The burden and predictors of cognitive impairment among 6- to 8-year-old children infected and uninfected with HIV from Harare, Zimbabwe: a cross-sectional study.

With long-term survival of children infected with HIV, information on cognitive function at school age is needed. To determine cognitive function among 6- to 8 year-old children exposed to HIV and to assess factors associated with cognitive impairment, we conducted a cross-sectional study from October 2010 to December 2011 among children whose mothers participated in a national HIV prevention program in Harare. Cognitive function was assessed using the McCarthy Scales of Children's Abilities (MSCA). Of the 306 assessed children, 32 (10%) were HIV infected, 121 (40%) exposed uninfected, and 153 (50%) unexposed uninfected. The mean (SD) General Cognitive Index for the whole study group was 82 (15). An overall of 49 (16%) out of the 306 children had cognitive impairment with no difference in general cognitive function among the three groups. Children with HIV infection scored lowest in perceptual performance domain, p = .028. Unemployed caregivers, child orphanhood and undernutrition were associated with impaired cognitive performance in univariate analysis. In multivariate analysis, caregiver unemployment status remained a factor associated with cognitive impairment with an ODDS ratio of 2.1 (95% CI 1.03-3.36). In a cohort of 6- to 8-year-olds, HIV infection did not show evidence of significant difference in general cognitive function. Children infected with HIV had major deficits in perceptive performance. Lower socioeconomic status was associated with cognitive impairment. In resource-constrained settings, strategies aimed at poverty alleviation and good nutritional management should complement early infant diagnosis and treatment of HIV in order to optimize neurocognitive potential.

Childhood Cancers in Zimbabwe: A 10 year review of the Zimbabwe National Cancer Registry data.

OBJECTIVE: To document the pattern of cancer in children (0-14 years) registered in the Zimbabwe National Cancer Registry from 2000-2009. DESIGN: Retrospective descriptive analysis. METHODS: Analysis of data from the Zimbabwe National Cancer Registry for the period 2000-2009. SETTING: The Zimbabwe National Cancer Registry. RESULTS: Childhood Cancer constituted 3.8% of all malignancies recorded at the cancer registry during the study period. The common cancers were: Wilm's Tumour 286 (16.2%), Kaposi Sarcoma 277 (15.7%), Retinoblastoma 231 (13.1%), Non- Hodgkins lymphoma 182 (10.3%), leukemia 158 (8.9%), brain and nervous tissue 107 (6.1%), connective tissue 105 (5.9%), bone 97 (5.5%), Hodgkins lymphoma 57 (3.2%), Non-melanoma skin 33 (1.9%). All the other remaining cancers were 233 (13.2%). Burkits lymphoma constituted only 2% of all cancers. The noted pattern of cancers in this study were compared to patterns from other countries and similarities and differences are discussed. CONCLUSION: This study showed high incidence rates of Nephroblastoma, Retinoblastoma and Kaposi sarcoma. In contrast to high income countries leukemia and brain tumours are more prevalent in older age group. Compared to other countries in Africa, Burkits lymphoma was rare. Further research is required to identify factors that influence relative frequencies in childhood cancers in Zimbabwe. Findings from this study provide baseline data for future studies.

Anaemia and iron deficiency in peri-urban school children born in a National HIV Prevention Programme in Zimbabwe: A cross-sectional study.

OBJECTIVE: To determine the prevalence of anaemia, iron deficiency and iron deficiency anaemia in school children who were born in a national HIV prevention programme. DESIGN: This was a community based cross-sectional study. SETTING: A resource poor peri-urban setting with high prevalence of HIV infection. SUBJECTS: School aged children six to 10 years old who were born in a national mother-to-child HIV prevention programme. MAIN OUTCOME MEASURES: Haemoglobin (Hb), serum Ferritin (F) and serum Transferrin receptor (sTfR) levels. RESULTS: Three hundred and eighteen children were recruited including 21 HIV positive. The prevalence of anaemia (Hb < 11.5 grams per litre), iron deficiency (F<15 micrograms per litre) and iron deficiency anaemia (Hb < 11.5 g/L and either F < 15 µg/L or sTfR > 8.3 µg/L) were 15%, 4% and 2% respectively. When a higher cut-off for ferritin of 30 micrograms per litre was applied to adjust for high infection disease burden, iron deficiency prevalence increased to 32% and iron deficiency anaemia increased to 5%. Anaemia was 4.9 (C.I 1.9-12.4) times more likely to occur in HIV infected children compared to the HIV uninfected children. Maternal HIV status at birth was not related to presence of anaemia in the school children. CONCLUSION: Anaemia was of mild public health significance in this cohort of children. Iron deficiency anaemia contributed less than a quarter of the cases of anaemia. HIV infection was an important determinant for presence of anaemia. Therefore continued efforts to eliminate paediatric HIV infection as a way of reducing anaemia in children are essential.

