Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya liyu zone, Amhara region, Ethiopia: a retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Bereka Tefera Marie ◽  
Weldemariam Sintayehu Argaw ◽  
Bitewa Yibelu Bazezew
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Stage ◽  
Severe Malnutrition ◽  
Amhara Region ◽  
Time To Death ◽  
Under Five ◽  
Under Five Children ◽  
Risk Of Death ◽  
Cox Proportional Hazard Regression

Abstract Background Human Immunodeficiency Virus (HIV) is infection which mainly attacks immune system of an individual. Its disease progress is rapid in children and if treatment is not initiated nearly half of infected children will die by the second year of infection. In Ethiopia, nearly twenty four percent of HIV related death is happen to under-five children; however studies done in this specific age group are limited are with poor evidence of predictors. Objectives To determine time to death and identify predictors of death in HIV infected under- five children on antiretroviral therapy in Amhara regional state, Oromia ‘liyu’ zone, Northeast Ethiopia, from 2014 to 2019. Methods Institution based retrospective follow up study was conducted in 376 under-five HIV- infected children on antiretroviral therapy from January 2014 to December 2019 in health institutions in Oromia Liyu Zone, Amhara region, Ethiopia. Multivariable Cox-proportional hazard regression model was used to identify independent predictors of mortality in HIV- infected under-five children on antiretroviral therapy. Result At the end of follow up, 304 (80.85%) of HIV-infected children were alive, 39 (10.95%) were lost to follow up, 12 (3.19%) were transferred out and 21 (5.59%) were reported dead due to HIV/AIDS. The cumulative survival probabilities of children after 3, 6, 12, 24 and 36 months were 0.99, 0.98, 0.97, 0.89 and 0.87 respectively. The overall mean time to death was 19.7 months (95%CI = 18.74–20.67) with incidence of 5.9 deaths per 100 child-months (95%CI: 3.89–9.09). Children with severe malnutrition at baseline (AHR = 4.9; 95 CI: 1.04, 23.50), advanced WHO clinical stage at enrolment (AHR = 3.9; CI: 1.37, 10.88), poor adherence to ART (AHR = 6.56; CI: 3.33, 10.14) and with no history of Isoniazide prophylaxis were significantly associated to higher mortality events (AHR = 3.6; CI: 1.24, 10.18). Conclusion Death of HIV-infected under-five children on ART is high within the first one year after enrolment. The risk of death increased if the child was malnourished at beginning of treatment, had poor ART adherence, with advanced WHO clinical stages and lack of Isoniazide prophylaxis during their age of infancy.

scholarly journals  Time To Death Among HIV-Infected Under-Five Children After Initiation Of Anti-Retroviral Therapy And Its Predictors In Oromiya Liyu Zone, Amhara Region, Ethiopia: A Retrospective Chohort

2021 ◽  
Author(s):  
Weldemariam Sintayehu Arega ◽  
Bereka Tefera Marie ◽  
Bitewa Yibelu Bazezew
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Stage ◽  
Severe Malnutrition ◽  
Amhara Region ◽  
Time To Death ◽  
Under Five ◽  
Under Five Children ◽  
Risk Of Death ◽  
Cox Proportional Hazard Regression

Abstract Background: Human Immunodeficiency Virus (HIV) is infection which mainly attacks immune system of an individual. Its disease progress is rapid in children and if treatment is not initiated nearly half of infected children will die by the second year of infection. In Ethiopia, nearly twenty four percent of HIV related death is happen to under-five children; however studies done in this specific age group are limited are with poor evidence of predictors. Objectives: To determine time to death and identify predictors of death in HIV infected under-five children on antiretroviral therapy in Amhara regional state, Oromia ‘liyu’ zone, Northeast Ethiopia, from 2014 to 2019. Methods: Institution based retrospective follow up study was conducted in 376 under-five HIV-infected children on antiretroviral therapy from January 2014 to December 2019 in health institutions in Oromia Liyu Zone, Amhara region, Ethiopia. Multivariable Cox-proportional hazard regression model was used to identify independent predictors of Mortality in HIV-infected under-five children on antiretroviral therapy. Results: At the end of follow up, 285 (80.28%) of HIV-infected children were alive, 39 (10.99%) were lost to follow up, 11 (3.94%) were transferred out and 21 (5.59%) were reported dead due to HIV/AIDS. The cumulative survival probabilities of children after 3, 6, 12, 24 and 36 months were 0.99, 0.98, 0.97, 0.89 and 0.87 respectively. The overall mean time to death was 19.7 months (95%CI= 18.74-20.67) with incidence of 5.9 deaths per 100 child-months (95%CI: 3.89-9.09). Children with severe malnutrition at baseline (AHR=4.9; 95 CI: 1.04, 23.50), advanced WHO clinical stage at enrolment (AHR=3.9; CI: 1.37, 10.88), poor adherence to ART (AHR=6.56; CI: 3.33, 10.14) and with no history of Isoniazide prophylaxis were significantly associated to higher mortality events (AHR=3.6; CI: 1.24, 10.18). Conclusion: Death of HIV-infected under-five children on ART is high within the first one year after enrolment. The risk of death increased if the child was malnourished at begging of treatment, had poor ART adherence, with advanced WHO clinical stages and lack of Isoniazide prophylaxis during their age of infancy.

