Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study

Abstract

BackgroundThe burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa.MethodsA cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2–19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d’Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition.ResultsOverall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7–13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6–12 %), 26 % (95% CI: 23–28 %), and 7 % (95% CI: 5–10 %), respectively. Among those malnourished, more than half of children didn’t receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5 years); and mixed malnutrition with male gender, age (<5 years), severe immunodeficiency and recent ART initiation (<6 months). Orphanhood and Cotrimoxazole prophylaxis were not associated with any type of malnutrition.ConclusionsThe prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes. Anthropometric measurements and appropriate nutritional care of malnourished HIV-infected children remain insufficient and a priority to improve health care of HIV-infected children in Africa.

Inequality in outcomes for adolescents living with perinatally acquired HIV in sub‐Saharan Africa: a Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Cohort Collaboration analysis

“…In male APH a smaller improvement in height growth was observed after starting ART than in female APH. This is consistent with previous studies in HIV‐infected as well as HIV‐uninfected children that have observed greater impairments in length growth in male than female children . In this cohort of adolescents with median follow‐up to 12 years of age, the timing of the pubertal growth spurt may account for some of this difference.…”

Nutritional, clinical and immunological status of children at HIV diagnosis in the continental region of Equatorial Guinea

“…It found a high prevalence of malnutrition, with 65.7% of children exhibiting some category of malnutrition, and a predominance of chronic malnutrition (58% of malnourished cases). This predominance corroborates the results of previous studies . The proportion of malnutrition at the time of HIV diagnosis in this population is similar to that documented for children from other sub‐Saharan countries , where 50–55% were reported as underweight, 33‐70% as stunted and 16–36% as wasted.…”

“…This predominance corroborates the results of previous studies . The proportion of malnutrition at the time of HIV diagnosis in this population is similar to that documented for children from other sub‐Saharan countries , where 50–55% were reported as underweight, 33‐70% as stunted and 16–36% as wasted. In Mali, children under 15 years of age showed 23% acute malnutrition, 23% chronic and 12% mixed at the time of HIV diagnosis.…”

Incidence of Postsuppression Virologic Rebound in Perinatally HIV-Infected Asian Adolescents on Stable Combination Antiretroviral Therapy

“…Wasting has been a significant complication of HIV infection since early in the epidemic [25,26], and remains an important clinical problem, particularly among children and adolescents living in Asian and African countries [27,28]. Although there are no studies demonstrating the adverse consequences of wasting on VR, it is well-documented that low weight-for-age has been significantly correlated with clinical and immunologic failure in children and adolescents [27,29].…”