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

Abstract

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.

Survival status and its predictors among undernourished children on antiretroviral therapy in Bahir Dar city, Northwest Ethiopia, 2010 – 2020, a multicenter retrospective cohort study

“…Children presented with hemoglobin level < 10 g/dl had a higher risk of death compared to children presented with hemoglobin level ≥ 10 g/dl. Previous study findings in Ethiopia [ 25 , 29 , 36 , 43 ], Tanzania [ 39 ], and Kenya [ 44 ] had shown that low hemoglobin level was a significant risk of death among children on ART. These could be justified by the fact that when ART is started after a child experiences anemia from HIV infection, the child’s condition may only be partially cured, which could eventually lead to a low quality of life and mortality [ 45 ].…”

Effects of undernutrition on mortality of HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

“…Undernutrition in the form of (wasting, stunting and underweight) is the leading cause of morbidity, low survival and mortality among children infected with HIV particularly in resource-deprived settings [ [11] , [12] , [13] ].In fact, initiation of ART dramatically reduce HIV/AIDS-related morbidity, mortality, and boost survival rate [ [14] , [15] , [16] ]. However, the responses of HIV-infected children for HAART(Highly Active Antiretroviral Therapy) are not similar to adults, because of deleterious impacts of the virus on the immature immunity system, nutritional status and negative consequence on the immunologic response of children living with HIV [ 8 , 17 ].…”