Implementation of Home Visit Programs in Improving Nutritional Status of Under-Five Children in Developing Countries: A Scoping Review

2020 ◽  
Author(s):  
Siti Zakiah Zulfa ◽  
◽  
Cesa Septiana Pratiwi ◽  
Keyword(s):  
Developing Countries ◽  
Nutritional Status ◽  
Scoping Review ◽  
Home Visit ◽  
Home Visits ◽  
Severe Malnutrition ◽  
Severe Problem ◽  
Under Five ◽  
Under Five Children ◽  
Review Question

Background: In developing country, malnutrition of under five children was still a severe problem because it may have an impact on the quality of human resources in the future. Various program has been tried in many places to overcome this problem, one of which is through a home visit program, which is very necessary for educational purposes to manage malnutrition. This study aimed to determine how to implement a home visit program to improve the nutritional status of under five children in developing countries. Subjects and Method: A scoping review method was conducted using Arksey and O’malley (2005) framework with five steps: (1) Identify the scoping review question; (2) Identify relevant articles; (3) Article selection; (4) Mapping; (5) Present the results, discussion and conclusion. The search included Pubmed, Wiley, Ebsco, Science Direct, and Google scholar databases. The inclusion criteria were original articles in Indonesian and English from developing countries published from 2010 to 2019. The data were reported by PRISMA flow chart. Results: Five of the 159 articles were selected, and found that five themes were summarized, namely: (1) effective implementation of home visits, (2) types of rehabilitation of nutritional status of under-five children on home visits, (3) home visit officers 4) time and activities for conducting home visits and 5 ) constraints on home visits for malnutrition education purposes. Conclusion: Home visit program is an effective and significant strategy to reduce the incidence of underweight, moderate and severe malnutrition, stunting and wasting in under five children only when combined with other programs. Several knowledge gaps identify which confirm through further research. Keywords: home visit, nutritional status of under-five children, malnutrition, developing countries Correspondence: Siti Zakiah Zulfa. Universitas ‘Aisyiyah Yogyakarta. Jl. Ringroad Barat No.63, Mlangi, Nogotirto, Gamping, Sleman, Yogyakarta. Email: [email protected]. Mobile: 085641349694. DOI: https://doi.org/10.26911/the7thicph.02.11

scholarly journals Self-Rated Health Predicts Mortality in Very Old Men—the Manitoba Follow-Up Study

2019 ◽  
Vol 22 (4) ◽  
pp. 199-204
Author(s):  
Christian R. Hanson ◽  
Philip D. St John ◽  
Robert B. Tate
Keyword(s):  
Very Old ◽  
Time To Death ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Specific Distribution ◽  
Long Time ◽  
Cox Proportional Hazard Models ◽  
Old Men ◽  
Second World

BackgroundSelf-rated health (SRH) predicts death, but there are few studies over long-time horizons that are able to explore the effect age may have on the relationship between SRH and mortality.Objectives1. To determine how SRH evolves over 20 years; and 2. To determine if SRH predicts death in very old men.MethodsWe analyzed a prospective cohort study of men who were fit for air crew training in the Second World War. In 1996, a regular questionnaire was administered to the 1,779 surviving participants. SRH was elicited with a 5-point Likert Scale with the categories: excellent, very good, good, fair and poor/bad. We examined the age-specific distribution of SRH in these categories from the age of 75 to 95 years, to the end of the follow-up period in 2018. We constructed age-specific Cox proportional hazard models with an outcome of time to death. ResultsSRH declined with age. The gradient in risk of death persisted across all ages; those with poor/fair/bad SRH had consistently higher mortality rates. However, the discrimination between good and excellent was less in those aged 85+. ConclusionsSRH declines with advancing age, but continues to predict death in older men.

