Risk of HIV and associated factors among infants born to HIV-positive women in northwest Ethiopia

Background: The high rate of HIV morbidity and mortality among pregnant and lactating women, and their infants, is still major health problem in Ethiopia. This study aims to assess the risk and determinants of mother-tochild transmission of HIV among infants born from HIV-positive mothers in West Gojjam Zone, northwestEthiopia.Methods: A facility-based, cross-sectional study was carried at prevention of mother-to-child transmission (PMTCT) clinics in West Gojjam Zone. The study participants were HIV-exposed infants enrolled at PMTCT clinics from 01 January to 30 December 2017 who had a recorded DNA-PCR result. The data sources were PMTCT logbooks and patient charts. Data were entered into Epi Info (version 7) and analyzed using SPSS (version 20.0). Both bivariate and multivariate analyses were carried out to identify associations.Results: A total of 636 infant records were included in the study. There were 39 cases (6.1%, 95% CI: 4.2, 8.2) of transmission of HIV from mother to child. Home delivery (AOR = 4.0, 95% CI: 1.5, 12), infant not receiving antiretroviral prophylaxis at birth (AOR =5.0, 95% CI: 1.6, 17.1), episiotomy (AOR = 5.1, 95% CI: 1.9, 15.1), andmixed infant feeding practices (AOR = 6.0, 95% CI: 2.1, 16.4) were significantly associated with mother-to-child transmission of HIV in the study.Conclusions and recommendations: The risk of HIV infection among infants born from HIV-positive mothers was high. Predictors for mother-to-child transmission of HIV were episiotomy, home delivery, mixed feeding and absence of antiretroviral prophylaxis at birth

Can routine inpatient mortality data improve HIV mortality estimates? Inpatient mortality at an urban hospital in South Africa

Background. South Africa (SA) has one of the world's largest HIV treatment programmes, to which a dramatic increase in life expectancy has been attributed. However, there continue to be concerns regarding the reporting of HIV-related mortality in SA, which varies by source. As accurate HIV mortality estimates are key to measuring the success of the national programme as well as identifying areas for improvement, we propose a complementary approach to monitoring changes in HIV-related mortality using routine inpatient records to examine trends in causes of death and HIV status over time.Objectives. To investigate the feasibility of this approach by calculating mortality due to natural causes in the medical ward of a hospital during 2010 by HIV status.Methods. We conducted a cross-sectional study of inpatient mortality at a regional hospital in Johannesburg, SA, analysing all deaths due to natural causes among adult medical ward inpatients. Cause of death was recorded from the mortuary register. HIV status was ascertained directly from the mortuary register or from laboratory tests specific for HIV diagnosis or monitoring.Results. Of 1 167 inpatients who died, the majority were HIV-positive (58%). HIV positivity among males (55%) was slightly lower than that among females (61%), and HIV-positive patients were younger (median 40 years) than those who were HIV-negative (56 years) and of unknown HIV status (68 years). 'Infections and parasites' was the most common cause of natural death (29%). On average, HIV-positive patients were admitted for slightly longer (mean 10.5 days) than HIV-negative patients (9.6 days) and those of unknown HIV status (8.9 days), yet HIV-positive inpatient deaths accounted for the majority (62%) of the total bed days.Conclusions. Even with widespread access to antiretroviral therapy, the majority of inpatient natural deaths at a large public sector hospital in 2010 were of HIV-positive patients and were probably related to HIV. In view of the importance of accurate data on causes of death, both for the HIV programme and to track other diseases, large-scale expansion of this approach over a longer period should be considered

HIV and/or AIDS-related deaths and modifiable risk factors: a descriptive study of medical admissions at Oshakati Intermediate Hospital in Northern Namibia

Background: High rates of HIV infection have decreased life expectancy in many African countries. Regardless of worldwide efforts to escalate treatment; care and prevention strategies; the number of deaths due to AIDS-related disorders is still high. Local healthcare workers suspect that there are modifiable factors in the care of HIV and/or AIDS patients which can be identified and improved. Aim: To describe the HIV and/or AIDS-related causes of adult mortality and identify modifiable factors amongst patients admitted to Oshakati Intermediate Hospital; northern Namibia. Methods: Data was extracted retrospectively and coded using the modified CoDe protocol for AIDS. Modifiable factors relating to the patient; health system or clinical care were identified using a standardised data collection tool.Results: A total of 177 HIV and/or AIDS patients were identified; 94 (53.1%) were male and 120 (68%) had a CD4 count of less than 200 cells/mL. The common HIV-related causes of death were tuberculosis (25.9%); renal failure (15.8%); Pneumocystis jirovecii pneumonia (11.3%); cryptococcal meningitis (9%); HIV wasting syndrome (7.9%) and AIDS-defining malignancy (7.9%). The analysis revealed 281 modifiable factors; patient-related factors were the most common (153 [54.4%]); followed by health system factors (97 [34.5%]) and healthcare personnel factors (31 [11%]).Conclusion: Our findings have highlighted the challenges in overall HIV and/or AIDS inpatient care and surrounding primary care facilities. The identification of specific modifiable factors can be used to reduce mortality by providing training as well as rational monitoring; planning and resource allocation

