<p>Determinants of Severe Acute Malnutrition Among HIV-positive Children Receiving HAART in Public Health Institutions of North Wollo Zone, Northeastern Ethiopia: Unmatched Case–Control Study</p>

Abstract

Background Over half of the children living with HIV/AIDS suffer from severe acute malnutrition especially in countries having food insecurity like Ethiopia. However, determinants of severe acute malnutrition among HIV-positive children receiving care and treatment in antiretroviral therapy clinics in Ethiopia are not abundantly investigated. The aim of this study was to assess the determinants of severe acute malnutrition among HIV-positive children receiving highly active antiretroviral therapy in public health institutions of the North Wollo Zone, Northeastern Ethiopia. Methods An institutional-based unmatched case–control study was conducted on 204 under-fifteen, HIV-positive children (68 cases and 136 controls). The data were collected by reviewing medical records and by interviewing attendants. Binary and multiple logistic regressions were employed, and odds ratio with 95%CI was used to interpret results. A p -value of <0.05 was considered as a significant difference between cases and controls for the exposure variable of interest. Results A total of 204 under-fifteen, HIV-positive children were included in this study. Of them, 49.5% were males. About 79.4% of those children had acquired HIV infection through vertical transmission. Poor adherence to ART Adj-OR: 5.72 (1.08–30.27), duration on ART Adj-OR: 5.54 (1.44–21.24), severe immunodeficiency Adj-OR: 6.41 (1.09–37.86), advanced WHO clinical stage Adj-OR: 3.58 (1.03–12.43), oropharyngeal disease Adj-OR: 4.72 (1.13–19.73) and chronic diarrhea Adj-OR: 3.98 (1.05–15.04) were identified to be determinants of SAM in those children. Conclusion Determinant factors for SAM among HIV-positive children were chronic diarrhea, severe immunodeficiency, duration and adherence to ART, oropharyngeal disease and advanced WHO clinical stage. Therefore, it is better if interventions are developed and implemented to address these identified factors.

Under-nutrition and associated factors among children on ART in Southern Ethiopia: a facility-based cross-sectional study

“…This study revealed that children in the advanced WHO clinical stages were more likely to be wasted. This is in line with previous studies conducted in Eastern Ethiopia children [ 5 , 22 ]. This can be explained by the fact that HIV-positive people who have advanced stage of the disease are more vulnerable to opportunistic infections, making them susceptible to undernutrition by decreasing intake, by altering digestion, absorption, and metabolism as well as by increasing energy need [ 21 ].…”

“…In this study, children who had recurrent oral lesions were more likely to be wasting. This is in line with previous studies conducted in Ethiopia-Gojam, Cameron, and North Wollo [ 8 , 14 , 22 ]. This is due to children with oral lesions have difficulty of swallowing, which reduces the amount of food intake that leads to nutritional imbalance less than body requirement.…”

Effects of Undernutrition and Predictors on the Survival Status of HIV-Positive Children after Started Antiretroviral Therapy (ART) in Northwest Ethiopia

“…In 2018, an estimated 1.7 million children (aged <15 years) were living with HIV worldwide [ 13 , 14 ]. In the same year, in Ethiopia, 44229 children were diagnosed with HIV and 2055 died related to AIDS [ 9 , 15 ]. Undernutrition in all its forms remains a global public health burden that accounts for 45% of all deaths for people living with HIV [ 2 , 16 ].…”

“…Several studies investigated whether lower CD4 cell count, age, wealth index, adherence, food insecurity, and social support were risk factors for malnourished HIV-positive children's mortality [ 1 , 2 , 15 , 26 – 28 ]. Ethiopia is one of the countries hardest hit by the HIV epidemic as well as malnutrition [ 1 ]; the prevalence of undernutrition among HIV/AIDS children ranges from 12.3 to 46.8% [ 19 , 29 ] and is blamed for 57% of deaths [ 6 , 13 ].…”

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

“…Severe acute malnutrition (SAM), is the most extreme and visible form of undernutrition characterized, in children aged <60 mo, by extreme wasting and weight-for-height zscore (WHZ) below -3 SDs of the median WHO growth standards (14). SAM is common in HIV-infected children (15)(16)(17). Given the additional challenges facing HIV-infected infants and older children, such as opportunistic infections, growth faltering, and nutritional deficiencies, it is essential to review new information on the optimal feeding regimens for HIV-infected children with SAM.…”