HIV Infection among Under-Five Malnourished Children in Kano State

doi:10.4236/wja.2013.34045

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World Journal of AIDS, 2013, 3, 350-356

Published Online December 2013 (http://www.scirp.org/journal/wja)

http://dx.doi.org/10.4236/wja.2013.34045

Open Access WJA

HIV Infection among Under-Five Malnourished

Children in Kano State

A. Sudawa1*, A. A. Ahmad2, S. Adeleke3, L. Umar4, L. D. Rogo5

1Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria; 2Department of Microbiology, Faculty of Sci-

ences, Ahmadu Bello University, Zaria, Nigeria; 3Department of Paediatrics, Teaching Hospital Gwagwalada, Abuja, Nigeria;

4Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 5Department of Medical Laboratory Sci-

ence, Faculty of Medicine, Bayero University, Kano, Nigeria.

Email: *[email protected]

Received August 22nd, 2013; revised September 22nd, 2013; accepted September 29th, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Objective: Human Immunodeficiency Viral infection and Protein Energy Malnutrition (PEM) are highly prevalent in

Nigeria and when they occur together, the outcome is usually severe as both conditions lead to immune suppression.

HIV alone accounts for 14.0% of childhood mortality even though children constitute only 6% of global HIV infection

burden. The objective of the study was to determine the prevalence of HIV infection among malnourished children be-

low 5 years in Kano State, Nigeria. Methods: A total of 400 malnourished children were randomly selected and tested

for the presence of HIV I & II using parallel ELISA rapid test kits, Stat park and Determine (both immunochroma-

tographic techniques). Findings: Thirty-one samples were found to be positive to HIV 1 giving a prevalence of 7.8%.

There was no statistically significant difference between sexes when male to female ratio was 1:1.3 and peak age of

presentation was 2 - 3 years. Sixty-four percent (64.0%) were presented with severe form of HIV infection (stage 4)

according to WHO paediatric HIV clinical stage and about half of them came with marasmus by the Wellcome classifi-

cation of malnutrition. There was no significant association between the type of malnutrition and the severity of HIV

infection at present, (p value > 0.05). The commonest signs and symptoms were oral candidiasis (67.7%), lymphade-

nopathy (44.0%), fever (64.5%) and cough (54.8%). Sixty-four percent of the children were from polygamous families.

There was a significant statistical correlation between polygamy and incidence of HIV infection, (p < 0.01). Only

45.0% of the women were aware of their HIV status prior to this study. Seventy-four percent (74.0%) of those who

were aware of their status had no knowledge of the prevention of mother to child transmission (PMTCT) services and

even for those who were aware, none of them accessed the care. Conclusion: A population based HIV screening is

therefore recommended while perinatal HIV screening and PMTCT services need to be expanded.

Keywords: Human Immunodeficiency Virus; Protein Energy Malnutrition; Children; Oral Candidiasis;

Lymphadenopathy

1. Introduction

Human Immunodeficiency Virus (HIV) is a member of

Lentivirus genus, Retroviridae family (slowly replicating

retrovirus) that causes acquired immunodeficiency syn-

drome (AIDS), a condition in humans in which progres-

sive failure of the immune system allows life-threatening

opportunistic infections and cancers to thrive [1,2]. Pae-

diatric HIV infection is a growing health challenge

worldwide with an estimated 1500 new infections every

day [3]. According to UNAIDS report, about 2.5 million

children under the age of 15 were living with HIV/AIDS

in 2007 and 330,000 died of AIDS. The report added that

about 420,000 new infections have occurred in the same

year among children aged below 15 years. More than

95% of HIV infected infants in Africa acquire the infec-

tion from their mothers during pregnancy, at the time of

delivery, or postnatally through breastfeeding [4]. Stud-

ies from Federal Capital Abuja reported mother to child

transmission at (93.02%), blood transfusion (4.6%) and

unidentified route (2.3%) [5]. Reports from Zaria, North-

Western Nigeria showed vertical transmission of 88.6%,

blood transfusion 8.6%, and unknown routes 2.8% [6].

