Caracterización clínico epidemiológica de niños huerfanos con infección por VIH / Clinical Epidemiological Characterization of orphaned children with HIV infection

Antecedentes: En 2005, UNICEF, ONUSIDA iniciaron la campaña Únete por la Niñez, Únete con la juventud, Únete para vencer al sida, que se centra en cuatro esferas clave: prevención de la transmisión de la madre al niño, tratamiento pediátrico del sida, programas educativos para fomentar la preven- ción, y el apoyo a niños y niñas huérfanos con VIH en situación de vulnerabilidad. Objetivos. El Centro de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas (CAI /HNMCR) atiende a 365 niños VIH positivos, con este estudio se pretende conocer los aspectos clínicos y epidemioló- gicos que los caracteriza. Pacientes y Métodos: Se realizó un estudio descriptivo transversal, obteniéndose una muestra aleatoria de 67 niños huérfanos VIH positivos atendidos en el CAI/HNMCR. Utilizando para la recolección de datos la revisión del expediente clínico y la entrevista, tomando en cuenta las variables clínicas y epidemiológicas escogidas. Resultados: De los niños huérfanos con VIH el 70% tienen más de 13 años de edad y el 3% tiene menos de 5 años. El 38.8% viven en hogares destinados a su cuidado. El 100% de los niños huérfanos con VIH la vía de transmisión del virus fue transmisión perinatal, El 18% de los niños huérfanos con VIH son categoría clínica e inmunológica C3 y el 40% del total de estos niños han ameritado tratamiento antirretroviral de gran actividad (TARGA) de segunda línea en algún momento. Conclusiones: Es necesaria una respuesta más diligente como política de país que garantice que los derechos de estos menores en condiciones vulnerables sean respetados...(AU)

Situación social - familiar y de salud de los huérfanos de muertes maternas en trance obstétrico. Hospital regional "Dr. Ramón Carrillo". Santiago del Estero 2008 / Situação-familiar social e de saúde dos órfãos demortes maternas em estágio obstétrico. Hospitalregional “Dr. Ramon Carrillo”. Santiago del Estero.2008 / Health, social and family situation of orphans due to maternal deaths in obstetric situations regional hospital “Dr. Ramon Carrillo”, Santiago del Estero - 2008

Investigación cuanti-cualitativa. Se evaluó estado de salud(crecimiento y desarrollo) con normas de OMS/SAP, PruebaNacional de Pesquisa y situación social- familiar; de huérfanosmenores de 5 años, de madres fallecidas en trance obstétrico2008, mediante visitas domiciliarias, entrevistas semiestructuradas.Se identificaron 16 muertes maternas, 12 con hijosprevios, que dejaron 51 huérfanos, 7 menores de 5 años.En crecimiento: 57% eutróficos; 29% desnutridos crónicos,14% sobrepeso. En desarrollo: Área personal-social (100%);motricidad fina y gruesa (86%), lenguaje (42%) acordes aedadLa situación social-familiar frágil; 87% pobres, 13%indigentes; 100% sin cobertura de salud, con serviciosbásicos carecientes, insuficientes o inadecuados. Resolvíanproblemas de salud con remedios caseros y/o curanderos.Escasa protección social.Conclusión: Estado de salud de los huérfanos, satisfactorio.En desarrollo algunos con retrasos en motricidad y lenguaje. En las familias cuidadoras aumentó la precariedad y vulverabilidad. Mostraron fuertes lazosde protección y amparo, hacia los huérfanos.

Quanti-qualitative research. Health condition (growth and development) was evaluatedusing WHO/SAP standars, PESQUISA NATIONAL TEST*; and the social family situationof motherless children under 5, from mothers who died in obstetric situations in 2008 wasassessed through home visits and semi-structured surveys. In growth: 57% eutrophic; 29%chronic undernurished; 14% over-weight. In development: Personal-social area (100%);fine and gross motor skills (86%), language (42%) according to age. Fragile social familysituation; 87% poor; 13% indigents, 100% with no medical coverage and absense, shortageor inadequacy of basic services. They solved health problems with homemade medicineor healers. Poor social protection.Conclusion: Health condition of motherless children, satisfactory. In deveplomentsome presented delays in language and motor skills. Precariousness and vulnerabilityhave increased in carer families. They showed strong bonds of protection towards thesemotherless children.

