Reasons for hospitalization in HIV-infected children in West Africa.
BACKGROUND
Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration).


METHODS
We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions.


RESULTS
From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1-8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7-23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%).


CONCLUSIONS
Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.
Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali.
Fatoumata
F
Dicko
Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France; Sophie.Desmonde@isped.u-bordeaux2.fr.
Sophie
S
Desmonde
Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin.
Sikiratou
S
Koumakpai
Hopital pour Enfants Albert Royer, Dakar, Sénégal.
Hélène
H
Dior-Mbodj
Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso.
Fla
F
Kouéta
Korle Bu Teaching Hospital, Accra, Ghana.
Novisi
N
Baeta
Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali.
Niaboula
N
Koné
Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin.
Jocelyn
J
Akakpo
Hopital pour Enfants Albert Royer, Dakar, Sénégal.
Haby
H
Signate Sy
Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso.
Diarra
D
Ye
Korle Bu Teaching Hospital, Accra, Ghana.
Lorna
L
Renner
Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France.
Charlotte
C
Lewden
Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France.
Valériane
V
Leroy
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000354:Africa, Western / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies
Africa; HIV; hospitalization; infectious diseases; morbidity; paediatrics