Rhabdomyosarcoma of the orbit in a four months old infant in Zimbabwe: A case report.

Infants younger than one year of age with Rhabdomyosarcoma appear to have worse prognosis compared to older children due partly to high rates of local failure. We report a 4 months old infant with orbital rhabdomyosarcoma with poor outcome. Reluctance to use aggressive local control measures and suboptimal chemotherapy dosing are significant contributory factors. Call is made for need for more studies to determine appropriate local therapy in infants with rhabdomyosarcoma.

Patterns of Retinoblastoma in Zimbabwe: 2000-2009.

OBJECTIVE: To document the pattern of retinoblastoma in children in Zimbabwe for the period 2000-2009. DESIGN: Retrospective study. METHODS: Analysis of data from the Zimbabwe National Cancer registry and records of patients admitted to the Paediatric Oncology unit. Data collected from cancer registry were basis of diagnosis, age and gender. Data from the patients medical records included clinical presentation, time to diagnosis and treatment. SETTINGS: The Zimbabwe National Cancer Registry and Paediatric Oncology Unit at Parirenyatwa Tertiary Hospital. RESULTS: 196 patients with retinoblastoma were registered at the cancer registry over the study period. The diagnosis was confirmed histologically on 89% of the cases and in 7% the diagnosis was based on clinical grounds. The age ranged from less than one month to 7 years with median age of 24 months. Males were 111 (56%) with male:female ratio of 1.3:1. Forty three patients (84%) had unilateral and 8 (16%) bilateral disease. Medical records were retrieved from only 54 /196 cases (27.5%). The commonest clinical presentation was proptosis 35/54 (65%). Leucocoria was present in 14/54 (26%). Time interval between first symptoms and diagnosis ranged from less than one month to 24 months with mean duration of 7.7 months (SD = 6.9). Enucleation was performed on 33/ 54 (61%), exenteration on 20/54 (37%) chemotherapy was given to 34/54 (63%) and only 6/54 (11%) received radiotherapy. CONCLUSION: Retinoblastoma is the third commonest registered malignancy of childhood in Zimbabwe, characaterised by late presentation and poor access to therapy.

Haematological features in children less than 12 years on cotrimoxazole prophylaxis seen in opportunistic infection clinics at Harare and Parirenyatwa Teaching Hospitals.

OBJECTIVE: To determine the prevalence of peripheral haematological abnormalities in children receiving cotrimoxazole prophylaxis. DESIGN: An outpatient hospital based cross sectional study. SETTING: The study was conducted at two tertiary peadiatric HIV clinics that offer comprehensive care to children living with HIV. SUBJECTS: 202 HIV infected, antiretroviral therapy naive children aged between 3 months and 12 years who were receiving cotrimoxazole prophylaxis for at least 1 month with more than95% adherence to prophylaxis were included. MAIN OUTCOME MEASURES: Haematological abnormalities on full blood count and peripheral film. RESULTS: The prevalence of anaemia was 62% with normocytic normochromic anaemia being the most frequent type (45%). The commonest red blood cell abnormality was rouleaux formation on the peripheral film. Monocytosis occurred in 62%, leucopaenia in 39%, eosinophilia in 34%, neutropaenia in 18% and lymphopaenia in 10% of the children. CONCLUSION: This study showed a high prevalence ofhaematological abnormalities in HIV infected children on cotrimoxazole prophylaxis. It emphasizes the need for evaluation for anaemia and its management in children on cotrimoxazole prophylaxis.