*Corresponding author.

HIV Infection among Under-Five Malnourished Children in Kano State 351

About 30% vertical transmission and blood transmission

of 68% mostly among sickle cell paediatric patients were

reported from Enugu-Eastern Nigeria [7]. These figures

indicated an improvement in the area of blood screening

over the decade. However, the rate of mother to child

transmission of HIV varies by geographical location. The

overall risk of mother to child transmission (MTCT)

without intervention is 15% - 30% in Europe and USA

[3]. Rates of 30% - 40% of MTCT have been reported in

African countries [4]. A transmission rate of 45% was

found in a study conducted at UCH Ibadan [8].

Vertical transmission of HIV and the effects of the vi-

rus on an immature immune system undoubtedly influ-

ence disease expression in ways that are yet poorly de-

fined. Without treatment, HIV infected children in de-

veloping countries have mortality rate of 45% - 59% by

two years of age compared to 10% - 20% in Europe and

USA [3]. Mortality as high as 92.8% below the age of

two years among HIV infected children has been re-

ported [8]. Factors that contribute to this difference in-

clude a higher rate of other infections, malnutrition and

deficiency of macronutrients in developing countries

compared to developed countries.

There are limited data on clinical and biological indi-

cators of disease progression in HIV infected children in

Africa. Some reports and clinical experience indicate that

children perinatally infected with HIV fit into one of

three categories: about 25% - 30% are the rapid progres-

sors who die by age of one year and are thought to have

acquired infection in utero or during early perinatal pe-

riod. Children who develop symptoms early in life, fol-

lowed by a downhill course and death by age three to

five years constituting about 50% - 60% form the second

category. The remaining 5% - 25% are the third category,

the long-term survivors, who live beyond eight years [4].

The impact of high poverty level endemic in Nigeria

and North Western zone in particular, leading to high

incidence of malnutrition among children could be por-

trayed lower than the actual prevalence rate of HIV in-

fection among the study population. Another new dimen-

sion in the epidemiology of severe PEM in sub-Saharan

Africa is the creation of a large pool of Aids related or-

phans [9]. There is estimated 1 - 1.5 million AIDS re-

lated orphans in the sub-Saharan Africa. These children,

whose parents died of AIDS, are often uncared for by

their relations and government, and they are highly sus-

ceptible to malnutrition. This has a highly significant

impact on AIDS in childhood malnutrition in Africa.

Psychosocial issues can lead to inadequate nutrition due

to limited food supply resulting from financial difficul-

ties. Parents may be too ill or disinterested to care for

themselves and their children due to HIV infection [10].

Therefore the aim of this research is to study HIV infec-

tion in under-five malnourished children in Kano State.

2. Materials and Methods

2.1. Study Area

The study was conducted in Kano State located in the

north-western part of Nigeria on 12˚N latitude and 9˚20′E

longitude. Kano is one of the commercial centers of Ni-

geria and has the largest population of 9,383,682 million

people according to the National Population Commission

census figures of 2006. Islam is the dominant religion in

the State which is practiced by about 99% of the popu-

lace and the major tribes are Hausa and Fulani.

The State comprises of 44 Local Government councils

which are divided into three Senatorial districts i.e. Kano

Central, Kano North and Kano South. The Kano Central

comprises of 14 Local Governments and it harbors about

50% of the entire population. There are a total of 26 gen-

eral hospitals spread across the state, and several Primary

Health Care centers and health posts which are under the

control of their respective local governments council.

2.2. Sampling and Methods

This is a multi-centered hospital based cross-sectional

study. Children below the age of 5 years who came with

malnutrition were consecutively selected from the se-

lected hospitals after getting consent from their mothers.

