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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Morbidity and mortality among a cohort of HIV-infected adults in a programme for community home-based care, in the Kilimanjaro Region of Tanzania (2003-2005)
Annals of Tropical Medicine and Parasitology, Volume 103, No. 3, Year 2009
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Description
Community home-based care (CHBC) plays an integral role in the care of HIV-infected patients living in resourcelimited regions. A longitudinal cohort study has recently been conducted, in the Kilimanjaro Region of northern Tanzania, in order to identify the components of an effective CHBC programme. Structured questionnaires were administered to clients over two census rounds, one in October 2003-February 2004 and the other in January 2005-October 2005. In the second round, follow-up interviews were completed for 226 (87.9%) of the 257 clients included in the first round. The clients included in the first round had a median (range) age of 38 (20-66) years and 182 (75.2%) of them were female. Although only 27 (12.9%) of them were using antiretroviral therapy (ART) when first interviewed, 108 (44.6%) were taking trimethoprim-sulfamethoxazole (SXT) prophylaxis. By the time of the follow-up interviews, 102 (45.1%) of the clients included in the first round had died, giving a mortality of 51/ 100 person-years of observation. The primary cause of death for 87 (85.3%) of the clients who had died was respiratory and/or gastro-intestinal infection, and the most common contributory causes of death were malnutrition (81.4%) and anaemia (42.2%). On bivariable analysis, the following first-round conditions were found to be significantly associated with death by the second census round: weakness for <1 month [odds ratio (OR)=2.64; P=0.008]; oral thrush (OR=2.31; P=0.015); painful swallowing (OR=2.02; P=0.036); staying in bed for part of the day over most of the previous month (OR=1.94; P=0.017); fever for <1 month (OR=1.95; P=0.016); and severe bacterial infections (OR=1.80; P=0.036). The high mortality was associated with advanced, symptomatic HIV disease for which antiretroviral therapy was indicated. Clients who were in the advanced stages of HIV disease (as defined by the World Health Organization's criteria) in the first census round were significantly more likely to have died by the time of the second round than the other clients investigated (log-rank x
2
=8.115; P=0.044). The high level of morbidity observed in this study, and the causes of mortality that were identified, emphasise the need for CHBC programmes to provide HIV-infected patients with improved access to basic resources such as SXT and isoniazid prophylaxis, clean water, oral rehydration therapy, and micronutrient supplementation, in addition to increased access to ART. © The Liverpool School of Tropical Medicine 2009.
Authors & Co-Authors
Tillekeratne, L. Gayani
United States, Durham
Duke University Medical Center
Thielman, Nathan M.
United States, Durham
Duke University Medical Center
United States, Durham
Duke University
Kiwera, Rehema A.
Unknown Affiliation
Chu, Helen Y.
United States, Durham
Duke University Medical Center
Kaale, L.
Unknown Affiliation
Morpeth, Susan Claire
United States, Durham
Duke University Medical Center
Ostermann, Jan
United States, Durham
Duke University
Mtweve, Sabina P.
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Shao, John F.
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Bartlett, John A.
United States, Durham
Duke University Medical Center
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Crump, John A.
United States, Durham
Duke University Medical Center
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Statistics
Citations: 12
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1179/136485909X398203
ISSN:
00034983
Research Areas
Environmental
Food Security
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative
Study Locations
Tanzania
Participants Gender
Female