The burden and determinants of anaemia in HIV infected children attending public hospitals in Dar es salaam.

Abstract

Background: Though anaemia is still a major problem in patients infected with HIV, there is paucity of data describing its magnitude and determinants among HIV infected children in Tanzania. Most of the studies among anaemic Tanzanian children were conducted before the era of HIV and HAART. Objectives: The study was aimed at determining the prevalence and contributing factors for anaemia among HIV-infected children attending public hospitals in Oar es Salaam. Materials and Methods:This was a descriptive cross sectional study that was conducted at Muhimbili National Hospital and Mwananyamala Municipal Hospital. The target population for the study included 167 consecutive HIV infected children attending the HIV clinic or admitted in paediatric wards for the period of August to November 2008. The subjects were 6 months to 59 months of age to be recruited in the study After written consent from the guardian of the child, information on social demographic and clinical characteristics was collected from the medical file and interview from the child's parents or guardians. Also, physical examination and laboratory tests on blood, stool, and urine were done for each study subject. The prevalence of anaemia was determined as a percentage among all children infected with HIV. Both univariate and multivariable logistic regression analyses were performed to identify possible risk factors associated with anemia in HIV-infected children. Findings: In this study the overall prevalence of anaemia (/-Ib<llg/dl) among HIV infected children attending hospitals was 44%. Among 167 enrolled HIV infected children, 35 (21.1 %) had mild anaemia, 14(8.4%) had moderate anaemia and 26(}5.6%) had severe anaemia. In a univariate analysis, not being on HAART, advanced HIV disease, having a history of TB disease in the past 6 months at the study, a history of chronic diarrhoea (14 days or more), a history of malnutrition, a history of recurrent malarial attack (every month), being HIV positive for less than 2.5 yrs and hookworm infestation were all associated with anaemia. The use of anthelmintics and rnultivitamins were found to be protective against anaemia. The final model derived by rnultivariate logistic regression

VII demonstrated that not being on HAART (OR 3.4, 95%CI (1.20-9.60), advanced HIY disease, having a history of TB disease in the past six months at the study (OR 3.23, 95%Cl (1.10-9.70) and having hookworm (OR 5.97, 95%CI (1.92-18.4) infestation were independent risk factors for anaemia among HIY infected children. Taking multivitamins (OR 0.07, 95%, Cl (0.02-0.38) and antihelminthics (OR 0.27, 95%CI (0.10-0.74) were still the protective factors against anaemia. Multivariate sub-analysis of factors associated with severe anaemia (HB<8g/dl) revealed that, having a history of TB disease in the past six months at the study, advanced HIY disease, being HIY positive for less than 2.5 yrs and having hookworm infestation were again independent risk factors for severe anaemia among HIY infected children. Taking multivitamins was also protective against severe anaemia. Conclusions and recommendations: Despite the availability of HAART, the prevalence of anaemia was high among study patients and was multifactorial in nature. Efforts to correct anaemia in HIY infected children should include use of HAART, treatment of infections such as TB, malaria, hookworms and improving access to diverse diets rich in iron.