Orfandade por aids ou por homicídio apresenta efeitos sobre o estado nutricional das crianças? / Does orphanhood by aids or by homicide effect nutritional status of children?

O artigo tem como objetivos avaliar o estado nutricional de órfãos por aids ou homicídios residentes em São Paulo e estimar a associação de índices nutricionais com variáveis relacionadas à orfandade. Trata-se de estudo transversal de base domiciliar que utilizou amostra representativa de 484 indivíduos de 5 a 14 anos que perderam um ou ambos os pais durante os anos de 2000 e 2004 devido à aids ou a homicídio no município de São Paulo. A avaliação nutricional foi feita com o índice de massa corporal-para-idade (IMC) e da altura-para-idade (altura). A associação entre os índices nutricionais e as variáveis relacionadas à orfandade foi estimada em análise hierárquica, com uso de modelo de regressão linear múltiplo. Órfãos por aids ou homicídios diferiram quanto às características da orfandade e à idade média. As condições econômicas, domiciliares, o estado de saúde e o estado nutricional foram semelhantes entre os grupos. O déficit de IMC ocorreu em 1,3% das crianças abaixo de 10 anos e em 2,1% dos adolescentes. O déficit de altura ocorreu em 0,7% das crianças e em 4,0% dos adolescentes. O excesso de peso ocorreu em 19% e 20% das crianças e adolescentes, respectivamente. A análise hierárquica indicou ausência de efeito das variáveis relacionadas à orfandade sobre o IMC ou a altura; o principal determinante do estado nutricional foi de natureza econômica. Os órfãos por aids ou homicídio de São Paulo apresentaram estado nutricional semelhante e majoritariamente influenciado pela situação econômica. O perfil nutricional identificado no grupo, caracterizado pelo excesso de peso, sugere que os órfãos de São Paulo não apresentam riscos adicionais decorrentes da orfandade.

The aims of this paper were to evaluate the nutritional status of children orphaned by aids or homicides in the city of São Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. The study was a household survey carried out between 2006 and 2007. We sampled 484 children representative of São Paulo, 5-14 years old who lost either or both of their parents from aids or homicides between 2000 and 2004. We selected body-mass-index-for-age (BMI) and height-for-age (height) as outcomes for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating BMI-for-age and height-for-age associated factors. Children from aids and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar between groups. Underweight accounted for 1.3% and 2.1% of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7% and 4.0% of children and adolescents, respectively. Overweight accounted for 19% and 20% of children and adolescents, respectively. BMI and height were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in the hierarchical model. Economic status was the main determinant of the nutritional profile. Nutritional status of children orphaned by aids or homicides in São Paulo was similar and mainly influenced by economic status. The nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhood-related variables.

Demographic and clinical features of orphans and nonorphans at a pediatric HIV centre in north India.

Objective. To determine the prevalence of orphanhood among HIV positive children and to compare their social and demographic and clinical characteristics with that of HIV-positive non-orphans. Methods. From February 2008 through March 2009, data was collected from 148 children registered at the antiretroviral (ART) clinic of a tertiary care hospital in Delhi, on their demographic profile, HIV status of parents, orphan status and cause of parental death, mode of transmission of the infection, current caregiver, school enrolment and clinical and immunologic parameters of HIV infection at presentation. Results. The prevalence of orphanhood was 49.3%. Majority of the orphans were paternal orphans. The primary caregiver was either the surviving parent or extended family members. The orphans were older at presentation and had shorter mean duration of follow-up. They lagged behind the non-orphans in immunisation, nutritional status, school enrolment and attendance and socioeconomic status. They presented more frequently with severe immunosuppression and had a higher prevalence of opportunistic infections. There was no significant difference between the orphans and the non-orphans in the WHO clinical stage of presentation and adherence to ART. Conclusions. The prevalence of orphanhood among the HIV-positive children is high. Although extended family is a cornerstone for care of HIV-positive orphans, these families are overwhelmed by the added responsibility of these children. Larger community-based studies are needed to determine the true magnitude of orphanhood and to evolve methods to socially and financially support the families taking care of these children.