Sample size was approximated to 400. Considering the

population distribution in the state half of the samples

(200) was taken from Kano central senatorial district and

100 samples each from the north and south senatorial

districts. In each study location, half of the study popula-

tion was taken from out-patient clinic and the other half

from in-patients.

Dry sterile plastic syringe (2 ml capacity) with

23SWG needle attached to was used for blood collection.

Blood was collected by applying soft tubing tourniquet

on the arm of the patient to enable the veins to be seen

and felt. The site was cleaned using methylated spirit and

allowed to air dry. The needle was inserted to the se-

lected straight vein with the bevel of the needle directed

upward in the line of the vein. Steadily the plunger of the

syringe was withdrawn until 2 ml of blood was obtained.

The tourniquet was loosed and the needle was removed

from the punctured vein. Pressure was applied to the

punctured site to secure haemostasis. The needle was re-

moved from the syringe and the blood was transferred to

a clean dry plain specimen bottle and labelled. The used

syringes and needles were disposed appropriately. The

blood samples were centrifuged at 1500 revolution per

minute for five minute (1500 rpm/min for 5 min) with

model 80 - 1 B centrifuge machine and the serum col-

lected into a clean and dry plain specimen bottles using

clean and dry Pasteur pipettes and stored at −20˚C until

needed for analysis [11].

Open Access WJA

HIV Infection among Under-Five Malnourished Children in Kano State

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352

Parallel tests were run using Stat-Pak Assay test kit

(Chembio Diagnostic Systems, Medford New York,

USA) and Determine (Abbott Japan Co. Ltd.). After al-

lowing the serum to come to room temperature and about

5 μl is dispensed onto the centre of the sample(s) well

and the test result read after 10 minutes. Same process is

repeated on the sample using Determine kit according to

the manufacturer’s instruction.

3. Results

A total of 400 samples were collected and analyzed for

the presence of HIV I & II using two parallel tests, that is

Stat park and Determine park. Thirty one (7.8%) samples

were found to be positive to HIV. No single case of dis-

cordance was recorded between the two Eliza test kits

used in the study. Mode of transmission was vertical in

all cases. Table 1 shows prevalence rate of HIV among

malnourished children attending selected hospitals in

Kano State and the prevalence in all the three geo-poli-

tical areas in the state. The state wide prevalence among

the study population is 7.8% while a prevalence rate of

13.0%, 4.0% and 1.0% was recorded for Kano central,

Kano South and Kano North respectively.

Table 2 shows age distribution among the HIV posi-

tive children. The peak age presentation is 2 - 3 years

which accounts for 52%. The male to female ratio was

1:1.3.

Table 3 shows type of malnutrition at presentation

among the HIV positive children according to well-

come classification of malnutrition. Fifteen children pre-

sented with marasmus, 10 with marasmic-kwashiorkwor,

four with kwashiorkwor and two were underweight.

Table 4 shows percentage of seropositivity in all the

Table 1. Prevalence rate of HIV among the malnourished

children in Kano State and in each geo-political area.

Geopolitical areaNo. Tested No. positive % positive

Kano central 200 26 13.0

Kano south 100 4 4.0

Kano north 100 1 1.0

Total 400 31 7.8%

Table 2. Age and sex distribution among HIV positive chil-

dren.

Age group (months)Males Females % sero-positvity in

each age group

0 - 23 2 3 16

24 - 35 7 9 52

36 - 60 4 6 32

Total 13 18 7.75

Table 3. Type of malnutrition at presentation among the study population to the hospital.

Type of Malnutrition No. of HIV + ve Children (%)Percentage (%)No. of HIV − ve Children (%) Percentage (%) Total

Males Females Male Female

Marasmus 6 (19) 9 (29) 48 20 (5) 37 (10) 15 72

Marasmic-Kwashiorkwo 4 (13) 6 (19) 32 30 (5) 40 (11) 19 80

Kwashiorkwo 3 (10) 1 (3) 13 32 (8) 55 (15) 23 91

Under Weight 0 2 (6) 6 67 (18) 88 (24) 42 157

Table 4. Percentage sero-positivity in the selected hospitals.

