Research Article
Volume 5 Issue 1 - 2021
Prevalence and Factors Associated with Tb/HIV Co-Infection among Severely Acute Malnourished Children Admitted in Mulago National Referral Hospital
Namale Vivian Ssonko1,2*, Mupere Ezekiel1 and Judy Orikiriiza1
1Makerere University College of Health Sciences, Kampala, Uganda
2Department of Neurology, Irving Medical Center, Columbia University, New York, USA
*Corresponding Author: Namale Vivian Ssonko, Makerere University College of Health Sciences, Kampala, Uganda and Department of Neurology, Irving Medical Center, Columbia University, New York, USA.
Received: October 05, 2020; Published: December 10, 2020


Objectives:: To determine the prevalence of Tuberculosis (TB)/Human Immunodeficiency virus (HIV) co-infection among severely malnourished children admitted in Mulago National Referral Hospital and determine the factors associated with co-infection in these children.

Methods:: This was a cross sectional study design which consecutively enrolled children aged 1 - 5 years who were severely malnourished, consented to the study and were admitted during the study period. We excluded children with severe co-morbidities which would otherwise increase risk of TB. A standardized questionnaire, HIV serology, MTB RIF gene x-pert on gastric aspirates, a tuberculin skin test (TST), MUAC, weight for Height Z scores and chest x-ray were performed on all children. HIV positive children who fulfilled criteria for TB diagnosis clinically or microbiologically were considered to have TB/HIV co-infection.

Results: A prevalence of TB/HIV co-infection of 20.2% (35/173) was found. Associated factors included positive contact of PTB AOR 10.7, (95% CI: 3.9 - 34.9), missed Bacilli Calmette-Guerin (BCG) vaccine AOR 1.2, (95% CI: 0.72 - 0.6), hypothermia AOR 10.7, (95% CI: 1.5 - 51.6), lymphadenopathy AOR 11.3, (95% CI: 2.1 - 39) and hepatomegaly AOR 6.2 (95% CI: 1.5 - 14.5).

Conclusion: While there was a high prevalence of TB/HIV co-infection, missed opportunity for early ART and IPT initiation was very high. Strengthening of implementation of guidelines on screening and initiation of TB, HIV treatment should be emphasized. High index of suspicion for all malnourished children presenting with hypothermia, lymphadenopathy and hepatomegaly.

