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Wudu MA, Belete MA, Yosef ST, Gelmo AT, Ali YS, Birhanu TA. Incidence and predictors of common opportunistic infections among children less than 15 years of age on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2025; 25:519. [PMID: 40221651 PMCID: PMC11993947 DOI: 10.1186/s12879-025-10945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Accepted: 04/08/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND Despite significant efforts to enhance access to antiretroviral therapy (ART), opportunistic infections among children on ART remain a major concern in low-income countries, including Ethiopia. Currently, there are no pooled estimates of opportunistic infections incidence among children on ART in Ethiopia. Consequently, this review aimed to determine the pooled incidence and identify the predictors of opportunistic infections among children under 15 years of age on ART, addressing the existing information gap. METHODS This systematic review followed the PRISMA guidelines, and relevant studies were obtained from the PubMed, CINAHL, Scopus, EMBASE, and Google Scholar databases. Data analysis for pooled estimates of incidence and predictors of opportunistic infections was conducted via STATA 17 software with random-effects model. Heterogeneity was evaluated via Cochrane's Q-test and the I2 statistic, and publication bias was assessed through funnel plots and Egger's test. RESULTS Of the 5,631 studies identified, 20 studies involving 9,196 participants were included in the meta-analysis. The pooled incidence of opportunistic infections among children under 15 years of age on antiretroviral therapy was 5.61 per 100 person-years (95% CI: 4.37-6.86), based on 36,716.4 person-years of observation. Predictors of opportunistic infections included advanced WHO clinical stage (HR 1.45, 95% CI: 1.35-1.55), poor ART adherence (HR 1.49, 95% CI: 1.35-1.63), lack of isoniazid (HR 1.56, 95% CI: 1.40-1.74) and cotrimoxazole preventive therapy (HR 1.56, 95% CI: 1.38-1.66), malnutrition (HR 1.50, 95% CI: 1.34-1.67), and severe immunosuppression (HR 1.39, 95% CI: 1.27-1.51). CONCLUSION The incidence of opportunistic infections in this review was high, highlighting the need for intensified efforts to achieve the 2030 target. Moreover, advanced WHO clinical stage, poor adherence, lack of isoniazid and cotrimoxazole preventive therapy, malnutrition, and severe immunosuppression were identified as predictors of opportunistic infections. This suggests that early initiation of ART, regular nutritional assessments, intensive follow-up and monitoring, and a multidisciplinary approach need be prioritized to address the identified predictors.
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Affiliation(s)
- Muluken Amare Wudu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia.
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia
| | - Selamyhun Tadesse Yosef
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Woldiya University, Woldiya, Ethiopia
| | - Aragaw Tesfaye Gelmo
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Woldiya University, Woldiya, Ethiopia
| | - Yimer Seid Ali
- CDC Project, Amhara Regional State Health Bureau, Zonal HIV Program Coordinator, Dessie, Ethiopia
| | - Tarikua Afework Birhanu
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, 1145, Dessie, Ethiopia
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Li H, Yuan S, Liao M, Tan S, Zheng J, Wan L, Tu Y, Yang M, Gao J. Effects of HIV exposure on anemia and vitamin D nutritional status in children aged 6-24 months: a hospital-based cross-sectional study. Sci Rep 2025; 15:2839. [PMID: 39843726 PMCID: PMC11754912 DOI: 10.1038/s41598-025-87101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/16/2025] [Indexed: 01/24/2025] Open
Abstract
There is little research on anemia and vitamin D deficiency in HIV-exposed uninfected (HEU) children. This study was aimed to describe and compare the prevalence of anemia and vitamin D inadequacy in HEU children and HIV-unexposed uninfected (HUU) children, and to examine the associations of HIV exposure with anemia and vitamin D inadequacy. This was a hospital-based descriptive cross-sectional study nested within the Prevention of Mother-to-Child Transmission (PMTCT) of HIV program in Hunan Province during July and September 2022. The HEU children aged 6 to 24 months were recruited from the PMTCT outpatient clinics located in five Municipal Maternal and Child Health Care