An investigation into the role of HIV exposure status in infectious disease mortality in children in Western Cape

Reed, Robert Anthony

An investigation into the role of HIV exposure status in infectious disease mortality in children in Western Cape

Master Thesis

2015

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Objective: To establish whether there is an association between HIV exposure and infectious disease mortality in children admitted to hospital in the Western Cape. Also to identify additional risk factors associated with mortality and the prevalence of HIV exposure. Methods: A case-control design was used to compare the HIV exposure status of 93 cases admitted with an infectious disease who died with 93 controls admitted with an infectious disease who did not die. Clinical and demographic data were collected via record review at three hospitals in the Western Cape . Factors associated with mortality were identified through regression analysis. Findings: 38.71% (36/93) of cases were HIV exposed versus 22.58% (21/93) of controls (p=0.017). 32.36% (30/93) of cases were HIV exposed uninfected (HEU) versus 18.28% (17/93) of controls (p=0.06). Being HEU was a risk factor for mortality after adjusting for age, sex, feeding practice, and main infection. The odds of death in HEU children was 2.29 times greater than in HUU (aOR: 2.29, 95% CI: 1.06-5.0). Age, sex, and feeding practice confounded the association between HIV exposure-infection and mortality. LRTI, septicaemia, and meningitis were all significantly associated with mortality at the 5% level. Children admitted with septicaemia demonstrated a 13.44 times increased odds of death (aOR: 13.44, 95% CI: 3.35-53.99). Conclusion: Children born to HIV positive mothers should be considered a vulnerable group even if vertical transmission has been prevented. Determination of exposure status could be a valuable tool for identifying children at increased risk of death. Septicaemia and meningitis also present a challenge in critical care in our sample.