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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.

Jesson J, Masson D, Adonon A, Tran C, Habarugira C, Zio R, Nicimpaye L, Desmonde S, Serurakuba G, Kwayep R, Sare E, Konate T, Nimaga A, Saina P, Kpade A, Bassuka A, Gougouyor G, Leroy V, Growing Up Working Gro - BMC Infect. Dis. (2015)

Bottom Line: 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.The prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes.

View Article: PubMed Central - PubMed

Affiliation: Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. Julie.Jesson@isped.u-bordeaux2.fr.

ABSTRACT

Background: The 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.

Methods: A 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.

Results: Overall, 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.

Conclusions: The 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.

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Selection of the population and prevalence of acute, chronic and mixed malnutrition (95 % Confidence Interval [CI])
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Fig1: Selection of the population and prevalence of acute, chronic and mixed malnutrition (95 % Confidence Interval [CI])

Mentions: Between September and December 2011, 2027 children were seen in the 12 participating centres of the Growing up Programme, representing more than 90 % of the active files. Among them, 1407 (69 %) had a confirmed diagnosis of HIV-infection. Of these children, 22 % were excluded for age criteria and 35 % for missing data. Finally, 1350 HIV-infected children were included in our study (Fig. 1). Their median age was 10 years (interquartile range [IQR] = [7–13]), 49 % were girls, 60 % were orphans for one or both parents, 77 % were on cotrimoxazole prophylaxis and 80 % were on ART for a median duration of 36 months (IQR = [18–61]). Of these children, 22 % had reached WHO clinical stage III or IV of HIV disease and 17 % were severely immunodeficient. Among the 237 children not on ART at the time of the study, 13 % were eligible (stage 3 or 4, or severely immunodeficient). More than 55 % of the included children did not receive any nutritional support at the time of the study or in the past 6 months (Table 1). Among the 45 % of children receiving nutritional support at inclusion, less than 2 % had received RUTF; and solid or semi-solid foods were the most frequently used (>80 %).Fig. 1


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.

Jesson J, Masson D, Adonon A, Tran C, Habarugira C, Zio R, Nicimpaye L, Desmonde S, Serurakuba G, Kwayep R, Sare E, Konate T, Nimaga A, Saina P, Kpade A, Bassuka A, Gougouyor G, Leroy V, Growing Up Working Gro - BMC Infect. Dis. (2015)

Selection of the population and prevalence of acute, chronic and mixed malnutrition (95 % Confidence Interval [CI])
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494161&req=5

Fig1: Selection of the population and prevalence of acute, chronic and mixed malnutrition (95 % Confidence Interval [CI])
Mentions: Between September and December 2011, 2027 children were seen in the 12 participating centres of the Growing up Programme, representing more than 90 % of the active files. Among them, 1407 (69 %) had a confirmed diagnosis of HIV-infection. Of these children, 22 % were excluded for age criteria and 35 % for missing data. Finally, 1350 HIV-infected children were included in our study (Fig. 1). Their median age was 10 years (interquartile range [IQR] = [7–13]), 49 % were girls, 60 % were orphans for one or both parents, 77 % were on cotrimoxazole prophylaxis and 80 % were on ART for a median duration of 36 months (IQR = [18–61]). Of these children, 22 % had reached WHO clinical stage III or IV of HIV disease and 17 % were severely immunodeficient. Among the 237 children not on ART at the time of the study, 13 % were eligible (stage 3 or 4, or severely immunodeficient). More than 55 % of the included children did not receive any nutritional support at the time of the study or in the past 6 months (Table 1). Among the 45 % of children receiving nutritional support at inclusion, less than 2 % had received RUTF; and solid or semi-solid foods were the most frequently used (>80 %).Fig. 1

Bottom Line: 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.The prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes.

View Article: PubMed Central - PubMed

Affiliation: Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. Julie.Jesson@isped.u-bordeaux2.fr.

ABSTRACT

Background: The 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.

Methods: A 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.

Results: Overall, 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.

Conclusions: The 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.

Show MeSH
Related in: MedlinePlus