Hospitals. The HUU children were recruited from routine child health examination clinics in the same five Hospitals. Questionnaires about children's characteristics and maternal gestational conditions were collected from children's caregivers, and blood samples were collected from all children. Descriptive statistics, Chi-square test, non-parametric rank sum test, and logistic regression were used for analysis. The study population included 336 HEU children and 334 HUU children. The overall prevalence of anemia in the HEU and HUU children was 10.4% and 8.1%, respectively. The median hemoglobin concentrations were 120 (115-126) g/L in the HEU children and 122 (116-129) g/L in the HUU children. Neither prevalence of anemia nor hemoglobin concentration was significantly different between the two groups (P > 0.05). The prevalence of vitamin D inadequacy in the HEU children (19.6% for deficiency and 25.0% for insufficiency) was significantly higher than that of the HUU children (11.4% for deficiency and 16.2% for insufficiency) (P < 0.001). The median 25(OH)D concentration in the HEU children was significantly lower than that of the HUU children (23.80 (13.50-34.08) vs. 32.08 (18.60-39.32) ng/ml) (P < 0.001). HIV exposure in HEU children was significantly associated with an increased risk of vitamin D deficiency (adjusted OR (AOR) 1.72, 95% CI: 1.13-2.61) and vitamin D insufficiency (AOR 1.53, 95% CI: 1.01-2.34), but not with anemia (AOR 0.80, 95% CI: 0.32-2.01). The PMTCT program shall strengthen vitamin D supplementation in HEU children and caregivers shall appropriately extend the outdoor activity time of HEU children to reduce the occurrence of vitamin D inadequacy.
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Affiliation(s)
- Huixia Li
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China.
| | - Shan Yuan
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
| | - Minghui Liao
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
| | - Sanfeng Tan
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
| | - Jianfei Zheng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lijia Wan
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
| | - Ying Tu
- Department of Maternal and Children Health, Xiangya School of Public Health, Central South University, Changsha, 410008, Hunan, China
| | - Min Yang
- Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
| | - Jie Gao
- Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
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Moges S, Lajore BA, Oleba AF, Godebo AS, Funga ML. The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. J Epidemiol Glob Health 2024; 14:1453-1463. [PMID: 39541033 PMCID: PMC11652469 DOI: 10.1007/s44197-024-00321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates have remained unacceptably high. Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia. However, the pooled effect of malnutrition and anemia on HIV-related death related to children receiving ART was not investigated in sub-Saharan Africa. METHODS We searched multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, and Web of Science) for observational studies published between January 1, 2010, and April 24, 2024 that reported the risk factors or effects of undernutrition and, anemia on HIV-related mortality among children. Study selection, data extraction, and quality evaluation were carried out separately by two reviewers. A meta-analysis was conducted using random effect models. RESULTS The review included 27 studies with a combined total of 61,796 study participants. The study findings showed that severe wasting (HR: 2.49; 95% CI: 1.87-3.30), being underweight (HR: 2.11; 95% CI: 1.64-2.72), and Anemia (HR: 2.58; 95% CI: 2.08-3.19) were highly linked to HIV-related death among children. The risk of death due to anemia was greater among children under the age of 5 years than older children. CONCLUSION Undernutrition and anemia in sub-Saharan African children increased the risk of HIV-related death. The impact of malnutrition and anemia among under 5 years old children with HIV/AIDS was more pronounced, suggesting that these conditions at this early age can have more serious consequences for a child's survival. The importance of combining nutrition with HIV treatment programs in sub-Saharan African countries is crucial.
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Affiliation(s)
- Sisay Moges
- Department of Family Health, Hossana College of Science, Hosanna, Ethiopia.
