Incidence and Predictors of Mortality among Children on ART in Health Facilities of Hawassa City, Southern Ethiopia: Retrospective Follow up Study

Abstract

Background: Highly active anti-retroviral therapy (HAART) has reduced mortality and morbidity of children with HIV.Identification of factors that affect the survival of children on Anti Retroviral Therapy (ART) is important to maximize benefits by addressing any modifiable cofactors. The aimof the study was to assess the incidence and predictors of mortality among children on ART in health facilities of Hawassa city administration, Southern Ethiopia.

Method: Institutional based retrospective cohort study was carried out on consecutively selected 416 medical records of children ≤14 years who started ART from January 1, 2010 to December 31, 2018.The data was collected in selected health facilities of Hawassa city, which have pediatrics ART service by trained health professionals.Data were analyzed by SPSS Version 21,   Kaplan Meir (KM) curve, Log rank test and Cox-Proportional hazards model were carried out to determine the predictors.

Result: Out of the 416 cohort of children on ART, 336(80.8%) were alive, 27(6.5%) weredead, 15(3.5%) were lost to follow up, 27(6.5%) transfer out and 11(2.6%)drop out. The overall incidence density rate was 17.25 per 1000 child year .Survival time at the end of 6, 12, 60 and 96 month was 98.3%, 95.5% 92.3% and 90.5.% respectively and overall mean survival time was 90.8 month(CI:88.59 to 93.0 ). Multivariate analysis showed that low hemoglobin level (AHR =6, 95% CI:1.83 to14.54), tuberculosis co infection (AHR=6.18, 95% CI:2.58 to 14.83) , baseline CD4 count below threshold (AHR=2.1,95%CI:1.15to3.77), Isonized prophylaxis (AHR=0.27, 95%CI:0.22to0.68), Cotrimoxazole prophylactic therapy (AHR=0.28,95% CI:0.15to0.46) and poor adherence to antiretroviral therapy (AHR=2.87, 95% CI:1.1 to7.49) were independent predictors of mortality of children on ART.

Conclusion: The study showed that higher mortality among children with TB co-infection, presence of anemia, and having lower CD4 cell count and poor adherence. Close follow up of children on HAART, with early detection of biomarkers deviation, diagnosis of opportunistic infections and early treatment initiation as well as strengthening adherence support should be underlined.