Reasons for hospitalization in HIV‐infected children in West Africa

Abstract

IntroductionCurrent knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration).MethodsWe performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions.ResultsFrom April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1–8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7–23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%).ConclusionsOverall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.

Predictors of hospitalization among children on ART in Ethiopia: A cohort study

“…This finding is a bit late than the one reported in West Africa where the HAART initiation age was 3 years (15). While HIV in children is known for its fast progression, the mortality is quiet high and if not treated timely.This study finding indicates that there has been delay in diagnosing and initiating HAART.…”

“…Furthermore, this study also revealed pneumonia to be the single predicator of hospitalizations among OIs. Other studies also showed that pneumonia to be the leading cause of hospitalizations (5, 15). …”

“…The median time of ART among those hospitalized in West Africa was 9.8 months (15). The first 6 months of treatment is characterized by high mortality of hospitalization until the patient gets stabilized (5).…”

“…This indicated that children were initiated late after they developed OIs and soon after treatment initiation got hospitalized either due to the OIs or IRIS. Care interventions aiming at identifying the earliest possible HIV-infected infants and treating them according to current guidelines would drastically reduce cost of HIV care including costs related to hospitalization (15). Studies in Thailand and South Africa have shown that early ART initiation incur lower in patient care costs (21, 22).…”

Clinical and Immunological Characteristics in HIV-Infected Patients at the Treatment Initiation at the University Hospital of Parakou (Benin)

“…Koné [10] reported that 64.50% of the patients were at stage III and 15.70% at stage IV. Dicko [11] reported similar results with 64% at stage IV and 27% at the stage III. In Cameroun the stage IV represented 55.5% of Mahy's range patients [12] whereas Zoungrana [13] in Burkina Faso reported that the patients at the stages III and IV represented 61%.…”