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  • Title: HIV infection in malnourished children in Harare, Zimbabwe.
    Author: Ticklay IM, Nathoo KJ, Siziya S, Brady JP.
    Journal: East Afr Med J; 1997 Apr; 74(4):217-20. PubMed ID: 9299820.
    Abstract:
    A descriptive study was undertaken to compare the pattern of socio-demographic features, nutritional profile and presenting features of HIV infected and uninfected children with malnutrition. A total of 140 children aged above 15 months admitted to the paediatric wards, Harare Hospital from December 1993 to February 1994 were studied. Sixty eight (48.6%) children were found to be HIV seropositive and 72 negative. The socio-demographic features were similar in both groups. Marasmus and marasmic kwashiorkor were predominant in the HIV infected children, whilst the majority (64%) of the children in the HIV uninfected group had kwashiorkor (p = 0.001). Pneumonia, lymphadenopathy, chronic discharging ears and oral thrush were significantly more frequent in the HIV infected than in the non HIV infected children (p < 0.01). Factors predictive of HIV infection were marasmus (OR 2.72, 95% CI 1.04-8.10), generalised lymphadenopathy (OR 2.77, 95% CI 1.16-6.64), oral thrush (OR 2.72, 95% CI 1.16-6.37) and discharging ears (OR 6.05, 95% CI 1.89-19.42) with a sensitivity of 57.6% (95% CI 45.7%-69.5%), specificity of 71.4% (95% CI 60.8% 82.0%). The high prevalence of HIV infection among the malnourished children emphasises the impact of the HIV epidemic on childhood nutritional morbidity. The HIV epidemic in Zimbabwe has increased the prevalence of child malnutrition. This descriptive study compared sociodemographic features, the nutritional profile, and clinical features of 140 HIV-positive and HIV-negative children 15 months of age and older with malnutrition admitted to Harare Hospital in 1993-94. 68 children (48.6%) were HIV-infected. There were no significant differences between infected and non-infected children in terms of sociodemographic factors such as area of residence, maternal education, caretaker, and breast feeding status. HIV-infected children were most likely to have marasmus and marasmic kwashiorkor; 64% of children in the HIV-negative group had kwashiorkor. Pneumonia, lymphadenopathy, chronic ear discharge, and oral thrush were significantly more prevalent among HIV-infected children. Four factors were predictive of HIV infection: marasmus (odds ratio (OR), 2.72; 95% confidence interval (CI), 1.04-8.10), generalized lymphadenopathy (OR, 2.77; 95% CI, 1.16-6.64), oral thrush (OR, 2.72; 95% CI, 1.16-6.37), and ear discharge (OR, 6.05; 95% CI, 1.89-19.42). 32 children (22.8%) died during their hospitalization. Mortality was significantly greater among children less than 60% of expected weight (severe malnutrition), but was not significantly related to HIV status.
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