Keywords: TB/HIV co-infection; SAM-NE; SAM-E; PTB; HIV


  1. TB global report ( 2016).
  2. Updates W Clinical Staging for HIV in infants and children below 18 years (2015).
  3. Graham SM., et al. “Evaluation of Tuberculosis Diagnostics in Children: 1. Proposed Clinical Case Definitions for Classification of Intrathoracic Tuberculosis Disease. Consensus From an Expert Panel”. The Journal of Infectious Diseases2 (2012): S199-S208.
  4. Fiorentino M., et al. “Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia”. PLoS One2 (2016): e0146442.
  5. Updates On The Management Of Severe Acute Malnutrition In Infants And Children (2015).
  6. Jaganath D and E Mupere. “Childhood tuberculosis and malnutrition”. The Journal of Infectious Diseases 12 (2012): 1809-1815.
  7. Bachou H., et al. “Severe malnutrition with and without HIV-1 infection in hospitalised children in Kampala, Uganda: differences in clinical features, haematological findings and CD4+ cell counts”. Nutrition Journal 5 (2006): 27.
  8. Health, M.O., <uganda_tb.pdf>.
  9. Wobudeya E., et al. “Epidemiology of tuberculosis in children in Kampala district, Uganda, 2009-2010; a retrospective cross-sectional study”. BMC Public Health 15 (2015): 967.
  10. Graham SM., et al. “Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel”. Journal of Infectious Diseases (2012): jis008.
  11. WHO, WHO Tb Report (2016).
  12. Organization, W.H., Global tuberculosis report (2015).
  13. Fergusson P and A Tomkins. “HIV prevalence and mortality among children undergoing treatment for severe acute malnutrition in sub-Saharan Africa: a systematic review and meta-analysis”. Transactions of the Royal Society of Tropical Medicine and Hygiene 6 (2009): 541-548.
  14. Palme IB., et al. “Impact of human immunodeficiency virus 1 infection on clinical presentation, treatment outcome and survival in a cohort of Ethiopian children with tuberculosis”. The Pediatric Infectious Disease Journal11 (2002): 1053-1061.
  15. Madhi S., et al. “HIV-1 co-infection in children hospitalised with tuberculosis in South Africa”. The International Journal of Tuberculosis and Lung Disease5 (2000): 448-454.
  16. Orikiiriza J., et al. “The clinical pattern, prevalence, and factors associated with immune reconstitution inflammatory syndrome in Ugandan children”. AIDS13 (2010): 2009-2017.
  17. Musoke PM and P Fergusson. “Severe malnutrition and metabolic complications of HIV-infected children in the antiretroviral era: clinical care and management in resource-limited settings”. The American Journal of Clinical Nutrition 6 (2011): 1716S-1720S.
  18. Nantongo JM., et al. “High incidence of pulmonary tuberculosis in children admitted with severe pneumonia in Uganda”. BMC Pediatrics 13 (2013): 16.
  19. Ticklay I., et al. “HIV infection in malnourished children in Harare, Zimbabwe”. East African Medical Journal4 (1997): 217-220.
  20. Collins S., et al. “Management of severe acute malnutrition in children”. The Lancet9551 (2006): 1992-2000.
  21. Buck WC., et al. “Risk factors for mortality in Malawian children with human immunodeficiency virus and tuberculosis co-infection”. The International Journal of Tuberculosis and Lung Disease11 (2013): 1389-1395.
  22. Wobudeya E., et al. “Epidemiology of tuberculosis in children in Kampala district, Uganda, 2009-2010; a retrospective cross-sectional study”. BMC Public Health1 (2015): 967.
  23. Mody A., et al. “Effects of HIV infection on the metabolic and hormonal status of children with severe acute malnutrition”. PLoS One7 (2014): e102233.
  24. Graham SM. “HIV and respiratory infections in children”. Current Opinion in Pulmonary Medicine 3 (2003): 215-220.
  25. Elhassan MM., et al. “Challenges in diagnosing tuberculosis in children: a comparative study from Sudan”. International Journal of Infectious Diseases 43 (2016): 25-29.
  26. Zar HJ., et al. “Effect of isoniazid prophylaxis on mortality and incidence of tuberculosis in children with HIV: randomised controlled trial”. British Medical Journal 7585 (2007): 136.
  27. Sekadde MP., et al. “Evaluation of the Xpert MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis in Uganda: a cross-sectional diagnostic study”. BMC Infectious Diseases 13 (2013): 133.
  28. Madebo T., et al. “HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis”. Scandinavian Journal of Infectious Diseases 4 (1997): 355-359.
  29. Menberu MA. “Performance of the WHO 2011 TB Symptom Screening Algorithm for Pulmonary TB Diagnosis among HIV-Infected Patients in Gondar University Referral Hospital, Ethiopia”. International Journal of Medical Microbiology (2016): 9058109.
  30. Young B., et al. “Improved outcomes from HIV/TB co-infection in Singapore following a switch to earlier anti-retroviral therapy”. Journal of the International AIDS Society 4-3 (2014): 19624.
  31. Crook AM., et al. “Tuberculosis incidence is high in HIV-infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy”. BMC Medicine 14 (2016): 50.
  32. Urassa W., et al. “Evaluation of the WHO human immunodeficiency virus (HIV) antibody testing strategy for the diagnosis of HIV infection”. Clinical and Diagnostic Virology 1 (1994): 1-6.
  33. Hicks RM., et al. “Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children”. International Journal of Tuberculosis and Lung Disease 9 (2014): 1074-1083.
  34. Kiboneka A., et al. “Clinical and immunological outcomes of a national paediatric cohort receiving combination antiretroviral therapy in Uganda”. AIDS18 (2008): 2493-2499.
  35. Mungrue K., et al. “Trends in HIV/TB coinfection in Trinidad and Tobago for the period 1998-2007”. Journal of the International Association of Providers of AIDS Care 3 (2009): 170-175.
  36. Bhaskaram P., et al. “BCG vaccination in malnourished child population”. Indian Pediatrics 1 (1922): 39-44.
  37. <master_2013postersubmission.pdf>.
  38. Prazuck T., et al. “HIV infection and severe malnutrition: a clinical and epidemiological study in Burkina Faso”. AIDS1 (1993): 103-108.
  39. Saloojee H., et al. “What's new? Investigating risk factors for severe childhood malnutrition in a high HIV prevalence South African setting”. Scandinavian Journal of Public Health 69 (2007): 96-106.
  40. Li P., et al. “Amino acids and immune function”. British Journal of Nutrition02 (2007): 237-252.
Citation: Namale Vivian Ssonko., et al. “Prevalence and Factors Associated with Tb/HIV Co-Infection among Severely Acute Malnourished Children Admitted in Mulago National Referral Hospital”. EC Emergency Medicine and Critical Care 5.1 (2021): 01-13.

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