The effect of HIV on morbidity and mortality in children with severe malarial anaemiaReport as inadecuate

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Malaria Journal

, 6:143

First Online: 31 October 2007Received: 06 October 2006Accepted: 31 October 2007


BackgroundMalaria and HIV are common causes of mortality in sub-Saharan Africa. The effect of HIV infection on morbidity and mortality in children with severe malarial anaemia was assessed.

MethodsChildren <5 years old were followed as part of a prospective cohort study to assess the transfusion-associated transmission of blood-borne pathogens at Mulago Hospital, Kampala, Uganda. All children were hospitalized with a diagnosis of severe malarial anaemia requiring blood transfusion. Survival to different time points post-transfusion was compared between HIV-infected and uninfected children. Generalized estimating equations were used to analyse repeated measurement outcomes of morbidity, adjusting for confounders.

FindingsOf 847 children, 78 9.2% were HIV-infected. Median follow-up time was 162 days inter-quartile range: 111, 169. HIV-infected children were more likely to die within 7 days Hazard ratio HR = 2.86, 95% Confidence interval CI 1.30–6.29, P = 0.009 and within 28 days HR = 3.70, 95% CI 1.91–7.17, P < 0.001 of an episode of severe malarial anaemia, and were more likely to die in the 6 months post-transfusion HR = 5.70, 95% CI 3.54–9.16, P < 0.001 compared to HIV-uninfected children. HIV-infected children had more frequent re-admissions due to malaria within 28 days Incidence rate ratio IRR = 3.74, 95% CI 1.41–9.90, P = 0.008 and within 6 months IRR = 2.66, 95% CI 1.17 – 6.07, P = 0.02 post-transfusion than HIV-uninfected children.

ConclusionHIV-infected children with severe malarial anaemia suffered higher all-cause mortality and malaria-related mortality than HIV-uninfected children. Children with HIV and malaria should receive aggressive treatment and further evaluation of their HIV disease, particularly with regard to cotrimoxazole prophylaxis and antiretroviral therapy.

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Author: Samuel Malamba - Wolfgang Hladik - Arthur Reingold - Flora Banage - Willi McFarland - George Rutherford - Derrick Mimbe - E


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