Comorbidities and Mortality Among Children Hospitalized With Diarrheal Disease in an Area of High Prevalence of Human Immunodeficiency Virus Infection
- 1 April 2006
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Pediatric Infectious Disease Journal
- Vol. 25 (4), 333-338
- https://doi.org/10.1097/01.inf.0000207400.93627.4c
Abstract
To describe the profile of comorbidities in children admitted with diarrhea to an urban hospital with high human immunodeficiency virus (HIV) prevalence in South Africa and to examine the contribution of comorbidities to inpatient mortality. Data from a retrospective random sample of 319 children were extracted and analyzed from a total of 1145 children hospitalized for diarrhea in 2001. We used multiple logistic regression models to determine the independent effects of HIV infection, malnutrition, pneumonia and bacteremia on inpatient mortality. Overall 68% of the diarrheal admissions were classified as HIV-infected and 61% were classified as malnourished, with 53% having evidence of both. HIV infection was strongly associated with malnutrition, pneumonia and bacteremia. Inpatient mortality was 14% [95% confidence interval (CI), 11-19%]. Mortality was higher among HIV-infected than among uninfected children [crude odds ratio (OR), 6.0; 95% CI 2.1-17.0]. History of low birth weight, previous admission, malnutrition, HIV infection, pneumonia, bacteremia, low hemoglobin, total white blood cell count and serum albumin were significant predictors of mortality in univariate analyses. After adjustment, severe malnutrition (OR 2.1; 95% CI 1.0-4.9), bacteremia (OR 2.9; 95% CI 1.2-7.2) and pneumonia (OR 3.9; 95% CI 1.3-12.0) remained independent predictors of mortality, whereas the association between HIV infection and mortality was significantly diminished (OR 4.0; 95% CI 0.8-18.1). In a setting of high HIV prevalence, malnutrition, bacteremia and pneumonia contribute independently to death in children hospitalized with diarrheal disease.Keywords
This publication has 17 references indexed in Scilit:
- Identifying deaths from AIDS in South AfricaAIDS, 2005
- UNDERNUTRITION AS AN UNDERLYING CAUSE OF MALARIA MORBIDITY AND MORTALITY IN CHILDREN LESS THAN FIVE YEARS OLDThe American Journal of Tropical Medicine and Hygiene, 2004
- Intestinal and Systemic Infection, HIV, and Mortality in Zambian Children With Persistent Diarrhea and MalnutritionJournal of Pediatric Gastroenterology and Nutrition, 2001
- Effect of human immunodeficiency virus infection on episodes of diarrhea among children in South AfricaThe Pediatric Infectious Disease Journal, 2000
- Paediatric HIV infection in a rural South African district hospitalJournal of Tropical Pediatrics, 2000
- Gram-negative bacillary bacteremia in human immunodeficiency virus type 1-infected childrenThe Pediatric Infectious Disease Journal, 2000
- Diarrheal Mortality in US InfantsArchives of Pediatrics & Adolescent Medicine, 1998
- Clinical spectrum of human immunodeficiency virus disease in children in a West African cityThe Pediatric Infectious Disease Journal, 1996
- Persistent diarrhea associated with AIDSActa Paediatrica, 1992
- Persistent and acute diarrhoea as the leading causes of child mortality in urban Guinea BissauTransactions of the Royal Society of Tropical Medicine and Hygiene, 1992