Characteristics of HIV-infected children seen in Western Kenya
| Autor: | Winston M. Nyandiko, Constance Tenge, Rachel Vreeman, Ann Mwangi, P M Gisore, E. Nabakwe, Samwel O. Ayaya |
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| Rok vydání: | 2010 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Referral Adolescent Anti-HIV Agents Psychological intervention HIV Infections Pharmacotherapy Age Distribution Risk Factors Health care medicine Chi-square test Humans Tuberculosis Body Weights and Measures Disease management (health) Child Retrospective Studies AIDS-Related Opportunistic Infections business.industry Infant Newborn Infant Retrospective cohort study General Medicine medicine.disease Kenya CD4 Lymphocyte Count Pneumonia Treatment Outcome Child Preschool HIV-1 Female business Follow-Up Studies |
| Zdroj: | East African Medical Journal; Vol 86, No 8 (2009) |
| ISSN: | 0012-835X |
| Popis: | Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.Design: A retrospective descriptive study.Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performedResults: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ)> -1 and 21% had WAZ scores < 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead.Conclusions: HIV -infected children were enrolled in care early in childhood. Orphan-hood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART. |
| Databáze: | OpenAIRE |
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