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.
Action Against Hunger Malawi, Lilongwe, Malawi.
Jobiba
J
Chinkhumba
Andrew
A
Tomkins
Theresa
T
Banda
Catherine
C
Mkangama
Pamela
P
Fergusson
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