Incidence and Predictors of Mortality among Children on Anti-Retroviral Therapy in Public Health Facilities of Arba Minch Town, Gamo Gofa Zone, Southern Ethiopia; Retrospective Cohort Study

Background: Evidence shows that earlier access to Anti-retroviral Therapy helps to increase survival of children by delaying the progression to AIDS. However its long-term effect on mortality has remained unanswered 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 among 421 HIV-positive children enrolled on anti-retroviral therapy from January 1st 2009 to December 30th 2016. The data on relevant variables was collected from patients` medical cards and electronic database by trained data collectors. 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 identify independent predictors of mortality. Result: Overall, 15.4% of children (n=65) died over a follow-up period of 21,175 person-months of observation. The mortality rate of this cohort was 3.07 deaths per 1000 person-months. The cumulative probability of survival after 96th month of treatment was 73.9% (95% CI=63.2-81.9). During the multivariate analysis of baseline variables, we observed that the delayed and regressed developmental milestone (AHR=4.42, 95% CI=1.99-9.75), (AHR=6, 95% CI=2.68-13.45), opportunistic infection at baseline (AHR=1.93, 95% CI=1.03-3.64), tuberculosis 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=1.12-4.79), (AHR=2.05, 95% CI=1.02-4.13), isoniazid preventive therapy (AHR=0.38, 95% CI=0.22-0.68) and Co-trimoxazole preventive therapy (AHR=0.26, 95% CI=0.15-0.46) were independent predictors of mortality. Conclusions: Mortality was high especially during the first sixth months following anti-retroviral therapy initiation. Therefore, higher priority should be given to HIV-infected children with tuberculosis co-infection further intervention like isoniazid preventive therapy and co-trimoxazole preventive therapy as well close follow should be given to all children after start of anti-retroviral therapy.