HIV and Childhood Disability: A Case-Controlled Study at a Paediatric Antiretroviral Therapy Centre in Lilongwe, Malawi

Autor: Atupele Makawa, Akash Devendra, Peter N. Kazembe, Nancy R. Calles, Hannah Kuper
Rok vydání: 2013
Předmět:
Male
Malawi
Pediatrics
Developmental Disabilities
medicine.medical_treatment
Child Health Services
Human immunodeficiency virus (HIV)
lcsh:Medicine
HIV Infections
Global Health
medicine.disease_cause
Child Development
Prevalence
lcsh:Science
Child
education.field_of_study
Multidisciplinary
Rehabilitation
Medical record
Child Health
HIV diagnosis and management
Disabled Children
Anti-Retroviral Agents
Child
Preschool
Learning disability
Medicine
Infectious diseases
Female
Public Health
medicine.symptom
Research Article
medicine.medical_specialty
Clinical Research Design
Population
Developing country
Viral diseases
medicine
Humans
education
Health Services Needs and Demand
business.industry
lcsh:R
Case-control study
HIV
Antiretroviral therapy
Case-Control Studies
Family medicine
Quality of Life
lcsh:Q
Physiotherapy and Rehabilitation
business
Zdroj: PLoS ONE
PLoS ONE, Vol 8, Iss 12, p e84024 (2013)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0084024
Popis: BACKGROUND: As paediatric antiretroviral therapy (ART) is rapidly scaled up in Southern Africa, Human Immunodeficiency Virus (HIV) infection is becoming a chronic illness. Children growing up with HIV may begin to encounter disabilities. The relationship between HIV, disability and the need for rehabilitation has added an additional element that needs to be addressed by paediatric HIV treatment programmes. STUDY OBJECTIVES: 1) Estimate the prevalence of disabilities in HIV-infected and HIV-uninfected children in Lilongwe, Malawi. 2) Examine types of disability and associated clinical and socio-demographic factors. 3) Identify needs, opportunities and barriers for rehabilitation in Malawi. METHODS: A case-controlled study of 296 HIV-infected children aged 2-9 years attending an ART centre in Lilongwe (cases) and their uninfected siblings (controls) was conducted. Disability was assessed using the WHO Ten Question Screen (TQS). Socio-demographic and clinical data were collected using a parent-proxy questionnaire and medical records. RESULTS: Of 296 case and control pairs recruited, 33% (98) versus 7% (20) screened positive for a disability (OR 8.4, 4.4-15.7) respectively. Of these 98 HIV-infected cases, 6%, 36%, 33%, 53%, 46% and 6% had a vision, hearing; physical, learning/comprehension, speech or seizure-related disability respectively and 51% had multiple coexisting disabilities. HIV-infected cases with a disability were more likely to be WHO stage III or IV at enrolment (71% vs. 52%, OR 2.7, 1.5-4.2), to have had TB (58% vs. 39%, OR 2.3, 1.4-3.8) and to have below-average school grades (18% vs. 2%, OR 11.1, 2.2-54.6) than those without. Sixty-seven percent of cases with a disability had never attended any rehabilitative service. Twenty-nine percent of caregivers reported facing stigma and discrimination because of the child's disability. CONCLUSION: This study reveals the magnitude of disability among HIV-infected children and the large unmet need for rehabilitation services. This expanding issue demands further investigation to provide an evidence base for holistic care for disabled children living with HIV.
Databáze: OpenAIRE
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