Incidence and Predictors of Mortality among Children on Anti-Retroviral Therapy in Public Health Facilities of Arba Minch Town, Gamo Gofa Zone, Southern Ethiopia; Retrospective Cohort Study

Boti, Negussie; Debere, Mesfin Kote; Enderis, Bilcha oumer; Abyu, Direslgne Misker

doi:10.4172/2090-7214.1000267

Cited by 16 publications

(21 citation statements)

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“…Within a total follow-up time of 14,600 child-months, the mortality rate of HIV-positive children receiving ART in our study hospitals was 3.2 (95% CI: 2.3, 4.3) per 100 child-years of observation. Our finding is comparable with studies reported from Arba Minch Town Public Health Facilities, Gamo Gofa Zone, Southern Ethiopia (3.1 deaths per 100 child-years) [ 17 ], Nigeria (3.0 deaths per 100 child-years) [ 18 ], and Andhra Pradesh, India (3.0 deaths per 100 child-years) [ 19 ].…”

Section: Discussionsupporting

confidence: 90%

“…This study identified the predictors of mortality among HIV-positive children receiving ART using a multicenter facility-based historical cohort study. Within a total [17], Nigeria (3.0 deaths per 100 child-years) [18], and Andhra Pradesh, India (3.0 deaths per 100 child-years) [19]. Nonetheless, our finding is lower than studies conducted in Addis Ababa Public Hospitals, Ethiopia (12.4 deaths per 100 child-years) [20], Debre Tabor General Hospital and Dessie Referral Hospital, Ethiopia (6.3 deaths per 100 child-years) [21], and Kenya (8.4 deaths per 100 child-years) [22].…”

Section: Discussionmentioning

confidence: 99%

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Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

et al. 2020

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Background Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region. Methods A multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p -values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results The cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5 , 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality. Conclusion A higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIV-positive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

et al. 2020

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“…We found late initiation on to ART from time of HIV testing was predictive of reduced survival. Studies have shown that late presentation for early infant diagnosis (EID) services leads to poor prognosis (27,28). This is also evidenced by findings of Bolton-Moore et al (29) in earlier studies in Zambia.…”

Section: Discussionmentioning

confidence: 91%

Survival of Children Living With HIV on Art in Zambia: A 13-Years Retrospective Cohort Analysis

Munthali

Michelo

Mee

et al. 2020

Front. Public Health

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Background: Research conducted before the introduction of anti-retroviral therapy (ART), showed that the majority of children living with HIV (CLHIV) would die before their second birthday. In Zambia, ART was rolled out to the public health system in 2004 with subsequent improved survival in CLHIV. However, the survival rates of CLHIV on ART in Zambia since 2004 have not been extensively documented. We assessed survival experiences and the factors associated with survival in CLHIV on ART in Zambia. Methods: We conducted a retrospective cohort analysis of CLHIV (aged up to 15 years) using routinely collected data from health facilities across Zambia, over 13 years to ascertain mortality rates. We explored survival factors using Cox regression giving adjusted hazard ratios (AHR) and 95% confidence intervals (95% CI). Nelson Aalen estimates were used to show the cumulative hazards of mortality for different levels of explanatory factors. Results: A total of 65,448 eligible children, were initiated on ART between 2005 and 2018, of which 33,483 (51%) where female. They contributed a total survival time of 275,715-person years at risk during which 3,265 children died which translated into an incidence rate of 1.1 deaths per 100 person-years during the review period. Mortality rates were highest in children in the first year of life (Mortality rate 2.24; 95% CI = 2.08-2.42) and during the first year on ART (Mortality rate 3.82 95% CI = 3.67-3.98). Over 50% of the children had been on ART for 5-10 years by 2018, and they had the lowest risk of mortality compared to children who had been on ART for <5 years. Conclusions: Children with HIV in Zambia are surviving much longer than was predicted before ART was introduced 14 years ago. This key finding adds to the literature on analysis of survival in CLHIV in low income settings like Zambia. However, this survival is dependent on the age at which ART is initiated and the time on ART highlighting the need to increase investments in early infant diagnosis (EID) to ensure timely HIV testing and ART initiation for CLHIV.