| | | | - Abera Feyisa Oleba
- Department of Clinical Nursing, Hossana College of Science, Hosanna, Ethiopia
| | - Abraham Samuel Godebo
- Department of Emergency and Critical Care, Hossana College of Science, Hosanna, Ethiopia
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Alemu GG, Tesfie TK, Yayeh AT, Woleli DA, Aweke MN. Incidence of anaemia and its predictors among HIV-infected children receiving highly active antiretroviral treatment in North-West Ethiopia: a multicentre retrospective follow-up study. BMJ Open 2024; 14:e083939. [PMID: 39266318 PMCID: PMC11407197 DOI: 10.1136/bmjopen-2024-083939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/13/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Anaemia is one of the most common problems in HIV-infected patients associated with increased HIV progression, decreased functional capacity, survival and quality of life. For better interventions, up-to-date information concerning anaemia among HIV-infected children less than 5 years of age on antiretroviral therapy (ART) is vital. Thus, this study aims to determine the predictors of anaemia among HIV-infected children less than 5 years of age receiving ART in North-West Ethiopia. DESIGN An institution-based retrospective follow-up study was conducted. STUDY SETTING Amhara region Comprehensive Specialized Hospitals, North-West Ethiopia. PARTICIPANTS In total, we examined 460 HIV-infected children less than 5 years of age who had followed highly active antiretroviral treatment from 2010 to 2020. OUTCOME MEASURES The outcome measures were median time to detection of anaemia, the incidence and the effects of cotrimoxazole preventive therapy (CPT), ART adherence, tuberculosis (TB), WHO clinical stage and wasting on anaemia. RESULTS The overall follow-up time was 9234 person-months of observation. The incidence density of anaemia was 8.34 per 1000 person-months of observation (95% CI 6.67 to 10.43). The cumulative survival probability of children after the last months of follow-up was 0.54. The independent predictors of anaemia were not receiving CPT (adjusted HR (AHR)=4.44; 95% CI 2.48 to 7.93), poor adherence to ART (AHR=2.46; 95% CI 1.37 to 4.42), TB (AHR=3.40; 95% CI 1.72 to 6.72), severe WHO clinical stage (AHR=3.03; 95% CI 1.40 to 6.58) and severe wasting (AHR=1.98; 95% CI 1.08 to 3.64). CONCLUSION AND RECOMMENDATION The incidence rate of anaemia was high and it was provoked by predictors like CPT, ART adherence, TB, WHO clinical stage and wasting. Therefore, it is necessary to emphasise for these predictors.
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Affiliation(s)
- Gebrie Getu Alemu
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Tadele Yayeh
- Department of Medical Nursing, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Dessalew Abelneh Woleli
- Department of Internal Medicine, Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia
| | - Mekuriaw Nibret Aweke
- Department of Human Nutrition, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Wang XM, Wang QY, Huang J. Anemia status of infants and young children aged six to thirty-six months in Ma'anshan City: A retrospective study. World J Clin Cases 2023; 11:6744-6753. [PMID: 37901006 PMCID: PMC10600847 DOI: 10.12998/wjcc.v11.i28.6744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Anemia in infants and young children can have long-term effects on cognitive and physical development. In Ma'anshan City, China, there has been growing concern about the prevalence of anemia among children aged 6 to 36 mo. Understanding the factors influencing this condition is crucial for targeted interventions and improving overall child health in the region. AIM To analyze the anemia status and influencing factors of infants and young children aged 6 to 36 mo in Ma'anshan City, China. Providing scientific evidence for reducing the incidence of anemia and improving the health level of children in this age group. METHODS The study encompassed 37698 infants and young children, aged from 6 to 36 mo, who underwent health examinations at the Ma'anshan Maternal and Child Health Hospital from January 2018 to October 2022 were included in the study. Basic information, physical examination, and hemoglobin detection data were collected. Descriptive analysis was used to analyze the prevalence of anemia in children in the region, and univariate analysis was used to analyze the influencing factors of anemia. RESULTS The mean hemoglobin level of infants and young children aged 9 to 36 mo increased with age, and the anemia detection rate decreased with age. The anemia detection rate in rural infants aged 6, 9, and 12 mo was higher than that in urban infants. Although the anemia detection rate was higher in 6-mo-old boys than girls, it was higher in 24-mo-old girls than boys. There were statistically significant differences in the anemia detection rates among 9-mo-old and 12-mo-old infants with different nutritional statuses (emaciation, overweight, obese, and normal). Moreover, there were no statistically significant differences in anemia detection rates among infants and young children with different nutritional statuses at other ages. Besides, the anemia detection rates in obese infants aged 9 and 12 mo were higher than those in normal and overweight infants, with statistically significant differences. Finally, there were no statistically significant differences in the anemia detection rates between emaciation infants and those with other nutritional statuses. CONCLUSION The anemia situation among infants and young children aged 6 to 36 mo in Ma'anshan City, China, is relatively prominent and influenced by various factors. Our result shown that attention should be paid to the anemic infant and young child population, with strengthened education and targeted prevention and dietary guidance to help them establish good living habits, improve nutritional status, and reduce the occurrence of anemia to improve children's health levels.
