Haileamlak Abraham, Hagos Tesfalem, Abebe Workeabeba, Abraham Loko, Asefa Henok, Teklu Alula M
Department of Pediatrics and Child Health, Jimma University.
Department of Pediatrics and Child Health, Mekelle University.
Ethiop J Health Sci. 2017 Feb;27(Suppl 1):53-62. doi: 10.4314/ejhs.v27i1.6s.
Substantial progress has been made in the management of pediatric HIV infection in Ethiopia with the implementation of mother-to-child-prevention programs. Since the introduction of HAART in 2005, mortality among HIV-infected children has reduced while the rate of hospitalization was expected to rise. The purpose of this study, therefore, was to assess predictors of hospitalization in children on ART in seven university referral hospitals in Ethiopia.
A prospective cohort study design was employed on children age 0-18 years as part of a multisite observational study. ART-experienced eligible and ART-naïve children with HIV/AIDS were enrolled into the Advanced Clinical Monitoring (ACM) till December 31, 2012 were included. From the database, information on hospitalization and other independent variables were extracted. Analysis was done using both SPSS for Windows version 16.0 and STATA. Descriptive analyses and modeling was done using logistic regression.
Of the 405 children on ART (174 experienced, 231 naive), 86 (20.7%) were hospitalized for various reasons; two children were excluded since they were hospitalized for unrelated conditions (appendicitis and burn). Fifty one (60.7%) of the eighty four admitted children were hospitalized in the first six months of ART initiation. Of the independent variables, only the presence of opportunistic infections and duration on ART were significantly associated with hospitalization both on bi-variable and multivariable analyses (P-value <0.05). As the duration on ART increased by one month, the risk of hospitalization decreased by 5.4%, which is statistically significant (P < 0.001). Whereas the incidence (number) of OI's increased by one, the risk of being hospitalized increased by 35.2% (P = 0.002). Of the individual opportunistic infections, pneumonia was found to be the only predictor of hospitalization (P-value = 0.002).
This study showed that nearly two-third of the hospitalization was within 6 months of initiation of ART; and presence of OI and duration on ART were the only predictors of hospitalization.
随着母婴预防项目的实施，埃塞俄比亚在儿童艾滋病毒感染管理方面取得了重大进展。自2005年引入高效抗逆转录病毒治疗（HAART）以来，艾滋病毒感染儿童的死亡率有所下降，而住院率预计会上升。因此，本研究的目的是评估埃塞俄比亚七家大学转诊医院中接受抗逆转录病毒治疗（ART）的儿童的住院预测因素。
作为一项多中心观察性研究的一部分采用前瞻性队列研究设计，纳入0至18岁的儿童。有ART治疗经验的符合条件的艾滋病毒/艾滋病患儿以及未接受过ART治疗的患儿被纳入高级临床监测（ACM），直至2012年12月31日。从数据库中提取有关住院情况和其他独立变量的信息。使用适用于Windows的SPSS 16.0版和STATA进行分析。使用逻辑回归进行描述性分析和建模。
在405名接受ART治疗的儿童中（174名有治疗经验，231名无治疗经验），86名（20.7%）因各种原因住院；两名儿童因与艾滋无关的疾病（阑尾炎和烧伤）住院而被排除。84名入院儿童中有51名（60.7%）在开始ART治疗的前六个月内住院。在独立变量中，只有机会性感染的存在和ART治疗时长在双变量和多变量分析中均与住院显著相关（P值<0.05）。随着ART治疗时长增加一个月，住院风险降低5.4%，这具有统计学意义（P<0.001）。而机会性感染的发生率（数量）每增加一个，住院风险增加35.2%（P = 0.002）。在个体机会性感染中，肺炎被发现是住院的唯一预测因素（P值 = 0.002）。
本研究表明，近三分之二的住院发生在开始ART治疗的6个月内；机会性感染的存在和ART治疗时长是住院的唯一预测因素。
