{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:00:57Z","timestamp":1770022857094,"version":"3.49.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Child mortality remains a global public health problem, particularly in Sub-Saharan Africa. After initiating ART, the mortality rate among HIV-infected children in Ethiopia was 12\u201317 deaths per 1000 child-year.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To determine the time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Ethiopia, from April 12, 2017, to May 12, 2022.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Method<\/jats:title>\n<jats:p>An institution-based retrospective follow-up study was conducted among 415 HIV-infected children at selected public hospitals of the Addis Ababa town administration. Computer generated simple random sampling technique was used to select each sampling unit. Data was extracted using a structured data extraction checklist. Data were entered into EPI data 4.2 and analyzed using STATA 14. The child mortality rate was calculated. The Cox proportional hazards regression model was fitted to identify predictor factors. The result of the study was presented using text, tables, graphs, and charts. An adjusted hazard ratio with a 95% confidence interval and a p-value less than 0.05 was used to declare the level of significance.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Result<\/jats:title>\n<jats:p>A total of 415 (97.42%) of the 426 children on ART were included for analysis. Of these, 41(9.88%) children were died during the following period. The study participants were followed for a total of 8237 person- months of risk time. The overall mortality rate was 4.98 (95% CI: 3.67\u20136.77) per 1000 child-months. The estimated survival after starting ART was 61.42% at 56 months of follow-up. Severe underweight (AHR = 3.19; 95% CI: 1.32\u20137.71), tuberculosis (AHR = 3.86; CI: 1.76\u20138.47), low hemoglobin level (AHR = 2.51; CI: 1.02\u20136.20), and advanced WHO clinical stages at enrolment (AHR = 3.38; CI: 1.08\u201310.58) were predictors of death among HIV-infected under-five children on ART.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The incidence of mortality was 4.98 per 1000 child-months. Severe underweight, tuberculosis infection, low hemoglobin level, and advanced WHO clinical stages at enrolment were predictors of death among under-five children on ART.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0288475","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T17:42:27Z","timestamp":1689874947000},"page":"e0288475","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Addis Ababa, Ethiopia, a retrospective follow up study"],"prefix":"10.1371","volume":"18","author":[{"given":"Enyew","family":"Mekonnen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikias","family":"Arega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6307-9452","authenticated-orcid":true,"given":"Dawit Misganaw","family":"Belay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dires","family":"Birhanu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadlo","family":"Tesfaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Habtamu","family":"Ayele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keralem Anteneh","family":"Bishaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"issue":"1","key":"pone.0288475.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-015-2332-y","article-title":"Understanding the determinants of under-five child mortality in Uganda including the estimation of unobserved household and community effects using both frequentist and Bayesian survival analysis approaches.","volume":"15","author":"JB Nasejje","year":"2015","journal-title":"BMC public health."},{"key":"pone.0288475.ref002","author":"T. Chenneville","year":"2017"},{"key":"pone.0288475.ref003","author":"C P","year":"2017","journal-title":"CDC P Helping Babies Born To Hiv-Positive Mothers In Sub-Saharan Africa Stay Healthy And Free Of Hiv"},{"key":"pone.0288475.ref004","article-title":"Children and HIV: fact sheet","author":"UNAIDS","year":"2016","journal-title":"Joint United Nations Programme on HIV\/AIDS Geneva, Switzerland"},{"key":"pone.0288475.ref005","article-title":"HIV Prevention in Ethiopia National Road Map 2018\u20132020","author":"H. Federal","year":"2018","journal-title":"Federal HIV\/AIDS Prevention and Control Office Addis Ababa, Ethiopia"},{"issue":"10","key":"pone.0288475.ref006","doi-asserted-by":"crossref","first-page":"e298","DOI":"10.1371\/journal.pmed.0040298","article-title":"Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review.","volume":"4","author":"S Rosen","year":"2007","journal-title":"PLoS medicine."},{"key":"pone.0288475.ref007","author":"E. FMOH","year":"2021","journal-title":"National Comprehensive HIV Prevention, Care and Treatment Refresher Training for Health care Providers"},{"key":"pone.0288475.ref008","author":"UNAIDS","year":"2020","journal-title":"Global information and education on HIV and AIDS"},{"issue":"1","key":"pone.0288475.ref009","first-page":"1","article-title":"Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya liyu zone, Amhara region, Ethiopia: a retrospective cohort study","volume":"22","author":"BT Marie","year":"2022","journal-title":"BMC pediatrics"},{"key":"pone.0288475.ref010","author":"Organization WH","year":"2010","journal-title":"Antiretroviral therapy of HIV infection in infants and children: towards universal access: recommendations for a public health approach-2010 revision: World Health Organization"},{"key":"pone.0288475.ref011","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/5415298","article-title":"Mortality and its predictors among HIV infected patients taking antiretroviral treatment in Ethiopia: a systematic review","volume":"2017","author":"M. Biset Ayalew","year":"2017","journal-title":"AIDS research and treatment"},{"issue":"3","key":"pone.0288475.ref012","doi-asserted-by":"crossref","first-page":"255","DOI":"10.7196\/SAMJ.2021.v111i3.15221","article-title":"High virological failure rates in HIV-1 perinatally infected children in South Africa: A retrospective cohort study","volume":"111","author":"Z Makatini","year":"2021","journal-title":"South African Medical Journal"},{"issue":"1","key":"pone.0288475.ref013","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-6444-7","article-title":"Long-term survival outcomes of HIV infected children receiving antiretroviral therapy: an observational study from Zambia (2003\u20132015).","volume":"19","author":"JN Mutanga","year":"2019","journal-title":"BMC Public Health."