Proyectos de aula

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controls. There is increase demand and metabolism as the children grow especially, and if intake is inadequate, growth can be impaired. HIV infected cause immune suppression causing recurrent infection placing an extra demand on the body’s requirement. This was similar to the studies24, 41, 42 where HIV infected children weighed less than the negative control with the difference in weight increasing as the children grew older. The result was different from another study⁴³, in which there was no difference in weight between non- infected, children of infected mother and negative children of non-infected mothers.

Though the study⁴³ was done below the age of two, it is still a pointer that HIV infection affect growth when compared to the other studies^41,42 where there was difference between infected children and controls, as non of the children were infected in the study⁴³.

The mean height for age, of the HIV infected children was lower than those of the controls at all age but was only significant after the age of 4years. A similar trend was observed, in a study ⁴¹ but the difference in height occurred earlier in 2years. This reason may be that there was a high level of stunting in this environment, which is a developing country compared to a developed country because of poor nutrition. In such situation, normal children if stunted may not show much difference from HIV infected until the infection is long enough to cause a marked difference in height In addition, genetic factors can also play a role in growth. In addition, height is a much slower process than weight and takes a longer time to evident; hence, a deficit may not be so obvious in a short time. Other studies.21, 24, 77 also showed that HIV infected children were shorter than their control.

These studies were done in similar environment and the results are comparable to this study.

The mid upper aim circumference of the HIV infected child were lower than those control being which is significant at all group age. Though there is limited date comparing mid upper arm circumference & HIV & control this is similar to a study⁷⁸ where infected

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children had lower mid arm circumference compared to controls. The reason is that infected children have loss of weight and muscle bulk.

The head size of the HIV infected, children were also significantly smaller than those of control below 36months. Rapid brain growth occurs in the first 2years of life and any disease affect children would have a profound effect. This differ from another study⁷⁹ in which there was no significant difference between HIV infected and controls. The reason for this difference is difference in care and early commencement of ARV in that study⁷⁹ as it conducted in a more advanced country with adequate facilities for health care.

The extents to which the weight of both infected children and control differ from the mean was shown by the weight for age, height for age and weight for height expressed in standard deviation. HIV infected children were more underweight than the controls.

The prevalence of underweight was 18.4% in this study. This is lower than 63% in India^49.

Secondly, the timing of the studies very different as they were conducted 5years apart.

Thirdly some of the previous studies were conducted prior to the use of ARV might accounted for the observed difference.

Increased awareness and early diagnosis could have reduced the prevalence of malnutrition in this study. Other studies ^{51, 52} had put underweight at 47% in HIV infected, which is higher than this study. The reason could be due to difference in timing with more

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knowledge of HIV & it effect and improved health care; prevalence of underweight would have reduced. In addition, there is a wider use of ARV now that in the past. Socio economic factor could also contribute to the prevalence of the overweight in the study ⁵¹ as a lower level of underweight was observed in those who had both parent alive compared to those who were orphans.

In the index study the level of underweight decrease as the children got older which is different from the study ⁵¹ where underweight got worse as the children got older. This was due to lack & care as most of the caregivers were elderly uneducated.

The infected children were more stunted than control. The difference between the two groups reduced with age. Another study^49,51 had given a much higher figure and this reduction is likely to be as the result of intervention given to the children as two studies were done at various time interval and in addition availability of treatment of HIV. This study was hospital based with optional care for child including administration of approval drug & food suppliant while the other studies were community based... A similar degree was stunting was observed in a recent study⁷⁷ and is the result of the similarity in the social setting as both are in Africa while the study that gave a different result was done in Asia and were both done in a Hospital based setting.

Wasting was observed to be more severe in the HIV infected children than control. It was observe that the weight for height of the infected children improved after the third year of life. There was twice as much wasting in HIV infected than controls. In this study, the level of wasting 17.5% in the HIV infected. However, a study ⁴⁹ in India gave a slightly lower value of 16% in children who were not on ARV. In Cambodia 28% were found to be wasted a lower result obtained may be due to availability of care and drug in the centre of study which was not in the other centre. The disparity in the figure can also be due to difference in location, background of wasting, economic status, and level of care in

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children in those countries.

The socio economic status had a liner relationship to weight and means that children would weigh more if the socio status improves. Improved socioeconomic status means improved social wellbeing, which connotes better health seeking behavior of parent, and will lead to early diagnosis and prompt treatment. It was also observed that there is a relationship between the use of ARV and weight and height; however, the study design does no make room for a conclusion, which can only be done by a multicentre cohort study.

This study supports the multi-faceted adverse effects of HIV infection on the growth of the child. Repeated and chronic infections in the presence of immune-suppression in HIV-infected children further worsen post natal growth. As a result about 50% of HIV-HIV-infected children die before their second birth day in the era prior to widespread use of antiretroviral drugs in younger children ⁶².

Explicably and consistent with the findings of other workers21,41,42,43,48-50’77,78 the HIV-infected children were shorter, weighed less with smaller heads and mid upper arms, although the difference reaching statistically significant levels at different age groups.

Also the conduct of the study in the Paediatric Special Clinic implies early detection of HIV infection in these children and interventions including use of HAART that may have alleviated the adverse effect of HIV infection on malnutrition. This is supported by the observation that the biggest differences in z score between the HIV-infected children and controls was seen in the youngest children (aged 12-24 months); and in older HIV-infected children the z score approached normal, more so after the age of 24 months for both weight for age and weight for height z score.

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In conclusion mean weights and heights of HIV infected children was less than control however, prevalence of malnutrition was lower than that observed in the other studies on HIV infected children.

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