HIV infection among paediatric in-patients in Blantyre, Malawi

Rogerson, Sheryle R; Gladstone, Melissa; Callaghan, Maria; Erhart, Laura; Rogerson, Stephen J; Borgstein, Eric; Broadhead, Robin L

doi:10.1016/j.trstmh.2003.12.011

« Previous Next »Transactions of the Royal Society of Tropical Medicine and Hygiene
Volume 98, Issue 9 , Pages 544-552, September 2004

HIV infection among paediatric in-patients in Blantyre, Malawi

Sheryle R Rogerson
- Department of Paediatrics, College of Medicine, University of Malawi, Malawi
- Corresponding author. Present address: Neonatal Unit, Royal Women’s Hospital, 131 Grattan Street, Carlton, VIC 3052, Australia. Tel.: +61-3-93442000; fax: +61-3-93472731.
Melissa Gladstone
- Department of Paediatrics, College of Medicine, University of Malawi, Malawi
- Permanent address: Department of Community Paediatrics, Alder Hey Children’s Hospital, Eaton Rd, Liverpool, L12 2AP, UK.
Maria Callaghan
- Department of Surgery, College of Medicine, University of Malawi, Malawi
Laura Erhart
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Permanent address: Arizona Department of Health Services, 150 N 18th Ave, Phoenix, AZ 85007.
Stephen J Rogerson
- Malawi-Liverpool–Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Malawi
- Department of Medicine (RMH/WH), University of Melbourne, Parkville 3050, Australia
Eric Borgstein
- Department of Surgery, College of Medicine, University of Malawi, Malawi
Robin L Broadhead
- Department of Paediatrics, College of Medicine, University of Malawi, Malawi

Received 22 September 2003; received in revised form 7 December 2003; accepted 7 December 2003.

Abstract

To investigate the impact of HIV infection on hospital admission and death we studied children admitted to paediatric medical and surgical wards in Blantyre, Malawi, in March 2000. Unselected children whose parents or guardians consented to HIV testing of the child were recruited and HIV infection was determined by serology, with confirmation in children aged 15 months or less by PCR. We assessed the prevalence of HIV infection by age, clinical diagnosis and outcome of admission. Of 1064 admissions, 991 were tested for HIV infection, and 187 (18.9%) were infected. HIV was most common in children aged less than six months, 53 of 166 (32%). Parents of HIV-infected children were better educated, and more likely to have died, than those of uninfected children. Clinical symptoms and signs were not adequately sensitive or specific to be used for diagnosis of HIV. HIV was common in children with malnutrition (prevalence 40%), lower respiratory tract infection (29%) and sepsis (28%), and less prevalent among children with malaria (11%) or surgical admissions (11%). Almost 30% of HIV-infected children died, compared with 8.9% of uninfected children, and HIV-infected children constituted over 40% of in-patient deaths.

Keywords: HIV, Hospital admission, Mortality, Paediatric, Malawi, Africa