Research consultancy

TIME SERIES ANALYSIS OF HIV/AIDS IN CHILDREN AGED 15 YEARS AND BELOW ON HEALTH STATUS

CHAPTER ONE

1.0 INTRODUCTION

This chapter presents the Background, problem statement, purpose, general objectives, specific objectives, research questions, Significance of the study, and scope of the study.

1.1 Back ground

The last two decades, HIV/AIDS has continued to spread across all continents causing the death of millions of adults in their prime age, disrupting and impoverishing families and turning millions of children into orphans, (UNAIDS, 2009). HIV/AIDS affects the most productive segments of the populations, and the epidemic has thus tremendously reduced workforces and reversed many years of economic and social progress and has in some cases posed threat to political stability.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS, 2009), there were about 39.5 million people living with HIV by the end of 2006. Out of these, 37.2 million were adults and 2.3 million were children below the age of 15 years. There were 4.3 million new infections in 2006. In Sub-Saharan Africa about 2.8 million people were infected with HIV and 24.7 million people were living with HIV. Despite recent improved access to antiretroviral treatment (ART) and care in many of the world’s regions, the epidemic claimed 2.9 million lives in 2006.

Although efforts have been put in place to fight HIV/AIDS in Uganda, about 1million people are leaving with HIV/AIDS (MOH and ORC Macro, 2006). According to Uganda HIV/AIDS sero behavioural survey (2004-2005), the prevalence of HIV among adults (18-59 years ofage) was 6.7 % and the prevalence is higher in Kampala district about 8.5 % than other districts. The high prevalence of HIV/AIDS in this most productive age has great impact on health, economic and social aspects.

The advent of potent Anti-Retroviral Treatment (ART) in 1996 led to a revolution in thecare of patients with AIDS in the developed world.

Although this treatment is not curative and also presents new challenges with respect to side effects and drug resistance, it has dramatically reduced rates of morbidity and mortality, have improved the quality of life of people with HIV/AIDS and have revitalized communities (3) Moreover, HIV/AIDS is now perceived as a manageable chronic illness rather than as a plague. Unfortunately, most of the 39.5 million people currently living with HIV/AIDS reside indeveloping countries and do not share this improvement in prognosis, (UNAIDS, 2009).

Most of body composition studies have been done in developed countries and it wasfound out there were changes in body composition among HIV positive individuals onHAART or and those not on HAART (Ottet al., 1993; Yelmokaset al., 2001;Shikumaet al., 2004).

Although there are data available from developed countries indicating that HAART may result in changes in body composition, these changes along with dietary pattern of HIV positive individuals initiating HAART are lacking in resource limited settings (Schwenk, 1999; Wanke, 2002), Basing on this background this study therefore intends to investigate into into time series analysis of HIV/AIDS in children aged 15 years and below on health status.

1.2 Problem Statement

The high increase in the availability of antiretroviral drugs among adults aged 18-50 years has a great impact on the nutritional status of people living with HIV/AIDS (PLHIV), (MOH and ORC Macro, 2006). HIV infection increases energy requirements and affects nutrition through increasing energy expenditure, reductions in food intake, nutrient malabsorption and loss and complex metabolic alterations (Macallan, 1995; Babamento and Kotler, 1997). The inadequate dietary intake among PLHIV to meet the increased demand for both energy and protein associated with HIV infection result in weight loss (Piwoz and Preble, 2000).

The increase in the number of children facing HIV AIDS in Uganda especially among the youths and in particular the children below the age of 15years is a matter of agent concern for the government and the international partners as well, this is despite of the government investments in this sector this study therefore intends to investigate into time series analysis of HIV/AIDS in children aged 15 years and below on health status.

1.3 Objective of the Study

1.3.1 General objective

The study intends to assess into time series analysis of HIV/AIDS in children aged 15 years and below on health status.

1.3.2 Specific Objectives

1. To determine the distribution of HIV/AIDS among the children below 15 years.
2. To forecast HIV/AIDS prevalence for children aged below 15 years in Uganda

1.4 Research hypotheses.

1. Ho₁: There is no trend for HIV/AIDS prevalence among the children below 15years.
2. Ho₂: There is no seasonality for HIV/AIDS prevalence among the children

1.5 Scope of the study

The study scope will cover the following aspects;

1.5.1 Study scope

The study scope will cover, the distribution of HIV/AIDS among the children below 15 years, compare HIV/AIDS prevalence by residence and region, and forecast HIV/AIDS prevalence for children aged below 15 years in Uganda

1.5.3 Time scope

The period of data to be considered will be from 2000-2015.