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Affiliation(s)
- Xue-Mei Wang
- Department of Pediatric, Ma’anshan Maternal and Child Health Center, Ma’anshan 243011, Anhui Province, China
| | - Qiong-Yao Wang
- Department of Pediatric, Ma’anshan Maternal and Child Health Center, Ma’anshan 243011, Anhui Province, China
| | - Jie Huang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
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Tiruneh MG, Kebede Bizuneh F. Determinates of anemia among Human Immune Deficiency Virus positive children on Anti-retro Viral Therapy in selected health facilities, Northwest Ethiopia: A Case-Control Study. J Nutr Sci 2023; 12:e95. [PMID: 37706072 PMCID: PMC10495818 DOI: 10.1017/jns.2023.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/09/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
Even though antiretroviral therapy (ART) access for human immunodeficiency virus (HIV)-infected children increased dramatically, anaemia has continued as a challenge regardless of a cluster of differentiation (CD4) count and viral load. Hence, the present study aimed to assess the determinants of iron deficiency anaemia among children living with HIV after the initiation of ART. An institution-based unmatched case-control study was conducted among consecutively selected 712 children on HIV care from 1 September to 30 October 2022 in the Metekel zone. A pre-tested and structured data extraction checklist was used to collect the data. Data were analysed using STATA version 16 software. Binary logistic regression was used to find the association between independent variables and anaemia. The level of statistical significance was declared at a value of P < 0⋅05. A total of 712 HIV-positive children (178 cases and 534 controls) were included in this study, with a completeness rate of 98⋅8 %. In multivariable analysis, variables that have a statistically significant association with anaemia were as follows: CD4 count <350 (Adjusted Odds Ratio [AOR] 2⋅76; 95 % CI 1⋅76, 4⋅34), World Health Organization (WHO) clinical stage III (AOR 7⋅9; 95 % CI 3⋅5, 17⋅91) and stage IV (AOR 7⋅8; 95 % CI 3⋅37, 18⋅1), cotrimoxazole prophylaxis therapy (AOR 0⋅5; 95 % CI 0⋅31, 0⋅8) and mid-upper arm circumference (MUAC) ≤11⋅5 mm (AOR 2⋅1; 95 % CI 1⋅34, 3⋅28). The present study found that CD4 count, WHO clinical stage, cotrimoxazole prophylaxis therapy and MUAC were significantly associated with anaemia in children on ART. Therefore, continuous screening of anaemia and nutritional treatment is essential in these patients.
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Affiliation(s)
- Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Fassikaw Kebede Bizuneh
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Maulide Cane R, Keita Y, Lambo L, Pambo E, Gonçalves MP, Varandas L, Craveiro I. Prevalence and factors related to anaemia in children aged 6-59 months attending a quaternary health facility in Maputo, Mozambique. Glob Public Health 2023; 18:2278876. [PMID: 37932958 DOI: 10.1080/17441692.2023.2278876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
Globally, anaemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by this condition. We carried out this study to estimate anaemia prevalence and evaluate structural determinants and haematological parameters association among children aged 6-59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. We collected data from 637 inpatients or outpatients who attended pediatric consultations at the Maputo Central Hospital. The overall rate of anaemia in children aged 6-59 months was 62.2% (396/637), with 30.9% moderate anaemia (197/637), 23.9% mild anaemia (152/637), and 7.4% severe anaemia (47/637). Among our study participants, critical factors for anaemia were those concerning the age group, child´s caregiver schooling, malaria and size of the liver.
