Arch Dis Child 94:512-516 doi:10.1136/adc.2008.142646
  • Original article

Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition

  1. P Fergusson1,2,
  2. J Chinkhumba3,
  3. C Grijalva-Eternod4,
  4. T Banda5,
  5. C Mkangama5,
  6. A Tomkins4
  1. 1
    Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2
    Action Against Hunger UK, London, UK
  3. 3
    Action Against Hunger Malawi, Lilongwe, Malawi
  4. 4
    Centre for International Health and Development, Institute of Child Health, London, UK
  5. 5
    Ministry of Health, Lilongwe, Malawi
  1. Pamela Fergusson, Liverpool School of Tropical Medicine, Disease Control Group, Pembroke Place, Liverpool L3 5QA, UK; pamela.fergusson{at}
  • Revised 13 October 2008
  • Published Online First 31 October 2008


Objective: Few studies have reported on nutritional recovery, survival and growth among severely malnourished children with HIV. This study explores nutritional recovery in HIV-infected and HIV-uninfected children during inpatient nutrition rehabilitation and 4 months of follow-up.

Design: Prospective cohort study.

Setting: Lilongwe district, Malawi.

Main outcome measures: Weight gain, anthropometrics.

Results: In our sample of 454 children with severe acute malnutrition (SAM), 17.4% (n = 79) of children were HIV infected. None of the children were on antiretroviral therapy upon admission. Among the HIV-infected children, 35.4% (28/79) died, compared with 10.4% (39/375) in HIV-uninfected children (p<0.001). All children who survived achieved nutritional recovery (>85% weight for height and no oedema), regardless of HIV status. HIV-infected children had similar weight gain to HIV-uninfected children (8.9 vs 8.0 g/kg/d, not significant (NS)). Mean increases in z-scores for both subscapular (2.72 vs 2.69, NS) and triceps (1.26 vs 1.48, NS) skinfolds were similar between HIV-infected and HIV-uninfected children, respectively, during nutrition rehabilitation. 362 children were followed for 4 months, at which time mean weight for height z-score was similar in HIV-infected and HIV-uninfected children (−0.85 vs −0.64, NS).

Conclusions: HIV-infected children with SAM have higher mortality rates than HIV-uninfected children. Among those who survive, however, nutritional recovery is similar in HIV-infected and HIV-uninfected children.


  • Competing interests: None.

  • Ethics approval: Ethical approval was given by the National Health Sciences Research Committee of Malawi.

  • Patient consent: Parental consent obtained.