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Effect of nutritional and HIV status on bacteraemia in Zimbabwean children who died at home
B H Wolf1, M O Ikeogu, E T Vos
1Department of Paediatrics, Mpilo Central Hospital, Bulawayo, Zimbabwe.
Insights
Bacteraemia is a major cause of death in malnourished children in Zimbabwe. This study found malnutrition, not HIV status, significantly increases the risk of bacteraemia in children under five.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Bacteraemia poses a significant threat to child mortality in developing nations.
- Understanding the interplay between nutritional status, HIV, and bacteraemia is crucial for targeted interventions.
Purpose of the Study:
- To investigate the relationship between bacteraemia, nutritional status, and HIV status in young children in Zimbabwe.
- To identify key risk factors for bacteraemia-related mortality in children aged 0-5 years.
Main Methods:
- A cross-sectional study was conducted on 212 deceased infants and children (0-5 years) in Bulawayo, Zimbabwe.
- Blood cultures were performed to identify pathogens, and HIV-1 serology was assessed.
- Nutritional status was evaluated, and statistical analyses adjusted for age and HIV status.
Main Results:
- Pathogens were isolated from 43% of children, with Klebsiella species being most common.
- Malnutrition was significantly associated with bacteraemia (OR 4.28; P < 0.001), independent of age and HIV status.
- No significant association was found between HIV serostatus and bacteraemia when controlling for nutritional status.
Conclusions:
- Bacteraemia, particularly Gram-negative bacterial infections, is a critical factor in the mortality of malnourished children in Zimbabwe.
- Nutritional status is a stronger predictor of bacteraemia than HIV status in this population.
- Public health strategies should prioritize nutritional support to reduce childhood mortality from bacteraemia.
Abstract:
From July 1992 to May 1993 a study was performed of the relationship between bacteraemia, nutritional status and HIV status in 212 out of 334 consecutive infants and children aged 0-5 years, who had died at home in Bulawayo, Zimbabwe. The remaining 122 children were excluded because the time period between death and arrival at the hospital was over 3 h. A pathogen was isolated from 92 (43%) children and Klebsiella species were most commonly isolated. A positive HIV-1 serology was found in 122 (58%) children and 110 (52%) children were malnourished. Malnutrition was significantly associated with bacteraemia at death after adjustment for the confounding effect of age and HIV status (odds ratio 4.28; 95% CI 2.27-8.07; P < 0.001). No association was found between either HIV serostatus or proven HIV infection and bacteraemia, which could not be attributed to nutritional status. Conclusion. Bacteraemia, in particular with Gram-negative bacteria, is an important cause of death in malnourished children in Zimbabwe regardless of their HIV-1 antibody status.