Nyandiko W M, Mwangi A, Ayaya S O, Nabakwe E C, Tenge C N, Gisore P M, Vreeman R C
Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya.
East Afr Med J. 2009 Aug;86(8):364-73. doi: 10.4314/eamj.v86i8.54156.
To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.
A retrospective descriptive study.
USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.
HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.
Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).
Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed.
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) > or = -1 and 21% had WAZ scores < or = 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.
HIV-infected children were enrolled in care early in childhood. Orphanhood 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.
描述肯尼亚西部一个大型艾滋病护理项目中登记接受护理的儿童的特征和结局。
一项回顾性描述性研究。
肯尼亚西部卫生中心的美国国际开发署-抗逆转录病毒治疗与关怀项目（AMPATH）艾滋病诊所；地区和分区医院；莫伊教学与转诊医院。
在肯尼亚西部18家诊所网络中就诊的15岁以下感染艾滋病病毒的儿童。
儿科艾滋病诊断与护理，包括治疗和预防机会性感染以及提供联合抗逆转录病毒疗法（CART）。
入组及随访时的诊断、临床分期和免疫状态；住院情况和死亡情况。进行了描述性统计分析和卡方检验。
2002年6月至2008年4月期间共观察了4017名感染艾滋病病毒的儿童。入组时的中位年龄为4岁（0至14.2岁），51%为女孩，25%为父方孤儿，10%为双亲孤儿，13%为母方孤儿。入组时，25%的儿童年龄别体重Z评分（WAZ）≥-1，21%的儿童WAZ评分≤-3。孤儿的WAZ评分更差（p = 0.0001）。25%的儿童被归类为世界卫生组织临床3期和4期，56%为世界卫生组织临床1期和2期，19%在入组时缺失临床分期。咳嗽（25%）、胃肠炎（21%）、发热（15%）、肺炎（10%）是最常见的症状。26%的儿童被诊断出患有结核病，只有25%开始接受复方新诺明预防性治疗（CPT）。入组时CD4%的中位数为16%（0至64%）；最新记录值为22%（0至64%）。64%的儿童接受了抗逆转录病毒联合治疗（cART+），开始治疗的中位年龄为5.4岁（0至14.4岁）。cART+组初始CD4%的中位数为13（0至62），未接受抗逆转录病毒治疗（cART-）组为24（0至64）。cART+组的CD4%中位数改善至22%（0至59）；而cART-组在最后一次随访时为23%（0至64）。在随访期间，接受cART治疗的儿童中有五分之一（19%）失访，未接受cART治疗的儿童失访率略超过三分之一（37%）。34%的儿童住院治疗；41%被诊断出患有肺炎。4017名儿童中有6%被证实死亡。
感染艾滋病病毒的儿童在幼儿期就开始接受护理。这些儿童中孤儿现象普遍，同时胃肠炎、发热、肺炎和严重免疫抑制也很常见。孤儿更有可能严重营养不良。只有四分之一的儿童接受了复方新诺明预防性治疗。儿童开始接受cART治疗较晚，但对治疗反应良好。接受cART治疗的儿童失访情况较少见。
