Assessment of clinical profiles, and treatment outcomes for children with diabetic ketoacidosis, in two hospitals selected from Addis Ababa, Ethiopia, 2020

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors

The effects of Ghana's capitation policy on hospital Under-5 mortality in the Ashanti Region

Objective: The study estimated the capitation policy's effect on the under-5 mortality (U5MR) rate in hospitals in Ashanti Region. Design: We used an interrupted time series design to estimate the impact from secondary data obtained from the DHIMS-2 database. Monthly under-5 deaths and the number of live births per month were extracted and entered into Stata 15.0 for analyses. The U5MR was calculated by dividing the number of live deaths by the number of live births for each of the 60 months of the study. Setting: Health facilities of the Ashanti Region with Data in the DHIMS 2. Intervention: the level and trend of U5MR for 31 months during the Capitation Policy implementation (January 2015 to July 2017) were compared with the level and trend 29 months after the withdrawal of the capitation policy (August 2017 to December 2019). Outcome measures: changes in trend or level of U5MR after the withdrawal of capitation. Main Results: During the capitation policy, monthly U5MR averaged 10.71 +/-2.71 per 1000 live births. It declined to 0.03 deaths per 1000 live births (p=0.65). After the policy withdrawal, the immediate (increase of 0.01 per 1000live births) and the trend (decline of 0.13 deaths per 1000 live births per month) were still not statistically significant. Conclusion: We conclude that the capitation policy did not appear to have influenced under-5 mortality in the Ashanti Region. The design of future healthcare payment models should target quality improvement to reduce under-5 mortalities

Neonatal morbidity and mortality: A 5-year analysis at federal medical centre, Gusau, Zamfara State, Northwest Nigeria

OBJECTIVES: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. MATERIAL AND METHODS: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). RESULTS: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. CONCLUSION: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.

linical Audit of Stillbirths at a Faith-Based Secondary Health Centre in Ibadan, Nigeria: A Six-Year Review

Objective:The determine the prevalence of stillbirth and identify associated factors among parturients in a faith-based secondary health centre.Method:This was a retrospective audit of two hundred and twenty-five stillbirth deliveries at the Our Lady of Apostle Catholic Hospital at Oluyoro, OkeOffainIbadan, Nigeria,betweenstst1January2010, and 31December, 2015. Data was extractedfromhospitalrecordsforsociodemographiccharacteristics, obstetricfactors,complications, and outcomes of pregnancy. Data analysis was done using SPSS version 20 and the level of statistical significance was set at p < 0.05. Results:The stillbirth rate was 27.75 per 1000 births. More than half (129; 57.4%) were macerated. The ratio of still birth rate among the booked and unbooked parturients was 1:21. The commoncausesofstillbirthswerehypertensivedisordersinpregnancy (24.9%), anaemia in pregnancy (20.4%); while the least were congenital anomalies (1.0%) and gestational diabetes mellitus (1.0%Conclusion: This study confirmed that most of the stillbirths were due to unsupervised or poorly supervised pregnancies. There is need to ensure quality antenatal care services for the early detection and management of risk factors in order to reduce the burden of stillbirths.

Neonatal morbidity and mortality: a 5-year analysis at federal medical centre, Gusau, Zamfara State, Northwest Nigeria

Objectives: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. Material and Methods: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). Results: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. Conclusion: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.

