Time to death and its predictors among under-five children on ART in public hospitals of Addis Ababa

What is it about?

even though, there were visible efforts aimed at improving HIV infected child survival have driven large reductions in mortality among children under- five years of age, presence of persistent and intolerably high numbers of child and young adolescent deaths mean more work remains to be done to address the specific survival needs of children and young adolescents in Ethiopia. So, this study is aimed to determine time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Ethiopia. From 2017 to 2022. An institution-based retrospective follow-up study was conducted among 415 HIV-infected children at selected public hospitals of the Addis Ababa town administration. Computer generated simple random sampling technique was used to select each sampling unit. Data was extracted using a structured data extraction checklist. Data were entered into EPI data 4.2 and analyzed using STATA 14. The child mortality rate was calculated. The Cox proportional hazards regression model was fitted to identify predictor factors. The result of the study was presented using text, tables, graphs, and charts. An adjusted hazard ratio with a 95% confidence interval and a p-value less than 0.05 was used to declare the level of significance. The current study found that, from total of 415 on ART, 41(9.88%) children were died during the following period. The study participants were followed for a total of 8237 person- months of risk time. The overall mortality rate was 4.98 (95% CI: 3.67-6.77) per 1000 child-months. The estimated survival after starting ART was 61.42% at 56 months of follow-up. Severe underweight (AHR = 3.19; 95% CI: 1.32-7.71), tuberculosis (AHR = 3.86; CI: 1.76-8.47), low hemoglobin level (AHR = 2.51; CI: 1.02- 6.20), and advanced WHO clinical stages at enrolment (AHR=3.38; CI: 1.08- 10.58) were predictors of death among HIV-infected under-five children on ART.

Featured Image

Why is it important?

Worldwide under-five children death due to HIV/AIDS accounted for 1.4% in 2015 and over 120,000 children died due to AIDS-related illnesses in 2016, this equates to 328 deaths every day. In fact, children aged 0–4 years living with HIV are more likely to die than any people living with HIV of any other age. Despite this significant progress, the number of under-five children becoming newly infected and dead with HIV remains unacceptably high, for instance about 150,000 children became infected with HIV in 2015, down from 490,000 in 2000. In Ethiopia estimated 722,248 people are living with HIV, current prevalence is 1.16%, with children accounting for around 10%. In 2018 PMTCT coverage, which is assumed to be major preventive factor for under-five child deaths, was still in between 63% to 93%, which needs high effort. Coverage of early infant diagnosis of HIV is estimated at around seventy percent and in 2019 from all causes of under-five mortality HIV/AIDS accounts for 2%. Although visible efforts aimed at improving HIV infected child survival have driven large reductions in mortality levels among children under- five years of age, presence of persistent and intolerably high numbers of child and young adolescent deaths mean more work remains to be done to address the specific survival needs of children and young adolescents in Ethiopia. So, this study is aimed to determine time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Ethiopia. From 2017 to 2022. Despite the availability of evidence regarding the issues; evidence regarding death is limited in developing countries like Ethiopia. Study was conducted in order to have a nearest five years retrospective cohort after Ethiopia implemented test and treatment program initiated. HIV-infected under- five children after initiation of ART and data on the predictors HIV-infected under five children limited or scarce, particularly in Addis Ababa. Most previous research focus on adult age group, study among under- five children after antiretroviral treatment are limited. In Ethiopia, neonatal mortality rate is increase and other previous studies recommended to focus on this age group, so age specific research is necessary.

Perspectives