Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort studyReport as inadecuate




Pre-ART nutritional status and its association with mortality in adult patients enrolled on ART at Fiche Hospital in North Shoa, Oromia region, Ethiopia: a retrospective cohort study - Download this document for free, or read online. Document in PDF available to download.

BMC Research Notes

, 9:512

Public health

Abstract

BackgroundHuman immunodeficiency virus HIV compromises the nutritional status of infected individuals and in turn, malnutrition worsens the effects of the infection itself by weakening the immune system consequently accelerating disease progression and death. However, few studies have examined the association between nutritional status at antiretroviral therapy ART initiation and early mortality. Therefore, this study assesses pre-ART nutritional status and other baseline characteristics and mortality among adult patients on ART at Fiche Hospital, Ethiopia.

MethodsA retrospective cohort study was conducted among 489 ART enrolled adult patients between August 01, 2006 and September 30, 2013 in Fiche Hospital. Study participants were selected by using systematic random sampling method. Actuarial table was used to estimate survival of patients after ART initiation and log rank test was used to compare the survival curves. Cox proportional-hazard regression was used to determine independent predictors of time to death.

ResultsMost of the study subjects were females 254 51.9%. A total of 489 patients were included in the analysis, of whom 87 died during a median study follow-up of 22 months. The estimated mortality among malnourished was 21, 28, 33, and 38% at 5, 10, 15, and 25 months respectively with mortality incidence density of 5.63 deaths per 100 person years. The independent predictors of mortality were: BMI <18.5 kg-m AHR = 5.4 95% CI 3.03–9.58, baseline ambulatory functional status AHR = 3.84; 95% CI 2.19–6.74, bedridden functional status AHR = 4.78; 95% CI 2.14–10.65, WHO clinical stage III AHR 2.21; 95% CI 1.16–4.21, WHO clinical stage IV AHR 4.05; 95% CI 1.50–10.97 and CD4 count less than 200 cells-μl AHR = 2.95; 95% CI 1.48–5.88, two and more opportunistic infections AHR 2.30; 95% CI 1.11–4.75.

ConclusionsUndernutrition at the time of ART initiation was associated with increased risk of death, particularly during the first 3 months after ART initiation. Interventions to promote earlier HIV diagnosis and treatment and integrating nutrition counseling at all stages of ART implementation may improve ART outcomes in this vulnerable population.

KeywordsAntiretroviral therapy Malnutrition Mortality AbbreviationsAHRadjusted hazard rate

AIDSacquired immunodeficiency syndrome

ARTantiretroviral therapy

BMIbody mass index

SRSsystematic random sampling

CHRcrude hazard rate

CIconfidence interval

Hgbhemoglobin

HIVhuman immunodeficiency virus

HRhazard rate

IQRinter quartile range

Kgkilogram

OIopportunistic infection

PLWHApeople living with HIV-AIDS

PYOperson-year observation

SDstandard deviation

TBtuberculosis

WHOWorld Health Organization

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Author: Kokeb Tesfamariam - Negga Baraki - Haji Kedir

Source: https://link.springer.com/







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