Incidence of Pneumonia and Predictors Among Human Immunodeficiency Virus Infected Children at Public Health Institutions in the Northwest Part of Ethiopia: Multicenter Retrospective Follow-Up Study

Abstract

Introduction

Pneumonia is an inflammation of the lung parenchymal structure secondary to hematogens spread of pathogens, inhalation, or aspiration. It is also one of the most frequently occurring opportunistic infections in HIV-infected children. In Ethiopia, data on the incidence and predictors of opportunistic infection, especially pneumonia, among HIV-infected children is very limited. Hence, this study aimed to assess the incidence of pneumonia and predictors among HIV-infected children at public health institutions in the Northwest part of Ethiopia.

Methods

An institution-based retrospective cohort study was conducted among 342 HIV-infected children at public health institutions from January 1, 2013 to December 30, 2020. Log rank test was used to compare the survival curves between different explanatory variables. Bivariable Cox proportional hazards regression model was employed for each explanatory variable to check the association with the outcome variable. Variables found to have a p-value of < 0.25 in the bivariable analysis were candidates for the multi-variable proportional hazard model. Cox proportional hazards model was used at 5% level of significance to identify predictors of pneumonia.

Results

This study included 342 records of HIV-infected children who started antiretroviral therapy between the periods of January 1, 2013 to December 30, 2020. The overall incidence rate of pneumonia during the follow-up time was 5.57 (95% CI: 4.4, 7.0) per 100 child-years of observation. Those children who did not take cotrimoxazole preventive therapy (AHR: 3, 95% CI: 1.40, 6.44), being underweight at baseline (AHR: 2.6, 95% CI: 1.41, 4.86), having baseline advanced disease (clinical stages III and IV) (AHR: 2.8, 95% CI: 1.30, 6.04), and presenting with recently detected viral load (AHR: 5.9, 95% CI: 2.53, 14.06), were more likely to develop pneumonia.

Conclusion

Pneumonia incidence rate was high. Providing prophylaxis and nutritional supplementation for those children with baseline advanced disease stage, low weight for age and detectable viral load would reduce pneumonia occurrence.

Keywords:

• pneumonia
• incidence
• HIV
• children
• Ethiopia

Abbreviations

ART, Antiretroviral Therapy; BMI, Body Mass Index; CAP, Community Acquired Pneumonia; CMV, Cytomegalo Virus; CPT, Cotrimoxazole Preventive Therapy; EFMOH, Ethiopian Federal Ministry of Health; FU, Follow-Up; HAART, Highly Active Antiretroviral Therapy; Hgb, Hemoglobin; HIV, Human Immunodeficiency Virus; IPD, Invasive Pneumococcal Disease; KM, Kaplan–Meier; LRTI, Lower Respiratory Tract Infection; MRN, Medical Recording Number; NGOs, Non-Governmental Organizations; OIs, Opportunistic Infections; PCP, Pneumocystis Pneumonia; PH, Proportional Hazard; PMTCT, Prevention of Mother to Child Transmission; PY, Person-Year; SARI, Severe Acute Respiratory Infection; SDG, Sustainable Development Goal; SMART, Strategies for Management of Antiretroviral Therapy.

Data Sharing Statement

Data will be available upon request from the corresponding author.

Ethical Considerations

In order to conduct this research, the authors tried to address the Declaration of Helsinki Ethical principles for medical research. First, ethical clearance was obtained from Bahir Dar University, College of Medicine and Health Sciences, school of health sciences with Ethical Review Board number (CMHS/IRB 01-008) decided on the date February 26, 2021. Then, a letter was written to each study institution in Bahir Dar city by Bahir Dar University. A supporting letter was obtained from each selected health facilities general manager, health centers head and coordinators. As this was a retrospective study, informed consent from an individual patient was not requested because the authors had no physical contact with them and the data were collected from their medical charts after their discharge from the health institutions. Information in the data extraction was anonymous. The confidentiality of the information was kept throughout the study process and the information was used only for the study purpose.

Acknowledgments

Authors would like to acknowledge Bahir Dar University and Dire Dawa University. Authors also thank data collectors, supervisors, data clerks, and head of health institutions.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no competing interests in this work.