# Survival status and its predictors among undernourished children on antiretroviral therapy in Bahir Dar city, Northwest Ethiopia, 2010 – 2020, a multicenter retrospective cohort study

## TL;DR

This study examines survival rates and risk factors among undernourished children on HIV treatment in Ethiopia, finding that severe malnutrition and late-stage disease increase mortality.

## Contribution

The study identifies specific predictors of mortality in undernourished children on ART in a resource-limited setting, offering actionable insights for public health interventions.

## Key findings

- Severe stunting and underweight significantly increase mortality risk in undernourished children on ART.
- Cotrimoxazole prophylaxis reduces the risk of death among these children.
- Low CD4 count and advanced WHO disease stages are strong predictors of poor survival outcomes.

## Abstract

In environments with limited resources, undernutrition is a serious public health risk. Its dual relationship to human immunodeficiency virus infection (HIV) leads to crises in a child's physical, emotional, social, and economic spheres of life. Nevertheless, little research has been done on the survival rate and risk factors that lead to poor survival outcomes in undernourished children receiving antiretroviral therapy. This study sought to evaluate survival status and its predictors among undernourished children on antiretroviral therapy (ART) in public health facilities, Bahir Dar city, September 1, 2010 – December 31, 2020.

An institution-based retrospective cohort study design was used among 414 study participants from September 1, 2010 – December 31, 2020. A simple random sampling method was applied to select study participants. All collected data were entered into epi data version 4.6 and exported to STATA version 14.0 for analysis. Each independent predictor variable with a p-value < 0.05 in the multivariable Cox proportional hazard regression was considered statistically significant.

The overall incidence of mortality was 11.6 deaths per 1000 child year observation (95%CI: 7.7- 17.5). Baseline weight for age < -3 Z score (adjusted hazard ratio (AHR) = 4.9, 95% CI: 1.30–18.98), height for age < -3 Z score (AHR = 4.34, 95%CI 1.13–16.6), cotrimoxazole prophylaxis given (AHR = 0.27, 95%CI 0.08–0.87), hemoglobin level < 10 g/dl (AHR = 3.7, 95%CI 1.1–12.7), CD4 cells < threshold (AHR = 4.86, 95%CI 1.9–12.7), and WHO clinical disease stage III and IV (AHR = 8.1, 95%CI 1.97–33) were found independent predictors of mortality.

The incidence of mortality was determined in the study to be 11.6 per 1000 child years. Mortality was predicted by severe stunting, severe underweight, a low hemoglobin level, a low CD4 count, and WHO clinical stages III and IV. But the risk of death is reduced by starting cotrimoxazole preventative therapy early. The risk factors that result in a low survival status should be the primary focus of all concerned bodies, and early cotrimoxazole preventive treatment initiation is strongly recommended.