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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 1st, 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.

Received for publication November 1, 2002; accepted March 24. 2003.

From School of Medicine, Rush University (Dr Nathan), Chicago, Illinois; Institute of Molecular Medicine, John Radcliffe Hospital (Drs Nerlander, Dixon, Chakraborty), Department of Statistics (Dr Ripley), and Wellcome Epidemiology Unit (Dr Barnabas, Ms Palakudy, Dr D’Agostino), University of Oxford, Oxford. England; Northern Illinois University (Dr Wholeben), DeKalb, Illinois; and Nyumbani Children’s Home (Drs Musoke, Chakraborty), Karen, Nairobi.

R.C. was supported by the MRC (United Kingdom) as a Clinical Training Fellow.

L.M.N. and L.M.N, contributed equally to this work.

Reprints: Rana Chakraborty, Paediatric Infectious Diseases Unit, 5th Floor, Lanesborough Wing, St. George’s Hospital and Medical School. Blackshaw Road, Tooting, London SW17 0QT (e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.