Risk factors for under-five mortality in Ethiopia: Evidence from the 2016 Ethiopian Demographic and Health Survey

Background. The under-five child mortality (U5CM) rate is the most important sensitive indicator of the socioeconomic and health status of a community, and the overall development of a nation. Despite the world having made substantial progress in reducing child mortality since 1990, the global U5CM rate was 41 per 1 000 in 2016. The rate is higher in Ethiopia than in several other low- and middle-income countries. Objectives. To estimate the effects of socioeconomic and demographic factors on U5CM in Ethiopia. Methods. A community-based cross-sectional study was conducted on 10 641 under-five children. The 2016 Ethiopian Demographic and Health Survey data were used for this research. Binary logistic regression was employed to identify factors affecting the U5CM rate. Results. The U5CM rate was 60 deaths per 1 000 live births. Children who were delivered at home (adjusted odds ratio (aOR) 1.30; 95% CI 1.04 - 1.63) and male (aOR 1.36; 95% CI 1.15 - 1.60) were at an increased risk of death. Children whose family size was between 1 and 3 (aOR 5.54; 95% CI 4.08 - 7.54), and 4 and 6 (aOR 1.94; 95% CI 1.55 - 2.43) were more likely to die before age 5 than those whose family size was ≥6. First-born (aOR 0.49; 95% CI 0.36 - 0.67), second- or third-born (aOR 0.51; 95% CI 0.39 - 0.67) and fourth- or fifth-born (aOR 0.71; 95% CI 0.56 - 0.91) children were less likely to die than those who were sixth-born and above. Similarly, singleton children (aOR 0.20; 95% CI 0.15 - 0.28), children residing in urban communities (aOR 0.55; 95% CI 0.40 - 0.76) and children whose families had protected sources of water (aOR 0.84; 95% CI 0.71 - 0.99) had reduced risks of death compared with their respective counterparts. Conclusions. The present study identified risk factors for under-five mortality in Ethiopia. Programmes to reduce under-five mortality in Ethiopia must focus on the place of delivery, households with unprotected sources of drinking water and families residing in rural areas

Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and Inter VA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making

Demographics and predictors of mortality in children undergoing resuscitation at Khayelitsha Hospital, Western Cape, South Africa

Background. The clinical outcomes of paediatric patients requiring resuscitation depend on physicians with specialised knowledge,equipment and resources owing to their unique anatomy, physiology and pathology. Khayelitsha Hospital (KH) is a government hospital located near Cape Town, South Africa, that sees ~44 000 casualty unit patients per year and regularly functions at more than 130% of the bed occupancy. Many of these patients are children requiring resuscitation.Objectives. We sought to describe characteristics of children under the age of 12 who required resuscitation upon presentation to KH,determine predictors of mortality, and compare paediatric volume to specialist physician presence in the unit.Methods. A retrospective chart review was performed on patients younger than 12 years who were treated in the resuscitation area of KH during the six-month period from 1 November 2014 to 30 April 2015.Results. A total 317 patients were enrolled in the study with a median age of 14 months. The top 5 diagnoses were: pneumonia (n=58/317);neonatal sepsis (n=40/317); seizures (n=37/317); polytrauma (n=32/317); and acute gastroenteritis complicated by septic shock (n=28/317). Overall mortality was 7% (n=21/317) and mortality in children less than 1 month of age was 12% (n=5/42). Premature birth was associated with a mortality odds ratio of 8.44 (p=0.002). More than two-thirds (73%; n=231/317) of paediatric resuscitations occurred when specialist physicians were not physically present in the unit.Conclusion. The study findings indicate that children under one month of age with a history of prematurity are at high risk and may benefit most from paediatric-specific expertise and rapid transfer to a higher level of care

Individual versus community-level measures of women decision-making involvement and child survival in Nigeria

Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. Objectives. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. Methods. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. Results. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child's birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. Conclusion. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women's empowerment programmes targeting maternal and child health outcomes should also focus on communities

Where do Children Die and what are the Causes? Under-5 Deaths in the Metro West Geographical Service Area of the Western Cape; South Africa; 2011

