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Growth, Morbidity, and Mortality in a Cohort of Institutionalized HIV‐1‐Infected African Children

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 HlV‐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.