Predictors for the incidence of pneumonia among HIV-infected children on antiretroviral therapy in Amhara Regional State Comprehensive Specialized Hospitals, Ethiopia: a multicenter retrospective follow-up study.

BACKGROUND: Human Immune deficiency Virus (HIV) infected children are at higher risk of developing pneumonia. Particularly, in the early phase of HIV infection, the risk of acquiring pneumonia is high, and it remains a major public health problem even after the test and treatment strategy. There is no clear evidence of the overall incidence of pneumonia among HIV-infected children in Amhara region. Aimed to assess the incidence of pneumonia and its predictors among HIV-infected children receiving Antiretroviral therapy in Amhara Region Comprehensive Specialized Hospitals, 2022. METHODS: A multicenter retrospective follow-up study was conducted from June 10, 2014, to February 28, 2022, among 430 HIV-positive children receiving antiretroviral therapy. A simple random sampling technique was used. The data was taken from the national antiretroviral intake and follow-up forms. The data were collected via the KoBo toolbox and analyzed using Stata version 17. The Kaplan-Meier curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of pneumonia and a P-value < 0.05 was considered significant in to multivariable analysis. RESULTS: A total of 407 children with a record completeness rate of 94.7% were analyzed in the study. The incidence rate of pneumonia was 4.55 (95% CI; 3.5, 5.92) per 100 person-years observation. The mean survival time was 77.67 months and the total times at risk during follow-up period were yielding 1229.33 person-year observations. Having CD4 cell count below threshold [AHR; 2.71 (95% CI: 1.37, 5.35)], WHO stage III and IV [AHR: 2.17 (95% CI: 1.15, 4.08)], ever had fair and poor treatment adherence [AHR: 2.66 (95% CI: 1.45, 4.89)], and not initiated antiretroviral therapy within seven days [AHR: 2.35 (95% CI: 1.15, 4.78)] were the positive predictors for incidence of Pneumonia. CONCLUSIONS: In this study, the incidence of pneumonia was lower than the previous studies. CD4 cells below the threshold, ever had fair and poor adherence to antiretroviral therapy, WHO stage III and IV, and not initiated antiretroviral therapy within seven days were significant predictors. Therefore,, it is crucial to detect baseline assessment and give attention to those identified predictors promptly, and timely initiation of antiretroviral therapy need special attention.

Estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa: a systematic review with meta-analysis.

Malnutrition is more prevalent among children with cerebral palsy and a major factor for child morbidity and mortality in children with different co-morbidity, especially in Sub-Saharan Africa: The main aim of this systematic review and meta-analysis was to estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa. We searched PubMed, Web of Science, Google Scholar, Research Gate, and institutional repositories for papers that reported the proportion of malnutrition among children with cerebral palsy that were published between December 2010 and September 2023. Data were retrieved using the standardized JBI data extraction checklist through Microsoft Excel, and then exported to STATA 17 for further analysis. DerSimonian and Laird's estimator was used to calculate the pooled effect size in the random-effects model. Statistics such as the Cochran Q test and I2 test were employed to measure heterogeneity. Egger's test and the funnel plot were used to look for publication bias. This systematic review and meta-analysis used 16 studies from Sub-Saharan Africa to estimate the proportion of malnutrition among 2,120 children with cerebral palsy. The pooled proportion of malnutrition among children with cerebral palsy in Sub-Saharan Africa by using random-effects model analysis was found to be 59.7% (95% CI; 49.8-69.6). The proportion of malnutrition was also estimated by sample sizes categorized as ≤ 120 and > 120, and the proportion of malnutrition was found to be 54.0 (95% CI: 44.7-63.3) and 64.5 (95% CI: 50.5-78.5). Moreover, the proportion of malnutrition was estimated by accounting for the difference in the year of publication. In this regard, the study classified before ≤ 2017 and > 2017, and the proportion of malnutrition was found to be 53.7 (95% CI: 38.0-69.3) and 62.5 (95% CI: 49.7-75.3) in Sub-Saharan Africa respectively. Malnutrition among children with cerebral in Sub-Saharan Africa was found to be very high. Hence, enhancing and developing strategic guidelines for malnutrition screening, prevention, and nutritional support are crucial among children with cerebral palsy. Furthermore, systematic review, randomized control trials, and qualitative studies are recommended to understand the burden more among children with cerebral palsy in the continent.