BACKGROUND:Accurate child mortality data are essential to plan health interventions to reduce child deaths.OBJECTIVES:To review the deaths of children aged etlt;5 years during 2011 in the Metro West geographical service area (GSA) of the Western Cape Province (WC); South Africa; from routine data sources.METHODSA retrospective study of under-5 deaths in the Metro West GSA was done using the WC Local Mortality Surveillance System (LMSS); the Child Healthcare Problem Identification Programme (Child PIP) and the Perinatal Problem Identification Programme (PPIP); and linking where possible.RESULTS:The LMSS reported 700 under-5 deaths; Child PIP 99 and PPIP 252; with an under-5 mortality rate of 18 deaths per 1 000 live births. The leading causes of death were pneumonia (25%); gastroenteritis (10%); prematurity (9%) and injuries (9%). There were 316 in-hospital deaths (45%) and 384 out-of-hospital deaths (55%). Among children aged etlt;1 year; there were significantly more pneumonia deaths out of hospital than in hospital (144 (49%) v. 16 (6%); petlt;0.001). Among children aged 1 - 4 years there were significantly more injury-related deaths out of hospital than in hospital (43 (47%) v. 4 (9%); petlt;0.001). In 56 (15%) of the cases of out-of-hospital death the child had visited a public healthcare facility within 1 week of death. Thirty-six (64%) of these children had died of pneumonia orgastroenteritis. CONCLUSIONS:Health interventions targeted at reducing under-5 deaths from pneumonia; gastroenteritis; prematurity and injuries need to be implemented across the service delivery platform in the Metro West GSA. It is important to consider all routine data sources in the evaluation of child mortality

Estimation of Maternal and Child Mortality One Year after User-Fee Elimination: an Impact Evaluation and Modelling Study in Burkina Faso

Objective To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. Methods: Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change; we used interrupted time series; propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility; and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea; antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios. Findings Coverage increased for all variables; however; the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact; the intervention saved approximately 593 (estimate range 168-1060) children's lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189-228) in 2009. If a similar intervention were to be introduced nationwide; 14 000 t o 19 000 ( estimate range 4000-28 000) children's lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios. Conclusion In this setting; eliminating user fees increased use of health services and may have contributed to reduced child mortality

Evaluation of IgG antibodies against respiratory syncytial virus (RSV), and associated risk factors for severe respiratory tract infections in pre-school children in North-central, Nigeria

Background: Childhood mortality and morbidity due to RSV is increasing. Our current study was aimed at determining the sero-prevalence rate of RSV IgG antibodies and investigates certain known risk factors for RSV disease severity in infants and pre-school children presenting with various forms of respiratory tract infections in Ilorin, Nigeria. Materials and Methods: About 280, children and 30, aged matched controls were enrolled into the study at the specialist hospital Ilorin. Blood testing for anti RSV IgG was done using a commercial ELISA kit by IVD Research Inc® Carlsbad. California U.S.A. Information regarding Nutritional status, socio-economic status and other demographic variables were collected. Results: A prevalence rate of 85.7% was recorded among tested children and 23.3%, in controls, across age groups and gender. A statistically significant difference in age groups were recorded among patients with LRTI, (p <0.05), age <1 41%, age 1 <5, 27.6%. This was also the case for children with SRTI (Pneumonia and Bronchiolitis), with age < 1yr, 9%, and 1 <5yr, 19.8%. Analysed risk factors for disease severity showed thatnutritional status of children were statistically significant for disease severity, p-value, 0.039 (Chi square test). Conclusions: We report a high level of exposure to RSV in infancy and early childhood among children from a representative population in a major central Nigerian City, further studies into neutralising antibody levels and subtype distribution of RSV are advocated

Coverage and Equitability of Interventions to Prevent Child Mortality in Rural Jimma and West Hararghe Zones; Oromia Region; Ethiopia

