title: Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study.
abstract: BACKGROUND
  The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa.
  
  
  METHODS
  A cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2-19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d'Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition.
  
  
  RESULTS
  Overall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7-13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6-12 %), 26 % (95% CI: 23-28 %), and 7 % (95% CI: 5-10 %), respectively. Among those malnourished, more than half of children didn't receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5 years); and mixed malnutrition with male gender, age (<5 years), severe immunodeficiency and recent ART initiation (<6 months). Orphanhood and Cotrimoxazole prophylaxis were not associated with any type of malnutrition.
  
  
  CONCLUSIONS
  The prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes. Anthropometric measurements and appropriate nutritional care of malnourished HIV-infected children remain insufficient and a priority to improve health care of HIV-infected children in Africa.
authors.affiliation: Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. Julie.Jesson@isped.u-bordeaux2.fr.|Centre de Recherche Inserm U897, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen Case 11, 146 rue Léo Saignat, 33076, Bordeaux, Cedex, France. Julie.Jesson@isped.u-bordeaux2.fr.
authors.forename: Julie
authors.initials: J
authors.lastname: Jesson
authors.affiliation: Growing Up Programme - Sidaction & Initiative Développement, Paris, France. david.masson@esther.fr.
authors.forename: David
authors.initials: D
authors.lastname: Masson
authors.affiliation: RACINES (Recherches Actions Communautaires Initiatives pour un Nouvel Espoir), Cotonou, Bénin. racines_benin@yahoo.fr.
authors.forename: Arsène
authors.initials: A
authors.lastname: Adonon
authors.affiliation: Growing Up Programme - Sidaction & Initiative Développement, Paris, France. caroline.tran@rocketmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Tran
authors.affiliation: ANSS (Association Nationale de Soutien aux Séropositifs et malades du Sida), Bujumbura, Burundi. nigapiya@gmail.com.
authors.forename: Capitoline
authors.initials: C
authors.lastname: Habarugira
authors.affiliation: Growing Up Programme - Sidaction & Initiative Développement, Paris, France. r.zio@Sidaction.org.
authors.forename: Réjane
authors.initials: R
authors.lastname: Zio
authors.affiliation: APECOS (Association de Prise en Charge des Orphelins du Sida ), Bujumbura, Burundi. apecos.burundi@gmail.com.
authors.forename: Léoncie
authors.initials: L
authors.lastname: Nicimpaye
authors.affiliation: Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. Sophie.Desmonde@isped.u-bordeaux2.fr.|Centre de Recherche Inserm U897, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen Case 11, 146 rue Léo Saignat, 33076, Bordeaux, Cedex, France. Sophie.Desmonde@isped.u-bordeaux2.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Desmonde
authors.affiliation: SWAA (Society for Women against AIDS in Africa ) - Burundi, Bujumbura, Burundi. swaabdi@spidernet-bi.com.
authors.forename: Goreth
authors.initials: G
authors.lastname: Serurakuba
authors.affiliation: SWAA Littoral (Society for Women against AIDS in Africa), Douala, Cameroon. swaalittoral@yahoo.fr.
authors.forename: Rosine
authors.initials: R
authors.lastname: Kwayep
authors.affiliation: CSAS (Centre Solidarité Action Sociale), Bouaké, Ivory Coast. ong_csas@yahoo.fr.
authors.forename: Edith
authors.initials: E
authors.lastname: Sare
authors.affiliation: ARCAD (Association de Recherche, de Communication et d'Accompagnement à Domicile des personnes vivant avec le VIH et le sida), Bamako, Mali. arcadsida@arcadsida.org.
authors.forename: Tiefing
authors.initials: T
authors.lastname: Konate
authors.affiliation: AKS (Association Kenedougou Solidarité ), Sikasso, Mali. ksolidarite@yahoo.fr.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Nimaga
authors.affiliation: ADN (Association Djenandoum Naasson), Moundou, Tchad. modndeto@yahoo.fr.
authors.forename: Philemon
authors.initials: P
authors.lastname: Saina
authors.affiliation: AMC (Aide Médicale et Charité), Lomé, Togo. amc_lome@yahoo.fr.
authors.forename: Akossiwa
authors.initials: A
authors.lastname: Kpade
authors.affiliation: EVT (Espoir Vie Togo), Lomé, Togo. espoirvietogo@laposte.tg.
authors.forename: Andrée
authors.initials: A
authors.lastname: Bassuka
authors.affiliation: CRIPS (Centre de Recherche de d'Information Pour la Santé ) - Togo, Lomé, Togo. ahomawus@gmail.com.
authors.forename: Gustave
authors.initials: G
authors.lastname: Gougouyor
authors.affiliation: Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. Valeriane.Leroy@isped.u-bordeaux2.fr.|Centre de Recherche Inserm U897, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen Case 11, 146 rue Léo Saignat, 33076, Bordeaux, Cedex, France. Valeriane.Leroy@isped.u-bordeaux2.fr.
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D000354:Africa, Western / Q000453:epidemiology; D000886:Anthropometry; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents