Paediatric HIV in central Sudan: high sero-prevalence and poor performance of clinical case definitions.
BACKGROUND
Paediatric clinical case definitions (CCDs) for the human immunodeficiency virus (HIV) have been proposed as screening tools in resource-limited countries.


OBJECTIVE
We assessed the performance of the World Health Organisation CCD (WHO-CCD), the Bloemfontein CCD (B-CCD) and a locally modified version of the Bloemfontein CCD (MB-CCD) in comparison with HIV serology in acutely hospitalised children aged 1.5-14 years. We also determined the HIV sero-prevalence among this group of children.


METHODS
A cohort of 106 consecutive acute paediatric admissions to a major teaching hospital in central Sudan was recruited over a 3-month period.


RESULTS
The WHO-CCD, B-CCD, and MB-CCD were relatively specific with estimates of 96.0% (95% confidence interval [CI] 90.1-98.9), 88.0% (95% CI 80.0-93.6), and 74.0% (95% CI 64.3-82.3), respectively. However, corresponding sensitivities were poor with estimates of 16.7% (95% CI 0.4-64.1), 33.3% (95% CI 4.3-77.7), and 66.7% (95% CI 22.3-95.7), respectively. The HIV sero-prevalence was high at 5.7% (95% CI 2.1-11.9).


CONCLUSIONS
CCDs performed poorly against HIV serology in acutely hospitalised children aged 1.5-14 years in central Sudan and, therefore, we advocate improving access to serological diagnostic tools. The high HIV sero-prevalence rate among this group of children poses serious challenges to policy makers and warrants further research.
Abbas
Ahmed Abdalla
AA
Faculty of Medicine, University of Medical Sciences and Technology, PO Box 12810, Khartoum, Sudan. ahmedabbas08@hotmail.com
Gabo
Nour Elhouda Ata Alla Alla
NE
Babiker
Zahir Osman Eltahir
ZO
Herieka
Elbushra Ali Mohamed
EA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013397:Sudan; D014944:World Health Organization