Malnutrition and human immunodeficiency virus (HIV) in children admited to Harare Central Hospital

Abstract

ABSTRACT To determine whether HIV infection has altered the presentation, hospital course and mortality of malnutrition in Harare Hospital, children between 2 and 96 months of age were studied. Their sociodemographic, clinical presentation and immediate outcome were documented. Anthropomorphic parameters and physical findings were recorded. HIV (ELISA), serum potassium and albumen plus haematologic indices were measured. These findings were compared between HIV positive and HIV negative children.

One hundred and eighty children were enrolled from December 1993 to February 1994. Mean age was 26.1 months (range 2-96) and the male to female ratio was 1.2:1. Fifty-four point five percent had kwashiorkor, 26.7% marasmic-kwashiorkor, 9.4% marasmus and 9.4% were underweight. During the study 73 children died giving an overall Case Fatality Rate (CFR) of 35% (73/210) .

Thirty children with severe malnutrition died within 24 hours of admission and inadequate information was available therefore not included in the rest of the analysis. There was no significant difference in CFR between the different groups. Seventy-nine children were HIV positive and 80 HIV negative (no result obtained in 21) . The association of HIV positivity was significant in those with wasting and stunting (p<0.002) than with either stunting or wasting alone. Clinically, dehydration was more severe and oral thrush lymphadenopathy and ear discharge were present more frequently (p<0.001) . Haemoglobin and mean corpuscular volume were significantly lower (p<0.03 and p<0.001 respectively) Their hospital course was characterised by persistence of diarrhoea, lack of appetite and apathy (p <0.04). Mortality was marginally greater (p=0.055).

These findings suggest that all children presenting with malnutrition should be screened for their HIV status and that prevention of AIDS needs to be included in efforts to reduce childhood malnutrition in Zimbabwe.