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Growth and Pubertal Development Among Hiv Infected Children Aged 8-18 Years in Dar Es Saalam

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Growth and Pubertal Development Among Hiv Infected Children Aged 8-18 Years in Dar Es Saalam View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Digital Library of the Tanzania Health Community i GROWTH AND PUBERTAL DEVELOPMENT AMONG HIV INFECTED CHILDREN AGED 8-18 YEARS IN DAR ES SAALAM By Gloria Reginald Mbwile A Dissertation Submitted in Partial Fulfillment of the Requirement for the Degree of Master of Medicine (Pediatric and Child Health) of the Muhimbili University of Health and Allied Sciences. Muhimbili University of Health and Allied Sciences November 2012 i CERTIFICATION The undersigned certify that they have read and hereby recommend for acceptance by the Muhimbili University of Allied and Health Sciences dissertation entitled Growth and pubertal development among HIV infected children aged 8-18 years in Dar es Salaam, as partial fulfillment of the requirement for degree of Master of Medicine (Paediatrics and Child Health) of the Muhimbili University of Health and Allied Sciences. ______________________________ Date____________________ Dr R Kisenge (Supervisor) ______________________________ Date_____________________ Dr H Naburi (Supervisor) ii DECLARATION AND COPYRIGHT I, Gloria Reginald Mbwile, declare that this dissertation is my own original work and that it has not been presented and will not be presented to any other university for a similar or any other degree award. Signature………………….. Date……………………………. This dissertation is a copyright material protected under the Berne Convention, the copyright Act 1999 and other international and nation enactments, in that behalf, on intellectual property. It may not be reproduced by any means, in full or in part, except for short extracts in fair dealings, for research or private study, critical scholarly review or discourse with an acknowledgement, without the written permission of the Directorate of Postgraduate Studies, on behalf of both the author and the Muhimbili University of Health and Allied Sciences. iii ACKNOWLEDGMENTS This is a great opportunity to express my respect to Dr R. Kisenge and Dr Naburi for their support, understanding and patience. They were my supervisors despite their many other academic activities and professional commitments. Thanks to the Ministry of Health and Social Welfare for sponsoring my postgraduate degree course, and also to the management of the Muhimbili University of Health and Allied Sciences for allowing me to pursue this training. I gratefully acknowledge the efforts of the head of department and members of staff in the department of Paediatrics and Child Health, MUHAS and employees of Muhimbili National Hospital. They gave me various form of support during training to make my study time a success. I owe my gratitude to ICOHTRA for funding this research and make this work possible. I would like to appreciate and thank the DMO’s of two municipals of Dar es Salaam for granting permission to collect data at municipalities. Special thanks to my fellow classmates who helped me stay sane through these difficult years. Drs: Robert Moshiro, Julieth Kabengula, Frida Mghamba, Isabella Sylvester, Charles Shija, Alex Mphuru, Edward Mgelea, Christopher Richard, Winfred Kyambile and Fatou Secka. Thanks for being there. iv DEDICATION This work is dedicated to my parents, Dr Reginald and Enike Mbwile for their love, kind and support. To my lovely husband Dr. Issakwisa Habakkuk and adorable children Cleopatra and Joshua, for their patience and understanding as precious time was devoted to the completion of this work. To my brother Peter, Patrick, Martin and my sister Felister for their support And to God, the creator of all things, who is the source of all knowledge and healing power v ABSTRACT Background Advances in management of HIV-infected infants and children have been remarkable, majority of infected children are now surviving into adolescence. Several studies have shown that growth and pubertal development is often impaired among children with HIV and AIDS. Abnormalities include early deficits in height and weight, and delay in skeletal maturation. Onset of menarche and pubertal development are also delayed. The magnitudes of delayed puberty among HIV infected children in Tanzania have not been studied; however there is one unpublished study, which evaluated the growth and pubertal development parameters in the general population. Assessment of the onset and progression of sexual maturation is important in patients with HIV because this information has immediate clinical application in the interpretation of endocrine and growth status. Objective To assess growth and pubertal development among HIV infected children aged 8-18 in Dar es Salaam. Study design and Setting This was a cross section hospital based study at Care and treatment clinics (CTC) municipal Hospitals in Dar es Salaam. Methodology After obtaining informed consent data was collected using a structured questionnaire. Anthropometric measurements of growth and Tanner stages of sexual development of children with HIV and AIDS aged between 8 and 18 years were assessed. Blood was taken to assess CD4 count. Both female and male were classified as having puberty when they are at Tanner stage 2 or greater for breast and genital respectively and pubic hair development in both sexes. Data was analyzed using STATA version 10 statistical packages. vi Results During the study period, 330 HIV infected children were recruited out of whom 183 (55.4 %) were female. The median age of the study populations was 12.0 years. Median weight was 32.0 (IQR 25-45) kg and girls were significantly heavier and had higher BMI than boys. All participants enrolled had HIV which was confirmed and were on ART. Median duration of ART was 48 (IQR 30-62) month. Majority of the participants were in WHO stage III and had CD4 count above 500cells/ul. HIV infected children were found in Tanner stage 2 at an advanced age compared to the reference population. The median age at menarche was 15 (IQR 14-16) years compared to the reference population, which was 13.0 (IQR 12-15) years. Among HIV infected females there was no significant difference in weight, height and BMI compared to the reference population when they entered Tanner stage 2. Males in the reference population were in Tanner stage 2 with higher weight and BMI and they were taller compared with the reference population. In univariable and multivariable analysis advanced age was associated with onset of Tanner stage 2 or more. Conclusion and recommendation Children infected with HIV and AIDS have significant delay in growth and sexual maturation. Considering these findings monitoring of growth and pubertal development should be highly emphasized in this population, it should be part of the comprehensive package. Matched case control studies of HIV-infected and uninfected children are needed to better quantify the delay in pubertal onset and to compare the pace of pubertal maturation. vii ABBREVIATIONS AIDS - Acquired Immunodeficiencndrome ART - Antiretroviral Therapy BMI - Body Mass Index CD4 - Cluster of Differentiation 4 CDC - Centre for Disease and Control CTC - Care and Treatment Clinic GH - Growth Hormone HAART - Highly Active Antiretroviral Therapy HIV - Human Immunodeficiency Virus IDC - Infectious Disease Center IGF-I - Insulin Growth Factor 1 IQR Interquartile Range MDH - Management Development for Health MUHAS - Muhimbili University of Health and Allied Sciences PCR - Polymerase Chain Reaction U.S - United States of America WHO - World Health Organization ICOTRA - International Clinical Operation and Health on TB and AIDS UNAIDS - United Nations Programme on HIV/AIDS viii TABLE OF CONTENTS Content Page CERTIFICATION ....................................................................................................................... i DECLARATION AND COPYRIGHT ...................................................................................... ii ACKNOWLEDGMENTS ......................................................................................................... iii DEDICATION .......................................................................................................................... iv ABSTRACT ............................................................................................................................... v ABBREVIATIONS .................................................................................................................. vii CHAPTER ONE ......................................................................................................................... 1 1. INTRODUCTION AND LITERATUTE REVEW ................................................................ 1 1.1 Epidemiology of HIV and AIDS .......................................................................................... 1 1.2 Mode of transmission ........................................................................................................... 2 1.3 Normal Development ........................................................................................................... 2 1.4 Pubertal changes ................................................................................................................... 3 1.5 Effect of HIV on puberty ...................................................................................................... 4 1.5.1 Mechanisms of delay in puberty in HIV ........................................................................... 6 1.5.2 Effect of delay in puberty .................................................................................................
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