Under-nutrition and associated factors among human immunodeficiency virus-infected children in sub-Saharan Africa: A systematic review and meta-analysis.

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Abstract Background: In developing world including sub-Saharan Africa, HIV/AIDS has worsened the impact of under-nutrition in children. HIV infected children are highly vulnerable to malnutrition. Even though under-nutrition screening and intervention are incorporated into the care plan of HIV infected children, it is continued as a major problem for HIV infected children in Africa. Hence, the main aim of this systematic review and meta-analysis was to estimate the pooled prevalence of under-nutrition and associated factors among children infected with HIV.Methods: Primary studies were retrieved from PubMed/ MEDLINE online, Science direct, and Hinari databases. We found a total of 1847 records from these databases. After removing papers my using different exclusion criteria, 26 studies that report the prevalence of under-nutrition were included. We used a standardized data extraction format prepared in Microsoft Excel. STATA- version 14 statistical software was used for analysis. Heterogeneity was evaluated through I2 test. A random-effects meta-analysis model was used to estimate the pooled prevalence of under-nutrition and its associated factors. The summary estimates were also presented using Forest plots and tables.Results: The pooled prevalence of stunting, underweight, and wasting in HIV infected children were 51.4% (95% CI: 46.3, 56.4), 39.0% (95% CI: 33.7, 44.3), and 24.5% (95% CI: 19.2, 29.8) respectively. Household insecurity was associated with stunting [OR= 5.50 (95% CI 3.36, 8.98]. Low family economic status [OR= 5.25 (95% CI: 2.52, 10.92)])], feeding frequency [OR= 0.32 (95% CI 0.172, 0.605)] and caretakers attending dietary counseling [OR= 0.367 (95% CI: 0.182, 0.739)] were significantly associated with under-weight among HIV infected children. Conclusions: The pooled prevalence of under-nutrition among HIV infected children was high. Routine nutritional assessment and nutritional support shall be strengthened, monitored, and evaluated in HIV infected children. Implementation of policies and strategy sated by a national and international stakeholder in ART care centers should get maximum emphasis to reduce undernutrition in HIV infected children.

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