Evaluation of adherence to national guideline for clinical follow up of HIV infected children using the proxy hematological, biochemical and anthropometric indicators of care.

BACKGROUND

In HIV-infected children, assessment of liver and renal functions, growth pattern, hematologic and immunologic profiles is highly recommended. However, no study has evaluated the regularity of these kinds of assessment in hospital population.

OBJECTIVE

The objective of this study was to evaluate the regularity of selected haematological, biochemical and anthropometric monitoring

METHODS

A Multi-Centre Retrospective Cohort Study was done to analyze 1163 HIV-infected children who had follow up in seven public hospitals in Ethiopia. The frequency of the following measures was used as a proxy indicator of the quality of assessment: weight & height measurement, absolute CD4 count, haemoglobin level and Serum glutamic oxaloacetic transaminase (SGOT). Paired sample t-test was done to evaluate the change in weight, haemoglobin and SGOT levels.

RESULTS

Initially, for all children CD4 and haemoglobin levels were assessed. At 6 and 24 months after start of ART the proportion of children with a CD4 assessment was 68% and 37% respectively; 55% and 28% for haemoglobin; 62.7% and 6.4% for weight; and, 47% and 23% for SGOT. Mean weight for children age ten years and above, and mean height for children age two years and above was below the 5th percentile. Initially and at 24 months, the prevalence of all types of anemia was about 50% and 7%, respectively. There were no children with severe hepatotoxicity.

CONCLUSION

The proportion of children being assessed for CD4, haemoglobin, SGOT and weight measures were initially two-third and markedly declined as the cohort progressed. The prevalence of anemia after two years follow up reduced by about 8-fold, growth appears to be poor in older children while hepatotoxicity is observed to be a rare phenomenon.