Background: Interventions to prevent childhood illnesses are important components of the Ethiopian Health Extension Program (HEP). Although the HEP was designed to reduce inequities in access to health care; there is little evidence on equitability of preventive interventions in Ethiopia. Purpose: This article describes coverage of preventive interventions and how many interventions individual children received. We also examined which factors were associated with the number of preventive interventions received; and assessed the extent to which interventions were equitably distributed. Methods: We conducted a cross-sectional survey in 3;200 randomly selected households in the rural Jimma and West Hararghe Zones of Ethiopia's Oromia Region. We calculated coverage of 10 preventive interventions and a composite of eight interventions (co-coverage) representing the number of interventions received by children. Multiple linear regressions were used to assess associations between co-coverage and explanatory variables. Finally; we assessed the equitability of preventive interventions by comparing coverage among children in the poorest and the least poor wealth quintiles. Results: Coverage was less than 50 for six of the 10 interventions. Children received on average only three of the eight interventions included in the co-coverage calculation. Zone; gender; caretaker age; religion; and household wealth were all significantly associated with co-coverage; controlling for key covariates. Exclusive breastfeeding; vaccine uptake; and vitamin A supplementation were all relatively equitable. On the other hand; coverage of insecticide-treated nets or indoor residual spraying (ITN/IRS) and access to safe water were significantly higher among the least poor children compared to children in the poorest quintile. Conclusion: Coverage of key interventions to prevent childhood illnesses is generally low in Jimma and West Hararghe. Although a number of interventions were equitably distributed; there were marked wealth-based inequities for interventions that are possessed at the household level; even among relatively homogeneous rural communities

Keeping Children Alive and Healthy in South Africa : how do we Reach this Goal? Perspectives from a Paediatrician in a District Clinical Specialist Team

District Clinical Specialist Teams (DCSTs) are part of the primary healthcare re-engineering process in South Africa. These multi-disciplinary clinical teams were established throughout the country in 2012; and their main role is reduction of maternal and childhood mortality and morbidity through improvement of service delivery at primary care level in their health districts. The Tshwane DCST is used as a case study to describe the challenges encountered in establishing the team within the complex district health system. On the other hand; the cross-disciplinary approach has proved itself a winning combination if the team shares a common vision and has a work plan to guide the priorities and facility support visits. Through their clinical expertise; and using extensive networking; DCSTs are well positioned in the health system to have a strong positive effect on child health

Whose Child is Dying? Household Characteristics and Under-5 Mortality in Nigeria

Background. Over 2 000 under-5-year-olds die daily in Nigeria from vaccine-preventable diseases; placing the country as the third largest contributor to the global under-5 mortality rate. Nigeria is at serious risk of not meeting the Millennium Development Goal (MDG) of reducing child mortality by two-thirds (i.e. from an under-5 mortality rate of 93/1 000 in 1990 to 31/1 000 in 2015).Objective. To examine the association between household-level variables and under-5 mortality in Nigeria.Methods. Data were drawn from the 2008 Nigeria Demographic and Health Survey; which elicited information on demographic and health indicators at the national and state levels. A nationally representative sample of 36 800 households was selected. Data were collected from 33 385 women of reproductive age (15 - 49 years) and who had given birth to at least one live infant in the 5 years preceding the survey. Data were analysed using a multilevel-model approach.Results. In total; there were 104 808 live births; 18 121 (17.29) children died as under-5s and 86 687 (82.71) survived. Poverty; number of children ever born in a household; number of under-5s in the household; place and region of residence; maternal and paternal age; and maternal and paternal education level were critical determinants of under-5 mortality.Conclusion. The rate of under-5 mortality remains high in Nigeria. This will not be resolved until household-focused interventions are implemented using a tailored framework; and the need to improve maternal education in the country is addressed

Infant Feeding Practices during the First 6 Months of Life in a Low-Income area of the Western Cape Province

