Clinical case definition for AIDS in Africa [letter]

The aim of the World Health Organization (WHO) clinical case definition of pediatric acquired immunodeficiency syndrome (AIDS) in Africa was to provide a noninvasive means of diagnosing AIDS without serology. Although this definition has been evaluated in terms of its sensitivity and specificity little attention has been given to its ease of application. A review of 65 pediatric inpatient admissions in Ugandas Kisiizi Hospital indicated that there are indeed difficulties in applying the WHO clinical case definition. For example the definition requires parents to have detailed knowledge of their childs rate of growth. Not only are parents unable to report their childs weight but centile charts used at child health centers are rarely kept up to date. Moreover in Uganda where there is a shortage of hospital beds parents tend to exaggerate their childs symptoms to gain admission--a tendency that produces a high rate of false-positive AIDS diagnoses. Confirmed maternal human immunodeficiency virus (HIV) infection was also impossible to document both because of a lack of serologic screening capability and social stigma against acknowledging seropositivity. Finally language difficulties compounded parent-physician communication.