Premium
Predictors for mortality and loss to follow‐up among children receiving anti‐retroviral therapy in Lilongwe, Malawi
Author(s) -
Fetzer Bradley C.,
Hosseinipour Mina C.,
Kamthuzi Portia,
Hyde Lisa,
Bramson Brian,
Jobarteh Kebba,
Torjesen Kristine,
Miller William C.,
Hoffman Irving,
Kazembe Peter,
Mwansambo Charles
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2009.02315.x
Subject(s) - medicine , pediatrics , retrospective cohort study , multivariate analysis , proportional hazards model , cohort , population , surgery , environmental health
Summary Objectives To determine predictors of mortality in children on anti‐retroviral therapy (ART) who attended the Paediatric HIV Clinic at Kamuzu Central Hospital in Lilongwe, Malawi. Methods Retrospective case cohort study by chart review of children who had started ART between October 2004 and May 2006. Bivariable and multivariable analysis were performed with and without defaulters to evaluate associations according to vital status and to identify independent predictors of mortality. Results Forty‐one of 258 children (15.9%) were deceased, 185 (71.7%) were alive, and 32 (12.4%) had defaulted: 51% were female, 7% were under 18 months, 26% were 18 months to 5 years, and 54% were >5 years of age. Most were WHO stage III or IV (56% and 37%, respectively). On multivariate analysis, factors most strongly associated with mortality and defaulting were age <18 months [hazards ratio (HR) 2.11 (95% CI 1.0–4.51)] and WHO stage IV [HR 2.00 (95% CI 1.07–3.76)]. Conclusions To improve outcomes of HIV‐positive children, they must be identified and treated early, specifically children under 18 months of age. Access to infant diagnostic procedures must be improved to allow effective initiation of ART in infants at higher risk of death.