HIV and mortality in severe malnutrition in Malawi

P Fergusson, J Chinkhumba, A Tomkins

Research Objective

To investigate the relationship between CD4%, mortality and HIV in severely malnourished children.

Study setting and characteristics•3 Nutrition Rehabilitation Units in Lilongwe district

–2 rural–1 urban

•Therapeutic feeding and medical management

Sample characteristics: •507 mother/child pairs recruited•454 child/mother pairs HIV status available •HIV : 17.4%•Mortality: 14.8%

HIV and risk of mortality

HIV infected HIV uninfected

Child died

35.4%

(28/79)

10.4%

(39/375)

HIV infected children relative risk of mortality:

RR= 3.41 (CI 2.24 – 5.19)

Urban Rural divide

Urban children were significantly more likely than rural children to be HIV infected RR = 3.54

Urban Rural

HIV+ve 37% 10%

HIV-ve 63% 90%

Recommendations and conclusions

• HIV infected severely malnourished children in Malawi are clustered in urban environments – resource implications

• Small proportion of deaths occurring in NRU– Better integration between paeds and NRU– Training on severe malnutrition protocols for

paeds staff– Defining criteria for appropriate referral to

paeds

• CD4% cut offs for initiation of ART should be more clearly defined

Thank you

• The participating families Donors• National AIDS Council of Malawi• UNICEF• ACF ParisPartners• KCH, St. Gabriels, Mitundu hospitals • MOH Malawi• UNC Labs• CICHAAH London, Madrid and Malawi

Questions?