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dc.contributor.authorAmadi, Ben_US
dc.contributor.authorImikendu, Men_US
dc.contributor.authorSakala, Men_US
dc.contributor.authorBanda, Ren_US
dc.contributor.authorKELLY, MPen_US
dc.date.accessioned2016-04-20T13:19:10Z
dc.date.available2016-03-04en_US
dc.date.issued2016-03-07en_US
dc.date.submitted2016-03-09T14:19:01.761Z
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/11914
dc.description.abstractBackground While HIV has had a major impact on health care in southern Africa, there are few data on its impact on acute malnutrition in children in the community. We report an analysis of outcomes in a large programme of community management of acute malnutrition in the south of Lusaka. Programme activities and analysis Over 3 years, 68,707 assessments for undernutrition were conducted house-to-house, and children with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) were enrolled into either Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) respectively. Case records were analysed using tabulation and unconditional logistic regression. Findings 1,859 children (889 boys, 970 girls; median age 16 months) with MAM (n=664) or SAM (n=1,195) were identified. Of 1,796 children whose parents consented to testing, 185 (10.3%) were HIV positive. Altogether 1,163 (62.6%) were discharged as recovered from acute malnutrition. Case fatality while in the programme was 4.2% in children with SAM and 0.5% in those with MAM (RR of SAM 10.9; 95%CI 3.4,34.8; P<0.0001), and higher in children with HIV infection (RR 5.2, 95%CI 2.9, 9.0; P<0.0001). In multivariate analysis, HIV (OR 5.2; 95%CI 2.6, 10.1; P<0.0001), MUAC <11.5cm (OR 4.1; 95%CI 2.2, 7.4; P<0.0001) and the first year of the programme (OR 1.9; 95%CI 1.0, 3.4; P=0.04) all increased mortality. Children with HIV infection who were able to initiate antiretroviral therapy had lower mortality (RR 0.23; 95%CI 0.10, 0.57; P=0.0008). Interpretation Our programme suggests that a comprehensive community malnutrition programme, incorporating HIV care, can achieve low mortality even in a population heavily affected by HIV.en_US
dc.format.extente0149218 - e0149218en_US
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.ispartofPLoS Oneen_US
dc.rightsCC-BY
dc.titleIntegration of HIV care into community management of acute childhood malnutrition permits good outcomes: retrospective analysis of three years of a programme in Lusakaen_US
dc.typeArticle
dc.rights.holder© 2016 Amadi et al.
dc.identifier.doi10.1371/journal.pone.0149218en_US
pubs.notesNo embargoen_US
pubs.publication-statusPublisheden_US
pubs.volume11en_US
dcterms.dateAccepted2016-03-04en_US


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