BMC Public Health (Aug 2020)

Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study

  • Animut Alebel,
  • Eshetu Haileselassie Engeda,
  • Mengistu Mekonnen Kelkay,
  • Pammla Petrucka,
  • Getiye Dejenu Kibret,
  • Fasil Wagnew,
  • Getnet Asmare,
  • Zebenay Workneh Bitew,
  • Daniel Bekele Ketema,
  • Getnet Gedif,
  • Belisty Temesgen,
  • Yitbarek Tenaw Hibstie,
  • Mamaru Wubale Melkamu,
  • Setegn Eshetie

DOI
https://doi.org/10.1186/s12889-020-09418-6
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 11

Abstract

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Abstract Background Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region. Methods A multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results The cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5, 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality. Conclusion A higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIV-positive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality.

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