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Affiliation(s)
- Réka Maulide Cane
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
- Unidade de Ensino e Investigação de Saúde Pública Global, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Youssouf Keita
- Public Health Independent Consultant, Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ)/C4N-NIPN/ Clinton Health Access Initiative, Bamako, Mali
| | - Luisa Lambo
- Hospital Central de Maputo, Ministério da Saúde, Maputo, Mozambique
| | - Elcidio Pambo
- Hospital Central de Maputo, Ministério da Saúde, Maputo, Mozambique
| | | | - Luís Varandas
- Unidade de Ensino e Investigação de Clínica das Doenças Tropicais, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Unidade de Ensino e Investigação de Saúde Pública Global, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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Lubega J, Grimes A, Airewele G, Bulsara S, Kim TO, Haq H, Peckham-Gregory E, Wanless SR, Elyanu P, Musoke P, Lumumba M, Kekitiinwa A, Matshaba M, Despotovic J, Scheurer M. Risk factors and prognostic significance of anemia in children with HIV infection on antiretroviral therapy. AIDS 2022; 36:2139-2146. [PMID: 36052537 PMCID: PMC9671853 DOI: 10.1097/qad.0000000000003374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To establish the incidence, risk factors and prognostic effect of anemia in children living with HIV (CLWH). DESIGN Retrospective nested case-control study of patients 0-18 years in five centers in sub-Saharan Africa, 2004-2014. METHODS Incident cases of anemia were identified from electronic records and matched with CLWH without anemia. We calculated the incidence density of anemia and used conditional logistic regression to evaluate its association with risk factors, stratified by severity and type of anemia. We used a Cox proportional hazards model to evaluate the impact of anemia on survival. RESULTS Two thousand, one hundred and thirty-seven children were sampled. The incidence density of anemia was 1 per 6.6 CLWH-years. Anemia was moderate in 31.8% and severe in 17.3% of anemia cases, which had 10-year mortality hazards of 3.4 and 4.5, respectively. Microcytic anemia (36% cases) was associated with 2.3-fold hazard of 10-year mortality, and with malnutrition and CD4 + suppression. Normocytic anemia (50.5% cases) was associated with 2.6-fold hazards of 10-year mortality, and with more severe malnutrition, CD4 + suppression, and WHO stage, but inversely associated with lamivudine and nevirapine therapy. Macrocytic anemia (13.5% cases) was neither associated with higher 10-year mortality nor with severe malnutrition or CD4 + suppression but was associated with WHO stage II/III and negatively associated with lamivudine therapy. CONCLUSION This large multicountry study of CLWH found a high incidence density of anemia. Higher severity, normocytic and microcytic types of anemia were independently associated with long-term mortality. Laboratory studies are needed to decipher the mechanisms of anemia and how it impacts mortality in CLWH.
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Kebede SS, Yalew A, Yesuf T, Melku M, Bambo GM, Woldu B. The magnitude and associated factors of immune hemolytic anemia among human immuno deficiency virus infected adults attending University of Gondar comprehensive specialized hospital north west Ethiopia 2021 GC, cross sectional study design. PLoS One 2022; 17:e0274464. [PMID: 36201533 PMCID: PMC9536541 DOI: 10.1371/journal.pone.0274464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Immune hemolytic anemia commonly affects human immune deficiency infected individuals. Among anemic HIV patients in Africa, the burden of IHA due to autoantibody was ranged from 2.34 to 3.06 due to drug was 43.4%. IHA due to autoimmune is potentially a fatal complication of HIV which accompanies the greatest percent from acquired hemolytic anemia. OBJECTIVE The main aim of this study was to determine the magnitude and associated factors of immune hemolytic anemia among human immuno deficiency virus infected adults at university of Gondar comprehensive specialized hospital north west Ethiopia from March to April 2021. METHODS An institution-based cross-sectional study was conducted on 358 human immunodeficiency virus-infected adults selected by systematic random sampling at the University of Gondar comprehensive specialized hospital from March to April 2021. Data for socio-demography, dietary and clinical data were collected by structured pretested questionnaire. Five ml of venous blood was drawn from each participant and analyzed by Unicel DHX 800 hematology analyzer, blood film examination and antihuman globulin test were performed to diagnosis of immune hemolytic anemia. Data was entered into Epidata version 4.6 and analyzed by STATA version 14. Descriptive statistics were computed and firth penalized logistic regression was used to identify predictors. P value less than 0.005 interpreted as significant. RESULT The overall prevalence of immune hemolytic anemia was 2.8% (10 of 358 participants). Of these 5 were males and 7 were in the 31 to 50 year age group. Among individuals with immune hemolytic anemia, 40% mild and 60% moderate anemia. The factors that showed association were family history of anemia (AOR 8.30 at 95% CI 1.56, 44.12), not eating meat (AOR 7.39 at 95% CI 1.25, 45.0), and high viral load 6.94 at 95% CI (1.13, 42.6). CONCLUSION AND RECOMMENDATION Immune hemolytic anemia is less frequent condition in human immunodeficiency virus infected adults, and moderate anemia was common in this population. The prevalence was increased with a high viral load, a family history of anemia, and not eating meat. In these patients, early detection and treatment of immune hemolytic anemia is necessary.
