1. HIV and mortality in severe malnutrition in Malawi P Fergusson, J Chinkhumba, A Tomkins

2. Research Objective To investigate the relationship between CD4%, mortality and HIV in severely malnourished children.

3. Study setting and characteristics 3 Nutrition Rehabilitation Units in Lilongwe district –2 rural –1 urban Therapeutic feeding and medical management Sample characteristics: 507 mother/child pairs recruited 454 child/mother pairs HIV status available HIV : 17.4% Mortality: 14.8%

4. HIV and risk of mortality HIV infectedHIV uninfected Child died 35.4% (28/79) 10.4% (39/375) HIV infected children relative risk of mortality: RR= 3.41 (CI 2.24 – 5.19)

5. Urban Rural divide Urban children were significantly more likely than rural children to be HIV infected RR = 3.54 UrbanRural HIV+ve37%10% HIV-ve63%90%

8. Recommendations and conclusions HIV infected severely malnourished children in Malawi are clustered in urban environments – resource implications Small proportion of deaths occurring in NRU –Better integration between paeds and NRU –Training on severe malnutrition protocols for paeds staff –Defining criteria for appropriate referral to paeds CD4% cut offs for initiation of ART should be more clearly defined

9. Thank you The participating families Donors National AIDS Council of Malawi UNICEF ACF Paris Partners KCH, St. Gabriels, Mitundu hospitals MOH Malawi UNC Labs CICH AAH London, Madrid and Malawi

10. Questions?