Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study
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RESEARCH ARTICLE
Open Access
Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study Animut Alebel1,2* , Eshetu Haileselassie Engeda3, Mengistu Mekonnen Kelkay3, Pammla Petrucka4,5, Getiye Dejenu Kibret1,2, Fasil Wagnew1, Getnet Asmare6, Zebenay Workneh Bitew7, Daniel Bekele Ketema1, Getnet Gedif1, Belisty Temesgen8, Yitbarek Tenaw Hibstie8, Mamaru Wubale Melkamu8 and Setegn Eshetie3
Abstract Background: Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region. Methods: A multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results: The cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5, 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality. Conclusion: A higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIVpositive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality. Keywords: Amhara region, Ethiopia, ART, HIV-positive, Mortality
* Correspondence: [email protected] 1 College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia 2 Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credi
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