Characteristics of HIV-infected children seen in western Kenya

W. M. Nyandiko, A. Mwangi, S. O. Ayaya, E. C. Nabakwe, C. N. Tenge, P. M. Gisore, Rachel Vreeman

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. Design: A retrospective descriptive study. Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed Results: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ)≥ -1 and 21% had WAZ scores ≤ 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead.Conclusions: HIV -infected children were enrolled in care early in childhood. Orphan-hood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.

Original languageEnglish
Pages (from-to)364-373
Number of pages10
JournalEast African Medical Journal
Volume86
Issue number8
StatePublished - 2009

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Kenya
Orphaned Children
HIV
Pneumonia
Sulfamethoxazole Drug Combination Trimethoprim
Gastroenteritis
Weights and Measures
Fever
United States Agency for International Development
Therapeutics
District Hospitals
Lost to Follow-Up
Opportunistic Infections
Chi-Square Distribution
Child Care
Cough
Teaching Hospitals
Appointments and Schedules
Tuberculosis
Hospitalization

ASJC Scopus subject areas

  • Medicine(all)

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Nyandiko, W. M., Mwangi, A., Ayaya, S. O., Nabakwe, E. C., Tenge, C. N., Gisore, P. M., & Vreeman, R. (2009). Characteristics of HIV-infected children seen in western Kenya. East African Medical Journal, 86(8), 364-373.

Characteristics of HIV-infected children seen in western Kenya. / Nyandiko, W. M.; Mwangi, A.; Ayaya, S. O.; Nabakwe, E. C.; Tenge, C. N.; Gisore, P. M.; Vreeman, Rachel.

In: East African Medical Journal, Vol. 86, No. 8, 2009, p. 364-373.

Research output: Contribution to journalArticle

Nyandiko, WM, Mwangi, A, Ayaya, SO, Nabakwe, EC, Tenge, CN, Gisore, PM & Vreeman, R 2009, 'Characteristics of HIV-infected children seen in western Kenya', East African Medical Journal, vol. 86, no. 8, pp. 364-373.
Nyandiko WM, Mwangi A, Ayaya SO, Nabakwe EC, Tenge CN, Gisore PM et al. Characteristics of HIV-infected children seen in western Kenya. East African Medical Journal. 2009;86(8):364-373.
Nyandiko, W. M. ; Mwangi, A. ; Ayaya, S. O. ; Nabakwe, E. C. ; Tenge, C. N. ; Gisore, P. M. ; Vreeman, Rachel. / Characteristics of HIV-infected children seen in western Kenya. In: East African Medical Journal. 2009 ; Vol. 86, No. 8. pp. 364-373.
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abstract = "Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. Design: A retrospective descriptive study. Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed Results: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51{\%} girls, 25{\%} paternal orphans, 10{\%} total orphans and 13{\%} maternal orphans. At enrollment, 25{\%} had weight-for-Age Z scores (WAZ)≥ -1 and 21{\%} had WAZ scores ≤ 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56{\%} were WHO clinical stages 1 and 2 with 19{\%} missing clinical staging at enrollment. Cough (25{\%}), gastroenteritis (21{\%}), fever (15{\%}), pneumonia (10{\%}) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25{\%} started on cotrimoxazole preventive therapy (CPT). Median CD4{\%} at enrollment was 16{\%} (0-64{\%}); latest recorded values were 22{\%} (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median initial CD4{\%} among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4{\%} for cART+ improved to 22{\%} (0-59); whereas cART- was 23{\%} (0-64) at last appointment. During the period of follow-up, one fifth (19{\%}) of children on cART were lost to follow-up compared to slightly over one third (37{\%}) for those not on cART. Thirty four percent were hospitalised; 41{\%} diagnosed with pneumonia. Six per cent of 4017 were confirmed dead.Conclusions: HIV -infected children were enrolled in care early in childhood. Orphan-hood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.",
author = "Nyandiko, {W. M.} and A. Mwangi and Ayaya, {S. O.} and Nabakwe, {E. C.} and Tenge, {C. N.} and Gisore, {P. M.} and Rachel Vreeman",
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T1 - Characteristics of HIV-infected children seen in western Kenya

AU - Nyandiko, W. M.

AU - Mwangi, A.

AU - Ayaya, S. O.

AU - Nabakwe, E. C.

AU - Tenge, C. N.

AU - Gisore, P. M.

AU - Vreeman, Rachel

PY - 2009

Y1 - 2009

N2 - Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. Design: A retrospective descriptive study. Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed Results: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ)≥ -1 and 21% had WAZ scores ≤ 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead.Conclusions: HIV -infected children were enrolled in care early in childhood. Orphan-hood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.

AB - Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. Design: A retrospective descriptive study. Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed Results: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ)≥ -1 and 21% had WAZ scores ≤ 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead.Conclusions: HIV -infected children were enrolled in care early in childhood. Orphan-hood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.

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