The impact of HIV‐1 infection on child health in sub‐Saharan Africa: the burden on the health services

Abstract

Summary HIV‐I infection in sub‐Saharan Africa is resulting in substantial child mortality and an increase in the number of sick children presenting to health services. Many of the sick children come to health centres and hospitals, inflating numbers on paediatric wards. The presentations of childhood HIV‐I infection are many and varied so that HIV‐I infection is the new ‘great imitator’ of other conditions. Some other infections are more severe in HIV‐I infected children (specifically bacterial infections and measles). However, there is no clear evidence of consequent rises in the incidence of other childhood infections, though this is likely to be the case for tuberculosis. HIV‐I infected children with other infections often respond to locally available anti‐microbials, but may require longer courses. Treatment is problematic because of the impossibility of distinguishing infected from uninfected children and because of shortages of medicines, which are being intensified further by the child and adult HIV‐I epidemics. Severe HIV disease in adult family members is adding to child morbidity and creating substantial orphanhood. Staff fear nosocomial infection, while simultaneously experiencing falling personal incomes and lacking resources to care for their patients. Substantial numbers of trained staff are being lost because of HIV‐I caused disease and death. The reality of HIV‐I infection through breast‐feeding is not yet appreciated. When this becomes generally apparent, there is a risk that a lethal increase in bottle feeding could occur in some areas. Reduction in the number of new paediatric HIV‐I infections in sub‐Saharan Africa can be achieved only by ameliorating the adult HIV‐I epidemic, reducing unnecessary blood transfusions and ensuring a safe blood supply.

A case study of school support and the psychological, emotional and behavioural consequences of HIV and AIDS on adolescents

“…In a Nigerian study (in Benin), orphans and vulnerable adolescents were more frequently rejected and isolated at school than the control group children (GECA 2005). This finding is also supported by those of Loudon et al (2007); UNESCO & ESART (2009); Ntaote (2011); Grassly and Timaeus (2003); Foster and Williamson (2000) and Walraven et al (1997).…”

“…Findings from the study of Ntaote (2011) also showed that orphaned and vulnerable adolescents are severely affected by the stigma of the disease as they are often teased, bulled and gossiped about by other learners and some of their teachers and also experience discrimination and isolation from the members of their extended families. Other studies also confirm that orphans suffer more vulnerability than non-orphans in terms of education (Foster & Williamson 2000;Grassly & Timaeus 2003;Walraven et al 1997). This has been a serious concern especially in Sub-Saharan Africa, which continues to have the highest percentage of the global HIV and AIDS crisis (as evident in the UNAIDS World Report 2011).…”

Disease environments and subnational patterns of under-five mortality in sub-Saharan Africa

“…Southern Africa is thought to have the highest seroprevalence levels, with over 15% of the adult population in Botswana, Zimbabwe and Zambia being seropositive (Weekly Epidemiological Record, 1997). It is estimated that under-®ve mortality rates in urban centres with severe epidemics (30% seroprevalence in sexually active adults) will rise by as much as three-quarters (Walraven et al, 1996). In East Africa seroprevalence is estimated to be slightly lower, with 10±15% of the adult population seropositive in Uganda and Kenya.…”

HIV/AIDS and associated morbidity and mortality among hospitalised children in Kilifi, Kenya

“…HIV/AIDS in sub-Saharan Africa is resulting in substantial child mortality and an increase in the number of sick children presenting to health services (Walraven et al, 1996). HIV infection causes damage of the cell mediated immunity and subsequent development of various opportunistic infections (Lucas, 2002).…”