scholarly journals Analisis Implementasi Program Penanggulangan Gizi Buruk Di Puskesmas Wilayah Kerja Dinas Kesehatan Kota Sorong Provinsi Papua Barat

2016 ◽  
Vol 4 (1) ◽  
pp. 20-26
Author(s):  
Zaenab Ismail ◽  
Martha Irene Kartasurya ◽  
Atik Mawarni
Keyword(s):  
Primary Healthcare ◽  
Unit Cost ◽  
Control Program ◽  
Educational Background ◽  
Severe Malnutrition ◽  
Under Five ◽  
Under Five Children ◽  
Nutrition Care ◽  
West Papua ◽  
Primary Healthcare Centers

The prevalence of under-five children with severe malnutrition in Sorong city West Papua in 2008, 2009 and 2010 consecutively was 3.59%, 1.1% and 1.9%. Implementation of a program could be influenced by many factors such as communication, resources, disposition and bureaucracy factors. The objective of this study was to know the implementation of severe malnutrition control program at primary healthcare centers (puskesmas) in the working area of Sorong city health office West Papua in 2010. This was a qualitative study with cross sectional approach. Data was collected through in-depth interview using interview guideline. There were 5 primary healthcare centers studied with program executors as main informants. Triangulation informants were family or parents of under-five children with severe malnutrition, head of puskesmas and head of nutrition section of Sorong city health office West Papua province. Results of the study showed implementation of the program had not run according to the standard of implementation from the Ministry of Health. It was caused by not optimal communication that was done by Sorong city health office through program socialization. The availability of resources such as human resource to implement the program was insufficient. Only those who had nutrition educational background implemented the program and other workers were not involved in the program. There was no nutrition care team in all puskesmas. Additionally, the majority of the workers had not received training yet. Management of program funding was not according to the unit cost. Facilities were inappropriate and there was still improper puskesmas. The executor workers were needed for implementing the program; unfortunately due to less transparency and socialization, commitment was also low. No authority or standard operating procedure (SOP) given by Sorong city health office to puskesmas. In addition there was no supervision to the nutrition program workers. It was concluded that the implementation of severe malnutrition control program in Puskesmas in the working area of Sorong city health office West Papua province was not optimal. It was suggested to Sorong city health office to improve socialization about severe malnutrition control program to all program executors including heads of puskesmas in the working area of Sorong city health office; to create nutrition care and training teams. Funding allocation should be given to the right target and facilities should be completed.   Supervision, monitoring and evaluation were done continuously.

scholarly journals Using the General Social Survey – National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030330
Author(s):  
Erin Grinshteyn ◽  
Peter Muennig ◽  
Roman Pabayo
Keyword(s):  
Fear Of Crime ◽  
General Social Survey ◽  
National Death Index ◽  
Social Survey ◽  
Time To Death ◽  
Risk Of Death ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Relationship

ObjectivesFear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death.Setting and participantsData from the 1978–2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297).MethodsGSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex.ResultsAmong those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14).ConclusionsResearch has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully.

scholarly journals Prevalence of protein energy malnutrition in HIV-infected under five children and the effects of highly active antiretroviral therapy on their nutritional status in Nigeria

2021 ◽  
Vol 1 (3) ◽  
pp. 053-061
Author(s):  
Sylvia T Echendu ◽  
Kenneth N Okeke ◽  
Joy C Ebenebe ◽  
Ebelechuku F Ugochukwu ◽  
Chinyere U Onubogu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Antiretroviral Therapy ◽  
Nutritional Status ◽  
Highly Active Antiretroviral Therapy ◽  
Hiv Positive ◽  
Age Difference ◽  
Multivariate Logistic Regression ◽  
Under Five ◽  
Under Five Children ◽  
Highly Active