1.6 Significance of the study

1. The study will help other researchers in understanding the nature of the distribution of HIV/AIDS among the children below 15 years.
2. The study wills also the government to compare HIV/AIDS prevalence by residence and region.

• The study will also help other academicians to forecast HIV/AIDS prevalence for children aged below 15 years in Uganda

CHAPTER TWO

LITERATURE REVIEW

2.0 Introductions

This chapter reviews the study according to various authors.

2.1 The distribution of HIV/AIDS among the children below 15 years

AIDS is a global epidemic which is caused by the virus called human immunodeficiency virus (HIV). It will affect the immune system of the body of human beings. The epidemic was firstly recognized in the year 1980. Since then about 20 million people died and 38 million people are estimated living with HIV in the world (MOH, 2005). The rate of infection of the epidemic is still increasing in many countries of the world and it is distributed unevenly.

It is a major development concern in many countries and is destroying the lives and livelihoods of many people around the world. In spite of increased funding, political commitment and progress in expanding access to HIV treatment, the AIDS epidemic continues against the global response. The epidemic remains extremely dynamic. It is expanding fast and also changing its character as the virus exploits new opportunities for transmission. Hence, the number of people living with HIV/AIDS is growing substantially from year to year.

Since HIV/AIDS was acknowledged as a human being problem, the health researchers have been conducting different research in order to tackle or control the epidemic by developing medicine or vaccine. However, due to the very unique nature of the virus they could not succeed in developing a medicine or vaccine that totally cures or protects from the disease. The antiretroviral medicines which are available currently, at best can diminish the infection rate. i.e they are not able to cure people who are infected by this epidemic. More than this, the price of such medicines has been a major problem especially for developing countries (UNAIDS, 2004).

Almost all countries worldwide are affected by the HIV epidemic. No region of the world has been spared. Although the epidemic is global, there is a remarkable regional variation in its distribution. Some regions are highly affected by the epidemic as compared to other regions. Sub-Saharan Africa (SSA) is one of the hot spots where HIV AIDS is widely spread and it is more hard hit by the consequences of epidemic than other parts of the world.

It is the region where the highest number of victims of HIV/AIDS is found. Among all the people who are infected by diseases all over the world, about 68% (22.5 million) are living in this region (UNAIDS, 2010). According to the United Nation classification of ‘generalized epidemic’ about 90% of the countries which are located in SSA are severely affected by the epidemic. This epidemic has remained the major cause of death in this region. Although the region accounts only for 10% of the world population, it comprises almost 25.8 million of the victims of HIV/AIDS in the world. In 2005 an estimated 3.2 million people in the region became newly infected, while 2.4 million died of AIDS. Among the younger generation (15- 24 years) the percentage of HIV infected women and men account for 4.6% and 1.7%, respectively (UNAIDS, 2005). There were 2.7 million new HIV infections in 2010. HIV AIDS accounts for about approximately 90% of all infection.

The important role of knowledge in addressing the HIV/AIDS pandemic has been recognised. Knowledge about HIV/AIDS is considered an important step in behaviour change, while misconceptions can prevent individuals from making informed choices and taking appropriate action. A Joint United Nations Programme on AIDS (UNAIDS, 2005) report revealed that countries that had significantly reduced rates of new HIV/AIDS infections were those that typically invested heavily in AIDS education and awareness initiatives. Studies also show that young people who have been exposed to appropriate sex education tend to delay sex or use condoms (UNAIDS, 2003; UNFPA, 2003), contrary to the fear that sex education leads to greater sexual activity or experimentation.

In Nigeria, a study among unmarried male youths in the University of Ibadan (Adewole and Lawoyin, 2004) found that students who had obtained knowledge on HIV/AIDS early at the secondary school level were less likely to have multiple sexual partners, compared with those who acquired the knowledge later. In a Kenyan study, lack of factual knowledge on HIV/AIDS was among the factors found to be responsible for sexual intercourse among.

