Girma Desalegn, Abita Zinie, Guteta Mirresa, Abebe Abinet, Adugna Amanuel, Alie Melsew Setegn, Abebe Gossa Fetene
College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia.
College of Health Science, department of public health, Mizan-Tepi University, Mizan-Teferi, Ethiopia.
BMC Public Health. 2024 Jul 31;24(1):2061. doi: 10.1186/s12889-024-19579-3.
Human Immunodeficiency Virus (HIV) continues to be the major cause of childhood deaths, particularly in the sub-Saharan African region. In Ethiopia, though several primary studies have been conducted on the incidence of HIV-related child mortality, the pooled incidence density mortality rate among HIV-positive children is unknown. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence density mortality rate among HIV-positive children and identify its associated factors in Ethiopia.
We browsed PubMed, HINARI, Science Direct, Google Scholar, African Journals Online, and cross-references using different search terms to identify articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Meta-package was used to estimate the pooled incidence of mortality and hazard ratio (HR) of predictors. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection and Egger's test. Data was presented using forest plots and tables. The random effect model was used to compute the pooled estimate.
The overall pooled incidence density mortality rate among HIV-positive children was 2.52 (95% CI: 1.82, 3.47) per 100 child years. Advanced HIV disease (hazard ratio (HR): 3.45, 95% CI (Confidence Interval): 2.64, 4.51), tuberculosis co-infection (HR: 3.19, 95% CI: 2.08, 4.88), stunting (3.22, 95% CI: 2.46, 4.22), underweight (HR: 2.71, 95% CI: 1.72, 4.26), wasting (HR: 4.14, 95% CI: 2.27, 7.58), didn't receive Isoniazid preventive therapy (HR: 3.33, 95% CI: 2.22, 4.99), anemia (HR: 3.03, 95% CI: 2.52, 3.64), fair or poor antiretroviral therapy adherence (HR: 4.14, 95% CI: 3.28, 5.28) and didn't receive cotrimoxazole preventive therapy (HR: 3.82, 95% CI: 2.49, 5.86) were factors associated with a higher hazard of HIV related child mortality.
The overall pooled incidence density mortality rate among HIV-positive children was high in Ethiopia as compared to the national strategy target. Therefore, counseling on antiretroviral therapy adherence should be strengthened. Regular monitoring of hemoglobin levels and assessment of nutritional status should be done for all children living with HIV. Moreover, healthcare professionals should follow the national HIV treatment guidelines and provide cotrimoxazole preventive therapy and Isoniazid preventive therapy up on the guidelines for children living with HIV.
Registered in PROSPERO with ID: CRD42023486902.
人类免疫缺陷病毒（HIV）仍然是儿童死亡的主要原因，特别是在撒哈拉以南非洲地区。在埃塞俄比亚，尽管已经对与HIV相关的儿童死亡率进行了多项初步研究，但HIV阳性儿童的合并发病率密度死亡率尚不清楚。因此，本系统评价和荟萃分析旨在估计埃塞俄比亚HIV阳性儿童的合并发病率密度死亡率，并确定其相关因素。
我们使用不同的搜索词浏览了PubMed、HINARI、Science Direct、Google Scholar、非洲期刊在线，并进行了交叉引用以识别文章。使用乔安娜·布里格斯研究所的清单进行质量评估。使用Meta包估计死亡率的合并发病率和预测因素的风险比（HR）。使用I²统计量检验异质性。使用漏斗图视觉检查和Egger检验检验发表偏倚。数据以森林图和表格形式呈现。使用随机效应模型计算合并估计值。
HIV阳性儿童的总体合并发病率密度死亡率为每100儿童年2.52（95%置信区间：1.82，3.47）。晚期HIV疾病（风险比（HR）：3.45，95%置信区间（CI）：2.64，4.51）、结核合并感染（HR：3.19，95%CI：2.08，4.88）、发育迟缓（3.22，95%CI：2.46，4.22）、体重不足（HR：2.71，95%CI：1.72，4.26）、消瘦（HR：4.14，95%CI：2.27，7.58）、未接受异烟肼预防性治疗（HR：3.33，95%CI：2.22，4.99）、贫血（HR：3.03，95%CI：2.52，3.64）、抗逆转录病毒治疗依从性一般或较差（HR：4.14，95%CI：3.28，5.28）以及未接受复方新诺明预防性治疗（HR：3.82，95%CI：2.49，5.86）是与HIV相关儿童死亡风险较高相关的因素。
与国家战略目标相比，埃塞俄比亚HIV阳性儿童的总体合并发病率密度死亡率较高。因此，应加强对抗逆转录病毒治疗依从性的咨询。应对所有感染HIV的儿童定期监测血红蛋白水平并评估营养状况。此外，医疗保健专业人员应遵循国家HIV治疗指南，并根据针对感染HIV儿童的指南提供复方新诺明预防性治疗和异烟肼预防性治疗。
已在PROSPERO注册，注册号：CRD42023486902。