Youth Mortality Due to HIV/AIDS in South Africa; 2001-2009: An Analysis of the Levels of Mortality Using Life Table Techniques

South Africa has one of the highest HIV/AIDS prevalence rates in the world. It is estimated that 5.38 million South Africans are living with HIV/AIDS. In addition; new infections among adults aged 15+ were reportedly 316 900 in 2011. New infections among children (0-14 years old) was also high in 2011 at 63 600. This paper examines South Africa's mortality due to HIV/AIDS among the youth (15-34 years old). This age group is of fundamental importance to the economic and social development of the country. However; the challenges of youth development remain vast and incomparable. One of these challenges is the impact of HIV/AIDS on mortality. Life table techniques are used to estimate among others; sex differentials in death rates for the youth population; probability of dying from HIV/AIDS before the age of 35 and life expectancy should HIV/AIDS be eradicated from the population. The study used data from the National Registry of Deaths; as collated by Statistics South Africa from 2001 to 2009. Results show that youth mortality due to HIV/AIDS has remained consistently higher among older youths than in younger ones. By sex; mortality due to this cause has also remained consistent over the period; with mortality due to HIV/AIDS being higher among females than males. Cause-specific mortality rates and proportional mortality ratios reflect the increased mortality of older youth (especially 30-34 years old) and females within the South African population. Probability of dying from HIV/AIDS shows that over the period; fluctuations in likelihood of mortality have occurred; but for both males and females (of all age groups) the chances of dying from this cause decreased in 2007-2009

The Pattern of Medical Mortalities in a Specialist Hospital in North-Central Nigeria

Background: Review of causes of morbidity and mortality in health care facilities is an important exercise which gives a picture of the prevailing disease pattern in the particular community and at the same time looks out for any change in the disease pattern over time. This exercise is a necessary component for planning of the health care needs of the community. Objective: To determine the mortality pattern on the medical wards of the Kogi State Specialist Hospital; a tertiary center located in Lokoja; North-Central Nigeria. Methods: A retrospective review of medical records of all patients admitted to the medical wards of the hospital over a period of 18 months (December 2008 - May 2010) was carried out. The information recorded from these sources included the age and gender; diagnosis/cause of death and the duration of admission. Results: A total of six hundred and eighty-four patients were admitted during the period being studied with a predominance of female patients (Female: Male Ratio = 1.07). There were seventy-six deaths (11.1) during the period in question with HIV and related complications accounting for most recorded mortality (32.9) closely followed by non-communicable cardiovascular conditions (hypertension; heart failure and CVD) - 28.9. Conclusion: This study clearly shows that HIV infection and its complications remains the leading cause of death despite the advent of HAART. Clearly there is a need to revisit the strategies of HIV prevention and control. Also there is an urgent need to focus on the prevention and treatment of non-communicable diseases like hypertension and diabetes

Scaling up antiretroviral therapy for HIV-infected children in Côte d'Ivoire: determinants of survival and loss to programme

Objective: To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV- infected children in Cote d'Ivoire. Methods Between 2004 and 2007; HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections; (ii) losses to the programme (i.e. death or loss to follow-up) before ART; (iii) mortality and loss-to-programme rates during 12 months of ART; and (iv) determinants of mortality and losses to the programme. Findings The analysis included 3876 ART-naive children. Of the 1766 with HIV-1 infections (17aged 18 months); 124 (7.0) died; 52 (2.9) left the programme; 354 (20) were lost to follow-up before ART; 259 (15) remained in care without ART; and 977 (55) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up; respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight- for-age z-score -2; percentage of CD4+ T lymphocytes 10; World Health Organization HIV/AIDS clinical stage 3 or 4; and blood haemoglobin 8 g/dl. Conclusion The large-scale programme to scale up paediatric ART in Cote d'Ivoire was effective. However; ART was often given too late; and early mortality and losses to programme before and just after ART initiation were major problems

Human immunodeficiency virus related deaths at Adventist Hospital

Hospital records follow all patients who died during a 21 month period at Blantyre Adventist Hospital were reviewed to determine the cause of death. Sixty deaths were recorded. 22 patients with clinically suspected HIV disease were tested for HIV antibodies and 17 (81 percent) were positive and one result was lost. A number of other patients had clinical findings suggestive of HIV infection; but were not tested. HIV infection is a major cause of premature death at this hospital