Growth, morbidity, and mortality in a cohort of institutionalized HIV-1-infected African children

Lisa M. Nathan, Lina M. Nerlander, Jedediah R. Dixon, Ruth M. Ripley, Ruanne Barnabas, Brent E. Wholeben, Rachel Musoke, Tresa Palakudy, Angelo D'Agostino, Rana Chakraborty

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Objective: As a result of the HIV epidemic in Africa, much debate exists on whether institutionalized compared with community-based care provides optimum management of infected children. Previous reports calculated 89% mortality by age 3 years among outpatients in Malawi. No similar data are available for infected children in institutionalized care. We characterized patterns of morbidity and mortality among HIV-1-infected children residing at an orphanage in Nairobi. Methods: Medical records for 174 children followed over 5 years were reviewed. Mortality was analyzed by Kaplan-Meier methods with adjustment to account for survival in the community before admission. Anthropometric indices were calculated to include mean z scores for weight for length and length for age. Low indices reflected wasting and stunting. Opportunistic infections were documented. Results: Of 174 children, 64 had died. Survival was 70% at age 3 years. Morbidity included recurrent respiratory tract infections, gastroenteritis, parotitis, and lymphoid interstitial pneumonitis. No new cases of tuberculosis disease were noted after admission. Mean z scores for length for age suggested overall stunting (z = -1.65). Wasting was not observed (z = -0.39). Conclusion: The optimal form of care for HIV-infected children in resource-poor settings may be the development of similar homes. Absence of tuberculosis disease in long-standing residents may have contributed to improved survival. Stunting in the absence of wasting implied that growth was compromised by opportunistic infections and other cofactors.

Original languageEnglish (US)
Pages (from-to)237-241
Number of pages5
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
StatePublished - Oct 1 2003
Externally publishedYes


  • Africa
  • Children
  • Growth
  • HIV infection
  • Morbidity
  • Mortality

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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