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Affiliation(s)
- Samuel Sahile Kebede
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mizan Tepi University, Tepi, Ethiopia
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar Ethiopia
- * E-mail:
| | - Aregaw Yalew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar Ethiopia
| | - Tesfaye Yesuf
- Department of Internal Medicine School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mullugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar Ethiopia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Getachew Mesfin Bambo
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mizan Tepi University, Tepi, Ethiopia
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar Ethiopia
| | - Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar Ethiopia
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Belay AS, Genie YD, Kebede BF, Kassie A, Molla A. Time to detection of anaemia and its predictors among women of reproductive-age living with HIV/AIDS initiating ART at public hospitals, Southwest Ethiopia: a multicentre retrospective follow-up study. BMJ Open 2022; 12:e059934. [PMID: 35450914 PMCID: PMC9024268 DOI: 10.1136/bmjopen-2021-059934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the time to development of anaemia and its predictors among women of reproductive-age receiving antiretroviral therapy (ART) in public hospitals, Southwest Ethiopia. DESIGN Hospital-based retrospective follow-up study SETTING: Mizan-Tepi University Teaching Hospital, and Gebretsadik Shawo General Hospital Southwest Ethiopia. PARTICIPANTS A total of 389 records of women living with HIV/AIDS at public hospitals were reviewed using a systematic sampling method. The data were entered using Epi-Data Manager V.4.2 and exported to STATA V.14 for data analysis. A Cox-regression model was used and variables with a p-value of <0.05% and 95% confidence level in multivariable analysis were declared as statistically significant predictors for anaemia. PRIMARY OUTCOME Time to development of anaemia and its predictors among women of reproductive-age on ART in public hospitals. RESULTS Of 370 records of women of reproductive-age, 203 (54.86%, 95% CI (49.77% to 59.96%)) were anaemic with an incidence rate of 12.07 per 100 person months of observation, and the overall median survival time of 60 months. The total of 2.97%, and 80.26% of women were developed anaemia within the first 6 months and the last 6 months period of follow-up, respectively. Moreover, non-employed women, women with advanced WHO stage, women with baseline opportunistic infections and women who were on ART for long-duration were significantly associated with anaemia among women living with HIV/AIDS. CONCLUSION In this study, the incidence rate of anaemia was significantly high. The development of anaemia among women on ART was also increased with increased follow-up time. The risk of anaemia is increased in women living with HIV/AIDS due to advanced baseline WHO staging, presence of OIs at baseline, an increased duration on ART and low occupational status. Therefore, early identification and treatment of opportunistic infections and other coinfections are required to decrease the incidence of anaemia among women living with HIV/AIDS.
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Affiliation(s)
- Alemayehu Sayih Belay
- Maternal and Reproductive Health Unit, Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Yalemtsehay Dagnaw Genie
- Child Health Unit, Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Belete Fenta Kebede
- Department of midwifery, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Aychew Kassie
- Maternal and Reproductive Health Unit, Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Abebaw Molla
- Department of Nutrition, School of public health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
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Pelkonen T, Roine I, Kallio M, Jahnukainen K, Peltola H. Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola. BMJ Open 2022; 12:e057285. [PMID: 35288394 PMCID: PMC8921951 DOI: 10.1136/bmjopen-2021-057285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM). DESIGN Secondary analysis of descriptive data from five randomised BM treatment trials. SETTING Hospitals in Finland, Latin America and Angola. PARTICIPANTS Consecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission. OUTCOME MEASURES Prevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death. RESULTS The median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <-3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07. CONCLUSION Anaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents. TRIAL REGISTRATION NUMBER The registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838.
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Affiliation(s)
- Tuula Pelkonen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki, Finland
- Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | - Markku Kallio
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kirsi Jahnukainen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki, Finland
| | - Heikki Peltola
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010751. [PMID: 34682492 PMCID: PMC8535610 DOI: 10.3390/ijerph182010751] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/31/2022]
Abstract
In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.
