Growth, Morbidity, and Mortality in a Cohort of Institutionalized HIV-1-Infected African Children.

Nathan, Lisa M. MD; Nerlander, Lina M. BSc; Dixon, Jedediah R. MD; Ripley, Ruth M. PhD; Barnabas, Ruanne MD; Wholeben, Brent E. PhD; Musoke, Rachel MD; Palakudy, Tresa RN; D'Agostino, Angelo MD; Chakraborty, Rana PhD
JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2003
Epidemiology and Social Science: PDF Only

Objective: As a result of the HIV epidemic in Africa, much debate exists on whether institutionalized compared with community-based care provides optimum management of infected children. Previous reports calculated 89% mortality by age 3 years among outpatients in Malawi. No similar data are available for infected children in institutionalized care. We characterized patterns of morbidity and mortality among HlV-1-infected children residing at an orphanage in Nairobi.

Methods: Medical records for 174 children followed over 5 years were reviewed. Mortality was analyzed by Kaplan-Meier methods with adjustment to account for survival in the community before admission. Anthropometric indices were calculated to include mean z scores for weight for length and length for age. Low indices reflected wasting and stunting. Opportunistic infections were documented.

Results: Of 174 children, 64 had died. Survival was 70% at age 3 years. Morbidity included recurrent respiratory tract infections, gastroenteritis, parotitis, and lymphoid interstitial pneumonitis. No new cases of tuberculosis disease were noted after admission. Mean z scores for length for age suggested overall stunting (z = -1.65). Wasting was not observed (z = -0.39).

Conclusion: The optimal form of care for HIV-infected children in resource-poor settings may be the development of similar homes. Absence of tuberculosis disease in long-standing residents may have contributed to improved survival. Stunting in the absence of wasting implied that growth was compromised by opportunistic infections and other cofactors.

(C) 2003 Lippincott Williams & Wilkins, Inc.