INCIDENCE AND PREDICTORS OF MORTALITY AMONG CHLIDREN ON ANTI- RETROVIRAL THERAPY IN PUBLIC HEALTH FACILITIES OF ARBA MINCH TOWN, GAMO GOFA ZONE, SOUTHERN ETHIOPIA: A RETROSPECTIVE COHORT STUDY

Abstract

Background: Studies of Antiretroviral Therapy program in Africa have shown high incidence rate of mortality among children receiving antiretroviral therapy. However, factors those contribute for mortality were poorly described in Ethiopia especially in the study area. Objective: To assess incidence and predictors of mortality among Children on Anti-retroviral Therapy in Public Health Facilities of Arba-Minch Town, Gamo Gofa zone, Southern Ethiopia. Methods: Institution based retrospective cohort study was employed on 421 children enrolled on ART from January 2009 to December 2016 in Public health facilities of Arba-Minch town. The data on relevant variables was collected from patients` medical cards and electronic database by trained data collectors after getting ethical clearance. Data was entered and cleaned by Epi Info version 7 and analyzed by STATA version 11. Life table was used to estimate the cumulative survival of children and Kaplan Meier survival curve together with log rank test was used to compare survival between different categories of covariates. Cox proportional-hazard regression model was used to determine independent predictors of mortality Result: A total of 421 children were followed for 21,175person-months of observation with median follow up of 50 months. The mortality rate was 3.07deaths per 1000 person-months .The cumulative probability of survival at the end of 96th month was 73.9 %.The overall mean survival time of the children under the study was 82.32 month. Delayed and Regressed developmental milestone (AHR=4.42, 95%CI=1.99-9.75), (AHR=6, 95% CI=2.68- 13.45), OI at baseline (AHR=1.93, 95% CI=1.03- 3.64), TB co infection at base line (AHR=2.28, 95% CI=1.23 - 4.22), Low Hemoglobin level (AHR =3.32, 95%CI= 1.83-6.04), Absolute CD4 below threshold (AHR=2.08,95% CI=1.15-3.77),Fair and Poor adherence to ART were ( AHR=2.17, 95% CI=1.12 to 4.79), (AHR=2.05, 95% CI=1.02 to 4.13),INH prophylaxis (AHR=0.38,95% CI=0.22 -0.68) and CPT prophylaxis (AHR=0.26, 95%CI=0.15 – 0.46) were significantly and independent predictors of mortality. Conclusions: Mortality was high especially during the first sixth months following ART initiation. Therefore, higher priority should be given to HIV-infected children with TB co infection further intervention like CPT and INH prophylaxis and close follow should be given to all children after start of ART.