Background. Exclusive breastfeeding during the first 6 months of life protects against infant morbidity and mortality. Few studies describe the infant feeding practices of mothers living in low-income areas of the Western Cape Province of South Africa (SA).Objective. To describe the infant feeding practices of mothers of infants younger than 6 months in two low-income communities of SA. Methods. A cross-sectional community-based study using a structured questionnaire; and seven focus group discussions were conducted from February to August 2011 in Avian Park and Zwelethemba in Worcester; an urban area in the Western Cape. Results. Seventy-seven per cent of participants (n=108) had initiated breastfeeding. At the time of the study; 6 (n=8) breastfed exclusively. Ninety-four per cent (n=132) applied suboptimal breastfeeding practices: 36 (n=51) breastfed predominantly; 27 (n=38) breastfed partially and 31 (n=43) did not breastfeed. Ninety per cent (n=126) of the mothers had introduced water; of whom 83 (n=104) had done so before their infants were 1 month old. Forty-four per cent (n=61) of the mothers had introduced food or formula milk; of whom 75 (n=46) had done so before their infants were 3 months old. Qualitative findings indicated that gripe water; Lennon's Behoedmiddel and herbal medicines were also given to infants. Nutritive liquids and/or food most commonly given as supplementary feeds were formula milk and commercial infant cereal. Conclusion. Exclusive breastfeeding (EBF) during the first 6 months of life was a rare practice in these low-income communities. Water; non-prescription medicines and formula milk and/or food were introduced at an early age

Community-Based Agricultural Interventions in the Context of Food and Nutrition Security in South Africa

Despite South Africa being a food-secure country in terms of aggregate food availability; it is listed by the World Health Organization as one of 36 high-burden countries; home to large numbers of stunted children. Recent findings; in the context of both over- and under-nutrition; have indicated that adult and child malnutrition rates have deteriorated in South Africa. The complementarities and synergies between food availability; access and utilisation need to be aligned in interventions used to address and strengthen food and nutrition security. This is particularly pertinent in the context of the widespread AIDS epidemic which interacts with food insecurity in complex ways. It is against this backdrop that home-grown or small-scale food production is explored as a feasible contributor to food and nutrition security for the rural poor with particular emphasis on contextual and technical factors. By illustrating a few successful models of home gardening;the evidence for addressing micronutrient deficiencies in these types of interventions is presented. The challenges to establish sustainable home gardening practices and the efforts needed to address gender-distinctive issues are discussed. The case is made for community-based agricultural interventions as a critical component of the various interventions used to address food and nutrition security at the household level

Impact of HIV/AIDS on Child Mortality before the Highly Active Antiretroviral Therapy Era: a Study in Pointe-Noire; Republic of Congo

Few studies have documented the contribution of HIV/AIDS to mortality among children under 15 years. From June 30 to October 19; 2001; all child deaths (n=588) registered to the morgue and/or hospitals of the city of Pointe-Noire; Congo; were investigated using a combined approach including an interview of relatives and postmortem clinical and biological HIV diagnosis. Twenty-one percent of children were HIV positive; while 10.5of deaths were attributed to AIDS. The most common causes of death in HIV-infected children were pneumonia (30); pyrexia (22); diarrhoea (16) and wasting syndrome (16). Infant mortality rate was estimated 6.3 times higher in children born to HIV-infected mothers compared to HIV-uninfected mothers. This study provides a direct measure of HIV/AIDS as impact on child mortality using a rapid and reliable method. A significant number of deaths could be prevented if HIV infection was diagnosed earlier and infants were provided with antiretroviral treatments

Declining child mortality in northern Malawi despite high rates of infection with HIV

Objective:To determine whether routine surveys; such as the Demographic and Health Surveys (DHS); have underestimated child mortality in Malawi : Methods :Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32 000. After initial census; births and deaths were reported by village informants and updated monthly by project enumerators. Cause of death was established by verbal autopsy whenever possible. The likely impact of human immunodeficiency virus (HIV) infection on child mortality was also estimated from antenatal clinic surveillance data. Overall and age-specific mortality rates were compared with those from the 2004 Malawi DHS. Findings:Between August 2002 and February 2006; 38 617 person-years of observation were recorded for 20 388 children aged 15 years. There were 342 deaths. Re-census data; follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births; under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30 lower than those from national estimates as determined by routine surveys Conclusion: The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates

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