Gurmu Gelane, Merdassa Emiru, Tiruneh Gemechu, Efrem Keneni, Belay Firezer, Mekonnen Lalisa, Feyisa Jira Wakoya, Lema Matiyos, Shama Adisu Tafari, Desalegn Markos
Gimbi General Hospital, Oromia Regional Health Bureau, Gimbi, Ethiopia.
Departments of Nursing, School of Nursing and Midwifery, Institute of Health Science, Wollega University, Ethiopia.
PLoS One. 2025 Jan 24;20(1):e0314112. doi: 10.1371/journal.pone.0314112. eCollection 2025.
The mortality rate among Human immunodeficiency Virus (HIV) who have started antiretroviral therapy (ART) continues to be increased in resource-limited countries, despite a decline in developed nations. Furthermore, research within this age group is limited and has not previously been conducted in the study area. Consequently, this study aimed to determine the incidence of mortality and its predictors among HIV-positive children who have been receiving ART at public health facilities in West Wollega.
To assess incidence rate and predictors of mortality among HIV-positive children on ART at selected health facilities of West Wollega, Ethiopia, 2022.
A retrospective cohort study design was conducted. A simple random sampling method was employed to select 286 children living with HIV who started ART from 01 January 2012 to 31 October 2021. Data were entered into Epi-Data Version 3.1, and STATA Version 14 was used for statistical analysis. A Kaplan-Meir survival curve and Long Rank test were used to estimate survival probability and assess statistical differences. The Cox regression model was used to determine independent predictors of mortality.
The total follow-up time was 15, 652 child-months, and the overall incidence of mortality was 1.92 (95%CI: 1.34, 2.74) per 1000 child-months. The median time to death following the initiation of ART was 6 months. This study also showed that children with WHO clinical stage III (AHR = 3.4, 95% CI: 1.2, 7.4), stage IV (AHR = 5.4, 95%CI: 1.5, 19.8), Being anemic (AHR = 4.9, 95%CI: 1.8, 13.4), CD4 cell count below threshold (AHR = 3.7, 95%CI = 1.4, 9.5), delayed developmental milestone (AHR = 4.5, 95%CI: 1.7, 11.7) were at higher risk of mortality.
The overall mortality rate was lower compared to the previous study findings. Anemia, WHO clinical stage, CD4 cell count, and delayed developmental milestones were independent predictors of mortality. Therefore, the focus should be given to all children on ART during the early periods of ART initiation, advanced HIV disease, presence of anemia, severe immune deficiency, and delayed developmental milestones.
在资源有限的国家，尽管发达国家的死亡率有所下降，但开始接受抗逆转录病毒治疗（ART）的人类免疫缺陷病毒（HIV）感染者的死亡率仍在上升。此外，该年龄组的研究有限，且此前未在该研究地区开展过相关研究。因此，本研究旨在确定在西沃莱加的公共卫生机构接受ART治疗的HIV阳性儿童的死亡率及其预测因素。
评估2022年埃塞俄比亚西沃莱加选定卫生机构中接受ART治疗的HIV阳性儿童的死亡率及其预测因素。
采用回顾性队列研究设计。采用简单随机抽样方法，选取2012年1月1日至2021年10月31日开始接受ART治疗的286名HIV感染儿童。数据录入Epi-Data 3.1版本，使用STATA 14版本进行统计分析。采用Kaplan-Meir生存曲线和长秩检验来估计生存概率并评估统计学差异。使用Cox回归模型确定死亡率的独立预测因素。
总随访时间为15652个儿童月，总体死亡率为每1000个儿童月1.92（95%置信区间：1.34，2.74）。开始ART治疗后的中位死亡时间为6个月。本研究还表明，世界卫生组织临床分期为III期（调整后风险比[AHR]=3.4，95%置信区间：1.2，7.4）、IV期（AHR=5.4，95%置信区间：1.5，19.8）、贫血（AHR=4.9，95%置信区间：1.8，13.4）、CD4细胞计数低于阈值（AHR=3.7，95%置信区间=1.4，9.5）、发育里程碑延迟（AHR=4.5，95%置信区间：1.7，11.7）的儿童死亡风险较高。
与之前的研究结果相比，总体死亡率较低。贫血、世界卫生组织临床分期、CD4细胞计数和发育里程碑延迟是死亡率的独立预测因素。因此，应在ART治疗开始的早期阶段、晚期HIV疾病、贫血、严重免疫缺陷和发育里程碑延迟的情况下，关注所有接受ART治疗的儿童。
