HIV infection among paediatric in-patients in Blantyre, Malawi

Abstract

To investigate the impact of HIV infection on hospital admission and death we studied children admitted to paediatric medical and surgical wards in Blantyre, Malawi, in March 2000. Unselected children whose parents or guardians consented to HIV testing of the child were recruited and HIV infection was determined by serology, with confirmation in children aged 15 months or less by PCR. We assessed the prevalence of HIV infection by age, clinical diagnosis and outcome of admission. Of 1064 admissions, 991 were tested for HIV infection, and 187 (18.9%) were infected. HIV was most common in children aged less than six months, 53 of 166 (32%). Parents of HIV-infected children were better educated, and more likely to have died, than those of uninfected children. Clinical symptoms and signs were not adequately sensitive or specific to be used for diagnosis of HIV. HIV was common in children with malnutrition (prevalence 40%), lower respiratory tract infection (29%) and sepsis (28%), and less prevalent among children with malaria (11%) or surgical admissions (11%). Almost 30% of HIV-infected children died, compared with 8.9% of uninfected children, and HIV-infected children constituted over 40% of in-patient deaths.

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

“…7 Paediatric inpatient programmes were the most common context (17), 6,7,10,[13][14][15][16][17][18][19][21][22][23][24][25]29,30 followed by nutrition centres (four), 9,11,12,27 EPI centres (three), 20 programmes (three). 8,20,31 The assessment for quality showed that most of the included studies (20) [9][10][11][12][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31] were of fair or good quality and the remainder (six) [6][7][8]13,…”

“…We did a stratifi ed analysis of paediatric HIV prevalence in southern and eastern Africa (20 studies) 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][27]28,29 versus that in west and central Africa (four). 9,23,28,31 Paediatric HIV prevalence across contexts in southern and eastern Africa was 17·8% (95% CI 12·8-22·7) and prevalence in west and central Africa was 9·8% (95% CI 4·2-15·3).…”

“…Because of the small numbers of studies from Asia and Oceania, these geographical settings were not included in stratifi ed analyses. We did stratifi ed analysis examining universal (eight studies) 7,16,18,19,22,23,25,29 versus triggered testing (nine) 6,10,[13][14][15][16]22,24,30 in inpatient settings. Paediatric HIV prevalence detected via triggered testing (21·3%, CI 11·6-31·0) was slightly, but not signifi cantly (p=0·95), higher than that detected with universal testing (21·2%, 13·8-28·7; appendix pp 10-11).…”

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

“…Although we identified a significant association with oral candida, this occurred in over 20% of uninfected children, making it an unreliable marker of HIV infection in SAM. Candida is commonly cited as associated with HIV (2,13,(22)(23)(24). Many studies have found persistent diarrhoea to be much more common in paediatric HIV (2, 25, 33) with a relative risk of 6.1 reported on the wards in Blantyre (2).…”

“…Chronic suppurative otitis media (CSOM) has been reported as more common in HIV infection, both on pediatric wards (2), and in the NRU (24).…”