Aim: To determine the prevalence of malnutrition among HIV- infected under-five children and effect of highly active antiretroviral therapy (HAART) on the nutritional status. Method: This cross-sectional and descriptive study was conducted among under-fives presenting at the Paediatric HIV clinic in a tertiary centre in Nigeria. HIV positive children aged less than five years, who were on HAART and whose parents/caregivers gave consent were included. Odds ratios (ORs) and their 95% confidence intervals (CIs) were determined in a multivariate logistic regression analysis and p-values of <0.05 were considered significant. Result: A total of 92 HIV positive children comprising 52 (56.5%) males and 40 (43.5%) females were recruited, giving a ratio of 1.3:1. Children who were more than 48 months of age were (46.7%), while (9.8%) were aged 24 months or less. The mean age of the children was 44.5+12.9 months, while that of the male and female children were 43.9 +13.1 months and 45.2+12.6 months, respectively, and their age difference was statistically insignificant. The prevalence of undernutrition was 40.2% with a significantly higher proportion of them being male children (P= 0.02) while 1.1% of the children was overweight. The prevalence of severe wasting, severe underweight and severe stunting were 2.1, 3.3 and 17.4% respectively. A total of 12 (13.0%) were wasted, 14 (15.2%) were underweight, and 26 (28.3%) were stunted. Children who received HAART for more than 12 months were less likely to be wasted (P=0.02). Multivariate logistic regression also showed that being a male increased the risk of being underweight (OR=2.55, 95%CL=1.06-6.16) and stunted (OR=2.67, 95%CL=1.32-5.40). Conclusion: Malnutrition remains a problem of children living with HIV even while they are on HAART. The longer duration of HAART is significantly associated with better nutritional status.

scholarly journals Prevalence and Causes of Undernutrition among Under-five Sudanese Children: A Mini-review

2020 ◽  
pp. 12-20
Author(s):  
Shaza O. H. Kanan ◽  
Abd Elmoneim O. Elkhalifa
Keyword(s):  
Low Socioeconomic Status ◽  
Prevalence Rate ◽  
Maternal Education ◽  
Severe Malnutrition ◽  
Published Data ◽  
Childhood Diseases ◽  
Severe Stunting ◽  
Under Five ◽  
Under Five Children ◽  
Health Authorities

Background: Malnutrition among under-five children have significant interest for the health authorities in Sudan. This is considered by the fact that the prevalence of underweight children in Sudan is among the highest in the world and it is essential to determine its prevalence and causes, as this problem affects the future of the under-five children and the community as general. This review aimed to assess the prevalence and causes of undernutrition among under-five children in Sudan. Methods: Published data such as peer-reviewed articles, published dissertations and official reports on malnutrition and its causes among under-five Sudanese children during the last twenty years, were collected from Science Direct, Google Scholar, PubMed, and others. The information restored was reviewed and analyzed for inconsistency. Results: Data shows that the prevalence of under-nutrition among under-five children was high and diverse widely, and the majority of the studies were carried out in Khartoum state, which showed the prevalence of wasting (3.3 to 21.1%) stunting (20.3 to 51.0%), severe stunting (12.9 to 25.2%) and underweight and severe underweight represent 24.4 to 35.0% and 6.6 to 48.0%, respectively. The prevalence rate of malnutrition was reported to be 14.1, 23.6, and 10.7% in South Darfur IDP camps, while in North Darfur it was 14.7, 48.9, and 35.6%, for wasting, stunting, and underweight, respectively. In El Fau, Gadarif state the prevalence of moderate and severe malnutrition of the under-five children were 6% and 3.3%. Many causes were reported for malnutrition among the under-five children including bad feeding practices, childhood diseases, hygiene and sanitation, and low socioeconomic status. Conclusion: The prevalence rate of undernutrition among the under-five Sudanese children was very high, and stunting is the main shape of malnutrition. Many causes were contributed to under-five malnutrition and improvement in infant feeding and better maternal education are significant to get a high nutritional status of the children.

scholarly journals Survival Pattern and Its Determinants among Adult HIV-Infected Patients after Initiation of HAART in Dilla Hospital Ethiopia

2016 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Body Weight ◽  
Drug Addiction ◽  
Health Care Providers ◽  
Opportunistic Infections ◽  
Clinical Stage ◽  
Stage Iii ◽  
Care Providers ◽  
Hiv Patients ◽  
Risk Of Death

