Impact of adverse events of antiretroviral treatment on regimen change and mortality in Ugandan children

Background: Outcomes of antiretroviral treatment have been documented in both developed and developing countries. It has been reported consistently that the treatment is associated with many adverse events. However, little is known about their impact on the quality of life, clinical management, and survival in children aged less than 6 years in Uganda. Objectives: The purpose of this study was to determine the prevalence of the adverse events of antiretroviral treatment, their impact on mortality and the change in regimens prescribed to children treated at Mildway Centre in Uganda. Method: A retrospective chart review was performed for children younger than 6 years, treated since the Mildway Centre was opened in 1999. In order to achieve a larger sample, the records of children treated from January 2000 to July 2005 were included in the study. A pre-tested data collection form was used to collate socio-demographic and clinical data of the patients. These included the documented adverse events, causes of death, stage of infection, duration of treatment, regimen prescribed, year of enrolment into the treatment program, as well as whether or not they were still alive. Descriptive statistics were used in the analysis of data. Results: Of the 179 children, the majority were males and had a median age of 4 years. The majority (58.8%) of children had suffered from severe immune depression since they met the WHO clinical stage III and IV, 73.8% had a baseline CD4T of less than 15%. Four regimens were prescribed to the children. The most common was a regimen containing zidovudine, lamivudine, and nevirapine (34.6%), followed by a regimen containing stavudine, lamivudine, and nevirapine (27.9%). Eleven children (6.1%) had their regimen changed, of which six (54.5%) were due to adverse events. The prevalence of adverse events was 8%; of the 14 documented adverse events, the most common were severe anaemia (3), vomiting (3), and skin rashes (3). After 12 months on treatment, 8% of the patients had died. The most common causes of death were infectious diseases (28.6%), severe anaemia (21.4%), and severe dehydration (21.4%). Conclusion: The prevalence of adverse events was 8%; they were responsible for 54.5% of regimen changes and 21.4% of deaths in children treated at the study site. These findings suggest the need for incorporating pharmacovigilance practices into the provision of antiretroviral treatment

Profile of acute poisoning in three health districts of Botswana

Background: This study sought to characterise acute poisoning cases seen in three health districts of Botswana. Methods: A retrospective review of patients' records was conducted and included patients treated from January 2004 to December 2005. Data on the demographic status of the patients; information about the poisonous agent(s) involved; and the circumstances and outcomes of the poisoning incidents were recorded on a pre-tested data collection form. Results: A total of 590 cases of acute poisoning were included in the analysis. The most affected age category was that of children aged less than six years; who constituted 33.4of the cases. Most incidents were recorded in the urban district of Gaborone. Seventy-eight percent (78) of the incidents were accidental; with the remainder being intentional. The poisonous agents involved were pharmaceuticals (26.6); natural toxins (25.6); household products (14.6); foods (14.4); alcohol (6.9); traditional medicines (4.7); unspecified agents (3.2); and agrochemicals (2.7). The most common route of poison exposure was by oral (82.2); followed by dermal contact (16.5); while the inhalation of gases occurred in 1.2of cases. An incidence rate of 4.7/1000; a case fatality rate of 3.8/100; and 1.5of deaths were recorded over the two-year period. Conclusions: In conclusion; it can be stated that acute poisoning involved mainly young children and resulted in an incidence rate of 4.7/1000; a case fatality rate of 3.8/100; and 1.5of deaths over the two-year period. There were differences based on age category; gender and residence of the victims; the types of toxic agents involved; as well as the circumstances and the outcomes of the poisoning incidents. Given the fact that pharmaceuticals; natural toxins; household products and foods were the agents most commonly involved; targeted interventions should take these differences into account in addressing the problem of acute poisoning