S/N Selected Hospitals No. of SamplesNo. of Samples Positive TotalPercentage Sero-Positivity (%)

Males Females

1 Aminu Kano Teaching Hospital 40 4 7 11 22

2 Hasiya Bayero Pediatric Hospital 100 5 5 10 10

3 Murtala Mohd Specialist Hospital 50 2 3 5 10

4 General Hospital Wudil 50 1 2 3 6

5 General Hospital Gaya 50 1 0 1 2

6 General Hospital Gwarzo 50 0 1 1 2

7 General Hospital Danbatta 50 0 0 0

HIV Infection among Under-Five Malnourished Children in Kano State 353

selected hospitals during the study. Aminu Kano Teach-

ing Hospital had the highest seropositivity, 11 out of 50

samples accounting for 22% Hasiya Bayero Paediatric

Hospital 10 out of 100 samples (10%), Murtala Mo ham-

mad Specialist Hospital, fives out of 50 (10%), Wudil

General Hospital three out of 50 (6.0%), Gaya and Gwarzo

General Hospitals, one each (2.0%) and none recorded at

Danbatta General Hospitals (0.0%).

Table 5 below shows the commonest signs and symp-

toms with the sex distribution at presentation among the

HIV positive children. Fever, cough and diarrhoea were

the commonest symptoms while refusal of feed and vom-

iting were the least common. The commonest signs were

oral candidiasis followed by lymphadenopathy and the

least common sign was skin dyspigmentation.

Table 6 below illustrates the type of family setting of

the HIV positive Children obtained from the study.

64.0% were found to be from the polygamous settings

while 36.0% were from monogamous families. A chi-

square test shows a significant association between po-

lygamy and the incidence of HIV infection within the

family χ2 = 5.7, p < 0.01.

Table 7 below shows the stage of HIV infection with

the age distribution at presentation according to WHO

paediatric HIV clinical staging. Majority presented at

stage four (64.5%) while 29% and 6.5% presented at

stages three and two respectively.

Table 8 below shows relationship between type of

malnutrition and severity of HIV infection. A chi-square

Table 5. Sign and Symptoms among the HIV positive chil-

dren.

Sign and Symptoms Males (%) Females (%) Total No. (%)

Oral Candidiasis 10 (32) 11 (35) 21 (67.7)

Fever 12 (39) 8 (25) 20 (64.0)

Cough 12 (39) 5 (16) 17 (54.8)

Diarrhoea 10 (32) 6 (19) 16 (51.6)

Skin Rash 8 (26.6) 8 (25) 16 (51.6)

Ear Discharge 8 (25) 7 (22) 15 (48.3)

Lymphadenopathy 8 (25) 6 (19) 14 (44)

Hepatosplenomegally 4 (12.9) 8 (25) 12 (37.9)

Oedema 4 (12.9) 3 (9.6) 7 (22.5)

Parotids Swelling 2 (6.4) 4 (12.9) 6 (19.3)

Skin Ulcers 0 3 (9.6) 3 (9.6)

Refusal of Feeds 1 (3.2) 2 (6.4) 3 (9.6)

Skin Dyspigmentation 0 2 (6.4) 2 (6.4)

Vomiting 0 2 (6.4) 2 (6.4)

Table 6. Type of family settings among women whose chil-

dren are HIV positive.

Type of FamilyNo. of HIV + ve

Children

No. of HIV − ve

Children Total

Polygamous 20 252 272

Monogamous 11 117 128

TOTAL 31 369 400

χ2 = 5.7, df = 1, p < 0.01.

Table 7. W.H.O. paediatric HIV staging of children who

were found to be positive. Age at presentation (years).

