The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi

Abstract

A study was undertaken in a central nutritional rehabilitation unit in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. HIV seroprevalence in 250 severely malnourished children over 1 year of age was 34.4% and overall mortality was 28%. HIV infection was associated significantly more frequently with marasmus (62.2%) than with kwashiorkor (21.7%) (p < 0.0001). Breastfed children presenting with severe malnutrition were significantly more likely to be HIV-seropositive (p < 0.001). Clinical and radiological features were generally not helpful in distinguishing HIV-seropositive from HIV-seronegative children. The case fatality rate was significantly higher for HIV-seropositive children (RR 1.6 [95% CI 1.14-2.24]). The increasing difficulties of managing the growing impact of HIV infection on severely malnourished children in Malawi are discussed in the context of reduced support for nutritional rehabilitation units.

Reduction of unnecessary transfusion and intravenous fluids in severely malnourished children is not enough to reduce mortality

“…[20][21][22][23][24] In Malawi, HIV-1 infection is a major contributor to mortality in severely malnourished children. 25 In this study, the proportion of severely malnourished, HIV-1-infected children and their mortality rate were similar to reports from elsewhere in the region. 21,[25][26][27] The increase in children admitted with HIV infection probably reflects improved care in the community, including better accessibility to admission.…”

Features associated with underlying HIV infection in severe acute childhood malnutrition: a cross sectional study

“…The majority (54%) of children with HIV in this study presented with oedema, consistent with reports of oedema in 67% and 71% from Malawi (6,18) and 50% in Zambia (17), though rates were lower in Burkina Faso and Uganda at 37-43% (13,21,34).…”

“…However we found similar levels in children with SAM, present in 21% in HIV uninfected children and 23% of those with HIV. Others have similarly reported no differences in diarrhoea prevalence in SAM (13,18,21,24).…”

“…Oral candidiasis is more common in HIV (2, 13, 21-24), though not in all studies in malnutrition (18). Chronic suppurative otitis media (CSOM) has been reported as more common in HIV infection, both on pediatric wards (2), and in the NRU (24).…”

“…Nutritional features which may help identify underling HIV in a child with SAM include wasting (marasmus), reported to be 4-6 times more common in HIV infection (3,13,(15)(16)(17)(18)(19)(20), and a weight <60% of the expected median for age (18).…”