Mortality among HIV-infected paediatric patients in Barbados

Since the onset of the HIV epidemic, AIDS has become the leading cause of mortality in the paediatric age group in many developing countries. The main objective of this study was to review the mortality in HIV-infected paediatric patients in Barbados. It is a retrospective analysis of the hospitalization course of HIV-infected paediatric patients aged < 16 years who died during a 15-year period of surveillance. Using a specific database, information pertaining to number and duration of hospitalizations, and cause of death were analyzed. There were 39 (65%) deaths among 60 HIV-infected patients diagnosed during the period of study. Twenty-one (54%) were male and 18 (46%) were female. Twenty-seven (69%) case records were retrieved for analysis. The highest mortality (56%) was among patients aged < 1 year and between 1989 and 1995. Hospitalizations averaged three per patient. No patient received anti-retroviral therapy. Nineteen (70%) patients died during hospitalization on the paediatric ward. Lower respiratory tract infections suspected to be Pneumocystis carinii, gastroenteritis and septicaemia were the most frequent diagnoses at the time of death. The annual mortality ranged between 0 and 1.7 (mean 0.7) per 1000 live births. The overall mortality rate was high among HIV-infected paediatric patients, with lower respiratory tract infections being implicated as a major contributing cause of death. Results of this study definitely indicate a need for improved resources in the management of paediatric HIV/AIDS cases, especially focussing on the availability and administration of anti-retroviral therapy.