Clinical StagingNo. of Children (%) <2 2 - 3>3

Stage 4 20 (64.5) 2 12 6

3 9 (29) 2 3 4

2 2 (6.5) 1 1 0

Table 8. Relationship between type of malnutrition and

severity of HIV infection at presentation.

Severity of Malnutrition Paediatrics HIV

Clinical Stages

Type of Malnutrition Severe

(Stage 4)

Less Severe

(Stage 2 - 3)Total

Marasmus/Marasmic-Kwashiorkwo 15, 5 3, 2 18, 7

Kwashiorkwo/Underweight 2, 2 1, 1 3, 3

Total 24 7 31

χ2 = 0.0003, df = 1, p ≤ 0.97 (this is statically insignificant).

test of association indicates that there was no statistically

significant association between the type of malnutrition

and the severity of HIV infection. The chi-square value

of 0.0003 was obtained and p value was <0.97 at the de-

gree of freedom of 1.

4. Discussion

An HIV prevalence of 7.8% was found among malnour-

ished children below the age of five years attending se-

lected hospitals in Kano State. This figure is alarming

considering the state wide HIV sero-prevalence data

which shows steady decline over the years 4.9% in 2001,

3.6% in 2003 and 3.4% in 2005.

No previous studies, to the best of my knowledge,

were available stating the national or state prevalence of

HIV infection among paediatric age group with or with-

out specific disease conditions. Most of the available

studies were cross-sectional hospital based studies rather

than multi-centered. Studies from Ogbomosho General

Hospital South Western Nigeria and Aminu Kano

Teaching Hospital North Western Nigeria reported 3.0%

and 23.3% as HIV sero-prevalence among malnourished

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HIV Infection among Under-Five Malnourished Children in Kano State

354

children respectively [12]. Motayo et al., [13] reported a

prevalence of 5.8% in children in Abeokuta South West-

ern Nigeria. These findings correlate with the observed

prevalence in the adult HIV/syphilis seroprevalence sen-

tinel survey in those hospitals which recorded 1.3% and

4.3% for Ogbomosho General Hospital and Aminu Kano

Teaching Hospital respectively (2005 HIV sentinel sur-

vey). The same survey reported state wide prevalence

(for adults) in Oyo and Kano States as 1.8% and 3.4%

respectively. If finding from this study is compared with

the state prevalence quoted above, there is definite cause

for concern; this finding being on the high side even

though is less than what was reported from Aminu Kano

Teaching Hospital in 2004 (23.3%). It is also important

to note that case detection in paediatric HIV shows real

increase in prevalence rather than apparent increase since

incubation period is short and case fatality is very high.

The high prevalence could be attributed to poor effort

in the prevention of mother to child transmission services

and the assumption that the epidemic has stabilized over

the years as indicated by the 2005 sentinel survey might

not be as real. In a similar study from rural South African

Hospital, an age specific prevalence of 25.0% among 1 -

5 years age group was recorded [14]. This figure was

much higher compared to our finding but is not unex-

pected considering the magnitude of the epidemic around

the year 2000 in the South African nations.

It is important to note the degree of variation in the

prevalence rates between urban and rural areas. It was

observed according to 2005 sentinel survey that HIV

prevalence was generally higher in urban than the rural

sites even though this observation was not consistent

across states.

In this study, the urban sites accounted for 6.5% while

the rural sites accounted for only 1.2%. There was also a

wider variation even amongst the rural areas with Wudil

(a town closest to Kano among all the study locations)

accounting for the highest compared with other study

locations in the rural areas. This degree of variation

could not only be attributable to socio-cultural and eco-

nomic reasons alone but could be largely due to high

disparity in the provision of health care services between

the two settings. In all the study locations, there were

functional facilities for voluntary HIV testing and coun-

seling provided by GHAIN. Unfortunately, about 75%

health care resources both material and human are con-

centrated in the metropolitan. People in the rural areas

will always have to come to the major hospitals in towns

to attend to major health needs. Hence those HIV support

services in the rural centers are poorly patronized and the

services become grossly under utilized. This is especially

so because HIV support and care services especially at

entry point are not supposed to be accessed in isolation.