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Community-acquired bacteremia among HIV-infected and HIV-exposed uninfected children hospitalized with fever in Mozambique. Int J Infect Dis 2021; 109:99-107. [PMID: 34174435 PMCID: PMC8437032 DOI: 10.1016/j.ijid.2021.06.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Bacteremia is a major cause of morbidity and mortality worldwide. Children infected with HIV present with patterns of bacteremia generally associated with poor prognosis. In Mozambique, data on bacteremia are sparce. Methods: We conducted an observational study of HIV-infected and HIV-exposed uninfected children, aged 0–59 months, hospitalized with fever between April 1, 2016 and February 28, 2019. A single bacterial culture was collected at admission. Descriptive statistics were used to summarize microorganisms detected and antibiotic susceptibility testing. Results: A total of 808 HIV-infected (90%) and HIV-exposed uninfected (10%) children were enrolled. Blood culture positivity was 12% (95% CI: 9.9%–14.4%). Five organisms accounted for most cases: Staphylococcus Aureus (37%), Klebsiella spp (11%), Salmonella spp (11%), Escherichia Coli (9%) and Micrococcus (7%). Antibiotic resistance was common. Nearly 70% of Staphylococcus Aureus were methicillin-resistant and roughly 50% of Klebsiella had ESBL production. Conclusion: Community-acquired bacteremia was common in HIV-infected and HIV-exposed uninfected children hospitalized in Mozambique with a febrile illness. High rates of MRSA and ESBL producing organisms has implications for empiric antibiotics utilized in Mozambique. Longitudinal data on the prevalence and antimicrobial resistance patterns of important pathogens are badly needed to guide policy for drug formulary expansion and antibiotic prescription guidelines.
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Chanie ES, Feleke DG, Asnakew S, GebreEyesus FA, Tesfaw A, Bayih WA, Tigabu A, Anyalem YA, Amare AT, Belay DM, Dagnaw FT, Abate BB. Time to detection of anemia and its predictors among children living with HIV at Debre Tabor and University of Gondar Compressive Specialized Hospitals, 2020: a multicentre retrospective follow-up study. BMC Pediatr 2021; 21:151. [PMID: 33785009 PMCID: PMC8008653 DOI: 10.1186/s12887-021-02616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though antiretroviral therapy access for HIV infected children increased dramatically, anemia have been continued as a challenge regardless of a cluster of differentiation (CD4) count and viral load. Hence, this study aimed to assess the time to detection of anemia and its predictors among children living with HIV at Debre Tabor and university of Gondar compressive specialized hospital, 2020. METHODS A retrospective follow-up study was conducted from January 2010 to December 2018. A total of 372 children under the age of 15 who had received ART were included in the study. Data were collected from children's medical charts and ART registration logbook using a standard checklist. Besides, the data were entered into Epi data 4.2.2 and then exported to Stata 14.0 for further analysis. The Cox regression model, the variables having P-value ≤.05 with 95% CIs in multivariable analysis were declared as statistically significant for anemia. RESULT The mean (±SD) of follow-up periods were 56.6 ± 1.7 SD months. The overall median survival time free from anemia was 137 months, and the incidence rate of anemia was 6.9 per 100 PYO (95% CI: 5.3, 7.8). Moreover, WHO clinical staging of III/IV [AHR: 4.2, 95% CI: 1.80, 11.1], low CD4 count below threshold [AHR: 1.9, 95% CI: 1.09, 3.37], cotrimoxazole preventive therapy non-users, and poor level of adherence [(AHR: 2.4, 95% CI: 1.20, 4.85] were the main predictors of the time to detection of anemia. CONCLUSION The incidence rate of anemia in our retrospective cohort was high. The risk of anemia is present in children living with HIV infection but the risk for anemia is increased based on (WHO clinical staging III and IV, CD4 count below the threshold level, CPT non-users, and poor level of adherence). Since many of these risk factors are present routinely, even within one single patient, our clinical monitoring for anemia quarterly was fully justified as was our routine switch from standard therapies such as AZT to another regimen upon lab confirmation of anemia. Additional methods to improve cotrimoxazole preventative therapy and level of adherence are also needed.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Dejen Getanh Feleke
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, school of medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Aragaw Tesfaw
- Department of Public health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Agimasie Tigabu
- Department of Adult health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yared Asmare Anyalem
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome Dagnaw
- Department of Public health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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