Background: In resource poor countries like Ethiopia the survival of patients treated with ART depends on a variety of factors, which might vary greatly with economic, demographic, behavioral and health risk factors. However, factors affecting survival in Ethiopia are poorly understood. The aim of this study is to determine causes of mortality in adult HIVpositive patients receiving highly active anti-retroviral treatment (HAART) in Dilla referral Hospital. Methods: The medical records of 1391 ART patients who enrolled at Dilla Hospital between 2010 and 2014 were reviewed and sociodemographic, clinical, behavioral and immunological data were collected. Multivariable Cox proportional hazards regression model was used to measure risk of death and identify the independent predictors of mortality. Result: Out of 1391 cohorts of adults ART patients 1081 (77.7%) were alive and continued their treatment in the hospital, 128 (9.2%) were reported dead, 111 (8%) were transfer out, and 71 (5.1%) were lost follow up. The probability of remaining alive and on treatment after 60 months of follow up was 89.3% for TB/HIV patients and 91.1% for HIV only infected patients. HIV patients who developed TB had shorter survival time than not developed TB. Death occurred 26% and 52% in the first 3 and 12 months of ART initiation respectively. The overall incidence rate of mortality during ART treatment was 3.5 per 100 person year observations (PYO). In multivariate analysis low body weight BMI <18.5 kg/m2 (HR 3.12, 95% CI 1.39-7.76, P<0.0001), CD4 countless than 50 cells/mm3 (HR 4.55, 95% CI 1.19 – 8.44, p <0.002), anemia, WHO clinical stage III and IV, drug addiction and presence of active TB infection were predictor of survival and statistically significant association with mortality in HIV patients under ART follow up. Conclusion: The presence of lower baseline CD4-cell, TB infection, WHO clinical stage III and IV, lower body weight, anemia, and drug addiction were factors associated with mortality among ART clients. Improving nutritional status, prevention and control of TB and other opportunistic infections were the recalled recommendations to decrease AIDSrelated morality. These determinants should be taken into account by health care providers to enhance better clinical outcomes of ART attendees.

Time to Switching to Second-line Antiretroviral Therapy and Its Predictors Among HIV/AIDS Infected Children at General Hospitals, Northern Ethiopia: A Survival Analysis

2021 ◽  
Author(s):  
Migbar Sibhat ◽  
Tewodros Mulugeta ◽  
Dawit Aklilu
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Rank Test ◽  
P Value ◽  
Northern Ethiopia ◽  
Second Line ◽  
Cox Proportional Hazard Regression ◽  
Adherence Monitoring ◽  
Second Line Antiretroviral Therapy

Abstract BackgroundWith expanding access to pediatric antiretroviral therapy, a growing amount of patients in the developing world has switched to second-line therapy, and some requiring third-line medications. A delay in switch increases mortality and risk of developing opportunistic infections. There remain limited and often conflicting estimates on the use of second-line ART in children. Thus, this study intended to determine the incidence and predictors of switching to second-line antiretroviral therapy among children.MethodsRetrospective follow up study was conducted by reviewing all charts. Data were collected by extraction tool; entered using Epi-data; cleaned and analyzed by STATA V-14. Kaplan-Meier curve, log-rank test, and life table were used for data description and adjusted hazard ratios and p-value for analysis by Cox proportional hazard regression. Any variable at P≤0.25 in the bi-variable analysis was taken to multivariate analysis and significance was declared at P≤0.05. Data were presented using texts, tables, and figures.Results and conclusionAnalysis was conducted on 424 charts with total person-time observation of 11686.1 child-months and incidence switch rate of 5.6 (95% CI 4.36-7.09) per 1000 child-month-observations. Being orphaned [AHR=2.36; 95%CI: 1.10-5.07], suboptimal ART adherence [AHR= 2.10; 95% CI: 1.12-3.92], drug toxicity [AHR= 7.05; 95% CI: 3.61-13.75], advanced recent WHO stage [AHR=2.75; 95%CI: 1.05-7.15], and initiating ART with TB co-infection [AHR=3.08; 95%CI: 1.26-7.51] were significantly associated with switch to second-line ART regimen. Moreover, long duration of ART follow up [AHR=0.75; 95% CI: 0.71-0.81] was found to be protective against switching. Hence, it is better to give priority for strengthening the focused evaluation of tuberculosis co-infection and treatment failure with continuous adherence monitoring. Further research is also needed to evaluate the effect of drug resistance.

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