It is therefore most likely that a significant number of

children who tested positive to HIV are not residing in

the areas where they receive care.

Findings from this study showed almost equal male to

female ratio (M:F 1:1.3). The same was observed by

workers in Jos North-Central, Nigeria [12] and also as

reported in Ibadan by Babatunde et al., [15] although the

prevalence was higher in the present study. Except in

paediatric age group, most data suggest that HIV infec-

tion is commoner among females than males. Denis et al.,

[4] stated that females account for more than one half of

all new cases in adolescents, and three quarters of new

infections in adolescent females occur via heterosexual

transmission.

Studies reported from Ife, South-Western Nigeria,

showed more females than males while in another study

from India there was a male preponderance [16]. Since

behavioral factors do not come to play in paediatric HIV

infection, gender variations most probably occur by

chance.

Mode of transmission in all cases was vertical (moth-

ers were sero-positive). This finding has contrasted most

of the previous studies which recorded other minor

routes of transmission. Workers in Abuja, the federal

capital territory in 2006 reported blood transfusion and

unidentified routes to have accounted for 4.6% and 2.3%

respectively [8], while a similar retrospective study from

Zaria in the same year showed blood transfusion ac-

counting for 8.6% and unknown route 2.8% [6]. Denis et

al., [4] reported that mother to child transmission ac-

counted for up to 95.0% of paediatric HIV infection

while other minor routes accounted for 5.0%. Emeka et

al., [17] reported higher prevalence of about 12% in

children attending a treatment center in Oweri.

Vertical transmission accounting for all cases of HIV

among the infected children is a positive indicator of an

improvement on prevention through blood products or

use of contaminated sharp objects. This preposition will

be more glaring considering Emodi’s report from Enugu

(Eastern Nigeria) in 1998 where blood transfusion ac-

counted for 68% of HIV infection in children. Addition-

ally the age group under study is not exposed to other

major means of contracting the disease like sexual prom-

iscuity.

Two couples were found to be discordant. One had

blood transfusion during a caesarian section to deliver

the baby while the other who had two HIV positive twins

had history of surgical procedure in a rural hospital one

year prior to the delivery of the twins.

Fever, cough and diarrhoea were the predominant

symptoms recorded in the study accounting for 64.5%,

54.8% and 51.6% respectively. The signs and symptoms

observed correlate with findings from a previous study at

Aminu Kano Teaching hospital North Western Nigeria

[10], except that a lesser number of children presented

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HIV Infection among Under-Five Malnourished Children in Kano State 355

with diarrhoea in this study (51.6%) compared to the

previous one (60.9%). This difference could be attributed

to seasonal variation. Oral candidiasis and chest infection

were the commonest conditions observed followed by

diarrhoeal diseases, a finding similar to what was ob-

tained from Zaria, North-western Nigeria [6]. Similarly

in Enugu, Eastern Nigeria, children with oral candidiasis

recorded the highest seropositivity followed by severe

malnutrition [18]. In the Niger-Delta children with bron-

chopneumonia, septicemia and Pulmunary Tuberculosis

had the highest incidence of HIV seropositivity [19]. In a

similar hospital based cross-sectional study from India,

the highest seropositivity rate (25.0%) was reported

among children with disseminated TB and chronic diar-

rhea [16]. From this data we can extrapolate the com-

monest pattern of opportunistic infections in our envi-

ronment. Fungal infections rank the highest followed by

bacterial infections most likely encapsulated Gram posi-

tive organisms like Streptococcus pneumoniae leading to

chest infection.

