Predictors on mortality of human immunodeficiency virus infected children after initiation of antiretroviral treatment in Wolaita zone health facilities, Ethiopia: Retrospective cohort study

Abstract

Worldwide Human Immunodeficiency Virus/Acquired Immune Deficiency syndromes (HIV/AIDS) have created an enormous challenge on the survival of infected patients. Identifying baseline factors that predict morbidity could allow their possible modification in order to improve pediatric HIV care. Retrospective cohort study was conducted in 228 HIV infected children starting antiretroviral treatment at Wolaita zone selected health facilities, Ethiopia. WHO reference population was used to calculate Z- scores for height-for-age, weight-for-height, and weight-for-age. Data were analyzed by bivariate and multivariate analysis using Cox regression proportional hazard model. Survival were calculated and compared with the Kaplan Meier and log rank test. Males account 121(53.1%), mean age was 6.29 years. Mean survival time using Kaplan Meier analysis was 89.3 months (95% CI 85.71-92.97). Incidence of mortality rate 21.02 per 1000 person years of observation (95% CI 12.8-34.3). Overall nutritional status was, 62.5% stunted, 43.0% underweight and 44.7% wasted at baseline. As a result, rural residence AHR 4.30 (95% CI, 1.25-14.8), fair/poor of first three-month ART adherence AHR 8.95(95% CI 2.624-33.72), severely wasted children at baseline AHR 7.040 (95% CI, 1.27-39.13) and age of children were predictors of mortality. Mortality among HIV-infected children was high and strongly associated with malnutrition, residence in rural area, low adherence to ART, and beginning of ART at an advanced age; highlighting the urgent need for targeted interventions including promotion of early initiation and adherence to ART. Key words: Children, malnutrition, mortality, HIV/AIDS.