAM.
Chinkhumba
Jobiba
J
Action Against Hunger Malawi, Lilongwe, Malawi.
Tomkins
Andrew
A
Banda
Theresa
T
Mkangama
Catherine
C
Fergusson
Pamela
P
D017677:Age Distribution; D018791:CD4 Lymphocyte Count; D002662:Child Health Services / Q000592:standards; D015362:Child Nutrition Disorders / Q000178:diet therapy* / Q000401:mortality*; D002675:Child, Preschool; D042241:Early Diagnosis; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000534:rehabilitation; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage; D008295:Malawi / Q000453:epidemiology; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000401:mortality*; D012423:Rural Health