Young people constitute one of the most vulnerable groups to HIV/AIDS. Globally, people of ages 15 to 24 years make up one-third of all those infected with the disease worldwide, as well as half of all new infections every year (UNAIDS, 2002, 2004; UNFPA, 2003).

Anarfi and Appiah (2004) emphasized that since there is yet no cure for HIV/AIDS, education then becomes the only social intervention against the disease. Other studies similarly report of positive influence of knowledge of HIV/AIDS on sexual behaviour, including delaying sexual intercourse, using condoms, and stopping sex with commercial sex workers (Bankole, 2004; Camlin and Chimbwete, 2003; Magnani et al., 2002).

• Forecast HIV/AIDS prevalence for children aged below 15 years in Uganda

There are an estimated 2 million children worldwide living with the human immunodeficiency virus -1 (HIV-1) and 90% reside in sub-Saharan Africa [1]. Mother-to-child transmission of HIV (MTCT) remains the major mode of acquisition of HIV-1 infection in children with 400,000 new infections each year. In resource limited settings infected children have an extremely high mortality with 50% dying by  years of age [2]. These children die from common childhood infections including pneumonia, HIV and diarrhoea. Over the last 5 years there has been increasing  access to antiretroviral therapy (ART) for people living with HIV/AIDS in low-income countries. However, < 10% of the 3 million people on ART world wide are children . Access to antiretroviral treatment for children lags behind adults because of the limited paediatric antiretroviral drug formulations, complexity of prescribing antiretroviral therapy (ART) in children and an inadequate number of health care workers trained to provide paediatric ART services, (Laufer et al, 2008).

Uganda has 1 million people living with HIV-1, 150,000 of whom are children, Without access to prevention of mother to child HIV transmission (PMTCT) services, an estimated 20,000 new infections occur through MTCT each year in Uganda , Similar to HIV-1 infected children from other resource-limited settings, Ugandan infected children have a very high mortality [5]. Using the current WHO recommendations for ART initiation, about 76,750 children are eligible for ART. Currently, 19,954 children are on ART which accounts for only 26 % of the, children who require ART and 8 % of all individuals on ART in Uganda. The number of children on ART in Uganda falls below the WHO recommended target of 10% of the total population on ART, (Obimbo, 2006).

The high HIV-1 seroprevalence in pregnant women from sub-Saharan Africa continues to drive the paediatric HIV-1 epidemic. Prior to the introduction of PMTCT services 21-43 % of HIV-1 infected women in Africa transmitted HIV-1 infection to their infants compared to 14-25% in high-income countries , Advanced maternal disease and almost universal breastfeeding contribute to the higher vertical transmission rates in Africa. Despite significant breakthroughs in PMTCT research, along with WHO and country-specific guidelines for implementation of PMTCT services in antenatal clinics only 50% of the pregnant women worldwide are receiving them. As many pregnant women are unaware of their HIV status, their infants remain at high risk of acquiring HIV-1 infection during pregnancy and lactation, (WHO, 2010).

Prior to use of antiretroviral therapy, the median survival of infected children from Europe and USA was 8 years compared to 2 years in resource-limited settings, The high numbers and early mortality in infected children from resource-limited settings is due to severe recurrent infections, malnutrition, host immunity, HIV-1 subtype, poverty and limited access to quality health-care. Co-infections are associated with immune activation and stimulation of CD4 cells which leads to increased replication of HIV-1, increase in viral load and disease progression. Like previous reports from the USA, African children with a higher viral load (> 250,000 copies/ml) and lower CD4 cell count (< 15%) had a higher risk of death, Maternal factors including high viral load, low CD4 cell count and death also contribute to the mortality in HIV-1 infected children, (Serwadda, 2006).

The clinical features of AIDS in both adults and children are related to the severe immune deficiency associated with HIV-1 infection. Children present with recurrent and severe common childhood bacterial infections including pneumonia, otitis media, sinusitis, septicaemia and meningitis. In addition, lymph adenopathy, hepatomegaly, splenomegaly and malnutrition that presents with failure to thrive, stunting and severe acute malnutrition are also common features of infected children from resource limited settings,  In sub-Saharan Africa, 40–50% of children admitted to hospital with severe acute malnutrition are HIV-1 infected, (Chilongozi, 2008).