Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Introduction: More than half a million children worldwide die from the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) each year. In Uganda, HIV/AIDS is a major cause of infant and childhood mortality. Although the government of Uganda, through various strategies, has increased access to antiretroviral drugs (ARVs), resulting in national scaling up of accessibility to antiretroviral therapy (ART), initiation of ART in resource-limited areas remains a challenge due to constraints such as the absence of or limited number of CD4 machines and related laboratory constraints. Further scaling up of ART for children would be greatly strengthened by increased access to laboratory services for CD4 counts or the introduction of alternative indicators or guidelines for the initiation of ART. Aim: This study therefore set out to investigate, through the analysis of retrospectively collected data, whether anthropometric indices (wasting - weight for height; underweight - weight for age; and stunting - height for age) could provide a useful alternative guide when deciding about initiation of ART in children aged 2-12 years in the absence of sophisticated clinical and laboratory support. Methods: The study was conducted at the Mildmay Centre, an HIV/AIDS specialist centre located in Kampala, Uganda. Parameters such as the age at which children had been initiated onto ART, duration on ART, World Health Organisation (WHO) and Centre for Disease Control (CDC) disease stages at time of initiation, anthropometry at time of initiation, CD4% staging at time of initiation, support received from food aid programmes, referral to other health centres as a result of malnutrition and care-giver nutrition education/counselling were all determined retrospectively from clinical records. Results: It was found, based on CDC (2000) growth reference charts, that of the total number of children who took part in this study (N=125), 98.4% were mildly wasted, 52.8% mildly underweight and 75.2% mildly stunted when they were initiated onto ART. Of the children, who had WHO disease staging documented - 40% (N=50), the majority - 86% (N=43) were in WHO disease staging II and III during initiation of ART. and 96% (N=48) were mildly wasted. However, the relationship between WHO disease staging and wasting, underweight, and stunting at initiation of ART in children at the Mildmay centre was not significant. The relationship between CD4% and underweight or stunted children was also not significant. It was established however, that in the absence of CD4 laboratory parameters (since CD4% is vital in the initiation of ART in children) as is the case in resource limited areas, anthropometric indices (moderate to severe wasting, weight for height -W/H) could be used concurrently with CDC and WHO disease staging to initiate ART in children. However, it is important to note that anthropometric indices on their own cannot be used as a guide for initiating ART in children. Conclusion: Anthropometric status alone cannot be used to accurately determine when to initiate ART in children 2-12 years.

Uganda has experienced 1.6 million deaths to HIV/AIDS related illness. Introduction of free-ART in rural hospitals that bear the burden od AIDS reduces adults morbidity and mortality. The study design was a quantitative, retrospective and descriptive design through data mining of medical records. In the six years, hospital admissions decreased by 16.7% and the median age at death increased by seven years. Hospital admissions decreased from three to seven deaths per 100 admissions per month. Male and female mortality was 1:1.6 and females in the 15-34 age group had a 37% higher likeliness of dying in hospital compared to males. Deaths from sub-countries with an ART site reduced by 4% to 8.6%. The data revealed that despite ART coverage of 60%, mortality rates showed a rising trend. Free access to ART's over three years did not make any observable changes to overall mortality. Therefore, ART access contributed to a decline in overall hospital admissions, an increase in median age at time of death and a reduction in deaths from sub-counties with an ART site. There was no reduction in overall hospital mortality rate. / M.A. (Public Health) / Health Studies

Uganda has experienced 1.6 million deaths to HIV/AIDS related illness. Introduction of free-ART in rural hospitals that bear the burden od AIDS reduces adults morbidity and mortality. The study design was a quantitative, retrospective and descriptive design through data mining of medical records. In the six years, hospital admissions decreased by 16.7% and the median age at death increased by seven years. Hospital admissions decreased from three to seven deaths per 100 admissions per month. Male and female mortality was 1:1.6 and females in the 15-34 age group had a 37% higher likeliness of dying in hospital compared to males. Deaths from sub-countries with an ART site reduced by 4% to 8.6%. The data revealed that despite ART coverage of 60%, mortality rates showed a rising trend. Free access to ART's over three years did not make any observable changes to overall mortality. Therefore, ART access contributed to a decline in overall hospital admissions, an increase in median age at time of death and a reduction in deaths from sub-counties with an ART site. There was no reduction in overall hospital mortality rate. / M.A. (Public Health) / Health Studies