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“…Subgroup analysis was conducted by using the region and year of the primary studies published. From all studies which reported proportion of child mortality after ART initiation, 6 were from Addis, Ababa [ 18 , 26 – 29 , 33 ], 5 from Amhara [ 16 , 20 – 23 ], 2 from Oromia [ 30 , 32 ], 1 from Tigray [ 17 ], 1 from SNNPRS [ 19 ], and 1 from Harari [ 31 ]. In the subgroup analysis, the highest pooled proportion of mortality was reported in the Amhara region 16.76% (95% CI 9.63, 23.90) and the lowest in the Tigray 4.81% (95% CI 2.75, 6.87); subsequently, in Addis Ababa 10.43% (95% CI 7.29, 13.56), in Oromia 7.55% ( 95% CI 5.53, 9.58), in SNNPRS 15.40% (95% CI 11.95, 18.85), and in Harari 9.20% (95% CI 5.96, 12.44) were found (Fig.…”

Section: Resultsmentioning

confidence: 99%

Mortality and its association with CD4 cell count and hemoglobin level among children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

Wubneh

Belay

2020

Trop Med Health

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Background Even though there are advancements in HIV/AIDS prevention and treatment approach, HIV continues to be a global challenge. Pediatrics HIV is one of the challenges in the reduction of child mortality particularly in less developed countries like Ethiopia. Therefore, this study aims to estimate the pooled proportion of child mortality and the effect of hemoglobin level and CD4 cell count among children on antiretroviral therapy in Ethiopia. Method All published were articles searched using PubMed, EMBASE, Google Scholar, and Web of Science database. Besides, Ethiopian institutional research repositories and reference lists of included studies were used. We limited the searching to studies conducted in Ethiopia and written in the English language. Studies that were done in a cohort, cross-sectional, and case-control study design were considered for the review. The weighted inverse variance random effects model was applied, and the overall variations between studies were checked by using heterogeneity test Higgins’s (I2). Subgroup analysis by region and year of publication was conducted. All of the included articles were assessed using the Joanna Briggs Institute (JBI) quality appraisal criteria. In addition, publication bias was also checked with Egger’s regression test and the funnel plot. Based on the results, trim and fill analysis was performed to manage the publication bias. Result A total of 16 studies with 7047 participants were included in this systematic review and meta-analysis. The overall pooled proportion of mortality among children on antiretroviral therapy (ART) was found to be 11.78% (95% CI 9.34, 14.23). In subgroup analysis, the highest child mortality was observed in the Amhara region 16.76 % (95% CI 9.63, 23.90) and the lowest is in the Tigray region 4.81% (95% CI 2.75, 6.87). Besides, the proportion of mortality among children with low CD4 count and hemoglobin level was 2.42 (AOR = 2.42, 95% CI 1.65, 3.56) and 3.24 (AOR = 3.24, 95% CI 1.51, 6.93) times higher compared to their counterparts, respectively. Conclusion The proportion of mortality among children on ART was high in Ethiopia. Those children who had low CD4 cell count and low hemoglobin levels at baseline need special attention, treatment, and care. Trial registration The protocol of this systematic review and meta-analysis has been registered in PROSPERO with the registration number CRD42018113077.

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Incidence and Predictors of Mortality among Children on Anti-Retroviral Therapy in Public Health Facilities of Arba Minch Town, Gamo Gofa Zone, Southern Ethiopia; Retrospective Cohort Study

Abstract: Background: Evidence shows that earlier access to Anti-retroviral Therapy helps to increase survival of children by delaying the progression to AIDS. However its long-term effect on mortality has remained unanswered in Ethiopia especially in the study area.

Cited by 16 publications

References 16 publications

Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

Survival of Children Living With HIV on Art in Zambia: A 13-Years Retrospective Cohort Analysis

Mortality and its association with CD4 cell count and hemoglobin level among children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

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