Peak age of presentation was two to three years and

this corresponds to the second category in the natural

history of paediatric HIV infection which accounts for

50% - 60% of the infected children. In the absence of

treatment most of these children will die within this age

bracket but with the introduction of antiretroviral therapy

(ART) these children have the prospect of surviving to

adolescence and beyond.

Children with marasmus accounted for 48.3%, 32.3%

had marasmic kwashiokwor, while 12.9% and 6.5 pre-

sented with kwashiokwor and underweight respectively.

There was no relationship between the type of malnutri-

tion and the severity of HIV infection. This finding sug-

gests that the clinician should suspect and screen for HIV

when a child presents with malnutrition that does not

respond to conventional therapy or when convalescence

is very slow especially in a resource poor setting where

routine screening is neither feasible nor affordable.

Polygamous family was the commonest type of family

setting recorded among the HIV infected children ac-

counting for 64.0% while monogamous family was only

36.0%. From this data, a correlation has been established

between polygamy and incidence of HIV in the family.

Polygamy is an accepted tradition amongst people in the

study area and HIV being a sexually transmitted disease,

some forms of interventions may be necessary to address

the issues within the context of legal and religious frame

work.

Another point of concern is the age distribution of the

HIV positive mothers in this study. Majority 18 (58.0%)

were between the age of 15 - 24 years while the remain-

ing 13 (42.0%) were between the ages of 25 - 49. This

age bracket (15 - 24) is used as an index of estimating

new infections. The implication is that with new infec-

tions, the epidemic is not under control. Another obvious

implication as it is observed from experience is that,

these young women often lose their husbands at a later

time due to AIDS and continue another life with other

men in future thereby perpetuating the spread of the dis-

ease.

The most effective way to address the paediatric HIV

pandemic is prevention of mother to child transmission

and the knowledge of HIV status among pregnant

women is crucial to the success of such prevention. This

study further revealed that up to 17 women (54.0%)

whose children were HIV positive became aware of their

HIV status as a result of this study while the rest 14

(46.0%) were already aware. Amongst the 14 women,

data for two on the knowledge of PMTCT was missing

from the questionnaire and out of the remaining 12, three

(25.0%) said they were informed of the prevention of

mother to child transmission services and yet none of

them cared to benefit from the services and they all de-

livered at home. The remaining nine (75.0%) where not

informed of PMTCT.

Voluntary counseling and testing is a prerequisite to

enable women to access programme for prevention of

mother to child transmission. Although there were cen-

ters for HIV voluntary testing and counseling in all the

study locations, PMTCT services are not available at

Gaya and Danbatta locations.

5. Conclusions and Recommendations

The result from this study reveals that about 7.8% of

children attending selected hospitals in Kano with mal-

nutrition are HIV positive. This confirmed that HIV/

AIDS epidemic in Kano is still a public health problem

of enormous magnitude that deserves priority attention.

The commonest opportunistic infections observed

from the study were chest infections and diarrhoeal dis-

eases. There are still diagnostic difficulties in establish-

ing pulmonary tuberculosis in children. However, chil-

dren exposed to TB infected adults should be protected

with isoniazid prophylaxis. A pneumococcal vaccine

(including serotype 1 and 2) given to HIV-infected chil-

dren in Soweto, South Africa, substantially decreased

episodes of pneumonia and invasive bacterial diseases.

Growth failure is a common feature in HIV-infected

children and it is associated with early mortality. Ade-

quate nutritional supplements with the locally available

foods and prevention of micronutrients deficiency are

equally important and they may serve to prevent frequent

diarrhea seen in HIV infected infants. Additionally, ma-

ternal health and nutrition should be encouraged and ba-

sic hygiene education should be addressed.

The HIV prevalence within polygamous settings is in-

creasing at an alarming rate. Cases for whereby an HIV

positive second or third wife becoming source of infec-

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HIV Infection among Under-Five Malnourished Children in Kano State

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356

tion to the entire family are continuously reported, and

these need to be addressed within the context of the laws

that permit polygamy.

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