# Risk factors and mortality rates for children co-infected with HIV and TB in Ethiopia: a systematic review and meta-analysis

## TL;DR

This study finds high mortality rates in Ethiopian children co-infected with HIV and TB, highlighting key risk factors like poor treatment adherence and anemia.

## Contribution

The study provides the first pooled mortality rate and identifies specific risk factors for HIV-TB co-infected children in Ethiopia.

## Key findings

- The pooled mortality rate is 11.74% with an incidence of 1.5 deaths per 100 person-years.
- Key risk factors include WHO stages III/IV, poor ART adherence, missed IPT, and low hemoglobin levels.
- Systematic screening and treatment adherence could reduce premature deaths in co-infected children.

## Abstract

This systematic review and meta-analysis aimed to identify risk factors and mortality rates in HIV and TB co-infected children in Ethiopia. An electronic literature search was conducted using multiple databases, including PubMed, Medline, Web of Science, African Journal Online, Google Scholar and university research repositories for gray literature. Weighted inverse variance random-effects meta-regression was employed to calculate pooled mortality rates, utilizing Stata/SE-17 for analysis. The meta-analysis included six eligible studies, encompassing a total of 2025 co-infected children. Among these, 238 deaths were reported over 1670.6 person-years. This made the crude mortality rate 11.74% (95% CI 11.49 to 16.12%) with an incidence of 1.5 deaths (95% CI 1.17 to 1.89) per 100 person-years. Factors including WHO stages III and IV (4.34, 95% CI 2.25 to 8.36), poor antiretroviral therapy (ART) adherence (3.11, 95% CI 2.04 to 4.15), missed isoniazid preventive therapy (IPT) (3.07, 95% CI 1.52 to 6.23) and low hemoglobin levels of ≤10 mg/dl (2.84, 95% CI 2.02 to 3.99) were predictors compared with their counterparts.This review reveals an unacceptably high pooled incidence of mortality among HIV and TB co-infected children in Ethiopia. Therefore, implementing systematic screenings for IPT, enhancing ART adherence counseling and addressing anemia through early treatment are critical for preventing premature deaths.

Protocol registration in Prospero = CRD42024502038