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Hospital admissions from a pediatric HIV care and treatment program in Malawi

BACKGROUND: The scale up of pediatric antiretroviral treatment programs across Sub-Saharan Africa over the last decade has brought increasing numbers of children into HIV care. This patient population requiring life-long care presents new challenges in the outpatient and inpatient settings. We sough...

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Autores principales: Nosek, Carl A., Buck, W. Chris, Caviness, Alison C., Foust, Abbie, Nyondo, Yewo, Bottomani, Madalitso, Kazembe, Peter N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736238/
https://www.ncbi.nlm.nih.gov/pubmed/26830336
http://dx.doi.org/10.1186/s12887-016-0556-3
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author Nosek, Carl A.
Buck, W. Chris
Caviness, Alison C.
Foust, Abbie
Nyondo, Yewo
Bottomani, Madalitso
Kazembe, Peter N.
author_facet Nosek, Carl A.
Buck, W. Chris
Caviness, Alison C.
Foust, Abbie
Nyondo, Yewo
Bottomani, Madalitso
Kazembe, Peter N.
author_sort Nosek, Carl A.
collection PubMed
description BACKGROUND: The scale up of pediatric antiretroviral treatment programs across Sub-Saharan Africa over the last decade has brought increasing numbers of children into HIV care. This patient population requiring life-long care presents new challenges in the outpatient and inpatient settings. We sought to describe hospitalizations from a large pediatric HIV treatment facility to better understand the scope of the situation and identify areas for improved care delivery. METHODS: We conducted a retrospective case series of all HIV-infected and exposed patients <18 years enrolled at Baylor College of Medicine Children’s Foundation Malawi, from October 2004-October 2010. Patients admitted to the hospital on or after the day of enrollment were included. Data were extracted from electronic clinic records. Analysis was done at the patient and admission level, as some patients had multiple admissions. RESULTS: Of 5062 patients enrolled in care, 877 (17.3 %) had 1137 admissions at median age 24 months (IQR: 12–62). 191 (21.8 %) patients had multiple admissions. A high proportion of admissions occurred in patients under two years (49.4 %), those within one month of clinic enrollment (32.9 %), those with severe immune suppression (44.0 %), and those not on ART (48.5 %). The frequency of primary admission diagnoses varied across these same variables, with malnutrition, pneumonia, and malaria being the most common. CONCLUSIONS: Illness requiring hospitalization is common in HIV-infected and exposed children and these results reinforce the need for a comprehensive care package with special attention to nutrition. Strengthened programs for malaria prevention and expanded access to pneumococcal vaccine are also needed. The high burden of admissions in children under 24 months and those newly enrolled in care suggests a need for continued improvement of early infant diagnosis and provider-initiated testing programs to link patients to care before they are symptomatic. Similarly, the high proportion of admissions in those not yet started on ART emphasizes the importance of rapid initiation of ART for eligible pediatric patients.
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spelling pubmed-47362382016-02-03 Hospital admissions from a pediatric HIV care and treatment program in Malawi Nosek, Carl A. Buck, W. Chris Caviness, Alison C. Foust, Abbie Nyondo, Yewo Bottomani, Madalitso Kazembe, Peter N. BMC Pediatr Research Article BACKGROUND: The scale up of pediatric antiretroviral treatment programs across Sub-Saharan Africa over the last decade has brought increasing numbers of children into HIV care. This patient population requiring life-long care presents new challenges in the outpatient and inpatient settings. We sought to describe hospitalizations from a large pediatric HIV treatment facility to better understand the scope of the situation and identify areas for improved care delivery. METHODS: We conducted a retrospective case series of all HIV-infected and exposed patients <18 years enrolled at Baylor College of Medicine Children’s Foundation Malawi, from October 2004-October 2010. Patients admitted to the hospital on or after the day of enrollment were included. Data were extracted from electronic clinic records. Analysis was done at the patient and admission level, as some patients had multiple admissions. RESULTS: Of 5062 patients enrolled in care, 877 (17.3 %) had 1137 admissions at median age 24 months (IQR: 12–62). 191 (21.8 %) patients had multiple admissions. A high proportion of admissions occurred in patients under two years (49.4 %), those within one month of clinic enrollment (32.9 %), those with severe immune suppression (44.0 %), and those not on ART (48.5 %). The frequency of primary admission diagnoses varied across these same variables, with malnutrition, pneumonia, and malaria being the most common. CONCLUSIONS: Illness requiring hospitalization is common in HIV-infected and exposed children and these results reinforce the need for a comprehensive care package with special attention to nutrition. Strengthened programs for malaria prevention and expanded access to pneumococcal vaccine are also needed. The high burden of admissions in children under 24 months and those newly enrolled in care suggests a need for continued improvement of early infant diagnosis and provider-initiated testing programs to link patients to care before they are symptomatic. Similarly, the high proportion of admissions in those not yet started on ART emphasizes the importance of rapid initiation of ART for eligible pediatric patients. BioMed Central 2016-01-30 /pmc/articles/PMC4736238/ /pubmed/26830336 http://dx.doi.org/10.1186/s12887-016-0556-3 Text en © Nosek et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nosek, Carl A.
Buck, W. Chris
Caviness, Alison C.
Foust, Abbie
Nyondo, Yewo
Bottomani, Madalitso
Kazembe, Peter N.
Hospital admissions from a pediatric HIV care and treatment program in Malawi
title Hospital admissions from a pediatric HIV care and treatment program in Malawi
title_full Hospital admissions from a pediatric HIV care and treatment program in Malawi
title_fullStr Hospital admissions from a pediatric HIV care and treatment program in Malawi
title_full_unstemmed Hospital admissions from a pediatric HIV care and treatment program in Malawi
title_short Hospital admissions from a pediatric HIV care and treatment program in Malawi
title_sort hospital admissions from a pediatric hiv care and treatment program in malawi
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736238/
https://www.ncbi.nlm.nih.gov/pubmed/26830336
http://dx.doi.org/10.1186/s12887-016-0556-3
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