},{"issue":"S3","key":"pone.0288475.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25753","article-title":"Current allocations and target apportionment for HIV testing and treatment services for marginalized populations: characterizing PEPFAR investment and strategy","volume":"24","author":"A Jones","year":"2021","journal-title":"Journal of the International AIDS Society"},{"issue":"1","key":"pone.0288475.ref015","doi-asserted-by":"crossref","DOI":"10.1016\/j.medmal.2016.07.003","article-title":"Predictors of mortality among HIV-infected children receiving highly active antiretroviral therapy.","volume":"47","author":"AE Njom Nlend","year":"2017","journal-title":"M\u00e9decine et Maladies Infectieuses."},{"issue":"4","key":"pone.0288475.ref016","first-page":"0","article-title":"Determinants of survival among HIV positive children on antiretroviral therapy in public hospitals, Addis Ababa, Ethiopia.","volume":"25","author":"A Mulugeta","year":"2017","journal-title":"Quality in Primary Care."},{"issue":"1","key":"pone.0288475.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-6482-1","article-title":"Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis.","volume":"19","author":"I Ahmed","year":"2019","journal-title":"BMC public health."},{"issue":"9925","key":"pone.0288475.ref018","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/S0140-6736(13)62328-4","article-title":"Children growing up with HIV infection: the responsibility of success","volume":"383","author":"S Bernays","year":"2014","journal-title":"The Lancet"},{"issue":"05","key":"pone.0288475.ref019","doi-asserted-by":"crossref","DOI":"10.4172\/2375-4494.1000170","article-title":"Children Living in HIV Families: A Review","volume":"02","author":"JS Victor Minichiello","year":"2014","journal-title":"Journal of Child and Adolescent Behaviour"},{"key":"pone.0288475.ref020","author":"EJ Walakira","year":"2014"},{"key":"pone.0288475.ref021","author":"N Frehiwot","year":"2014"},{"key":"pone.0288475.ref022","doi-asserted-by":"crossref","DOI":"10.18356\/9789210012249","volume-title":"FACT SHEET\u2013WORLD AIDS DAY 2021: \u2014latest global and regional statistics on the status of the AIDS epidemic.","author":"UNAIDS","year":"2021"},{"key":"pone.0288475.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-020-05583-6","article-title":"The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia.","volume":"20","author":"MW Kassaw","year":"2020","journal-title":"BMC infectious diseases."},{"key":"pone.0288475.ref024","author":"Organization WH","year":"2021","journal-title":"Guidelines: updated recommendations on HIV prevention, infant diagnosis, antiretroviral initiation and monitoring."},{"key":"pone.0288475.ref025","author":"HEALTH FMO","year":"2017","journal-title":"NATIONAL GUIDELINES FOR COMPREHENSIVE HIV PREVENTION, CARE AND TREATMENT."},{"issue":"10","key":"pone.0288475.ref026","doi-asserted-by":"crossref","first-page":"e110116","DOI":"10.1371\/journal.pone.0110116","article-title":"Poor Clinical Outcomes for HIV Infected Children on Antiretroviral Therapy in Rural Mozambique: Need for Program Quality Improvement and Community Engagement.","volume":"9","author":"SH Vermund","year":"2014","journal-title":"PLoS ONE."},{"issue":"2","key":"pone.0288475.ref027","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/INF.0000000000002516","article-title":"Earlier Antiretroviral Therapy Initiation and Decreasing Mortality Among HIV-infected Infants Initiating Antiretroviral Therapy Within 3 Months of Age in South Africa, 2006\u20132017","volume":"39","author":"V Iyun","year":"2020","journal-title":"Pediatric Infectious Disease Journal"},{"key":"pone.0288475.ref028","unstructured":"Wikipedia tfe. Addis Ababa Population https:\/\/worldpopulationreview.com\/world-cities\/addis-ababa-population. 2022."},{"key":"pone.0288475.ref029","author":"Project AACAHBP","year":"2014","journal-title":"HIV\/AIDS in Addis Ababa:Background, Projections, Impacts and Interventions"},{"issue":"1","key":"pone.0288475.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12981-021-00353-z","article-title":"Predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy in Metema Hospital, Northwest Ethiopia: a retrospective follow-up study","volume":"18","author":"KL Workie","year":"2021","journal-title":"AIDS research and therapy"},{"issue":"1","key":"pone.0288475.ref031","article-title":"Preterm Neonatal Mortality and its predictors in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a retrospective cohort study.","volume":"31","author":"YA Aynalem","year":"2021","journal-title":"Ethiopian Journal of Health Sciences"},{"issue":"2","key":"pone.0288475.ref032","article-title":"Survival time and its predictors among HIV-infected children after antiretroviral therapy in public health facilities of Arba Minch town, Gamo Gofa Zone, Southern Ethiopia.","volume":"32","author":"NB Sidamo","year":"2018","journal-title":"Ethiopian Journal of Health Development"},{"key":"pone.0288475.ref033","author":"K. Wondwossen","year":"2019","journal-title":"SURVIVAL AND PREDICTORS OF MORTALITY AMONG HIV POSITIVE CHILDREN ON ANTIRETROVIRAL THERAPY IN PUBLIC HOSPITALS, EAST GOJJAM, ETHIOPIA, 2019."},{"key":"pone.0288475.ref034","author":"WHO","year":"2006","journal-title":"Child Growth Standards 1 year 2 years 3 years 4 years 5 years Length\/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age Methods and development."},{"key":"pone.0288475.ref035","doi-asserted-by":"crossref","first-page":"2050312119838957","DOI":"10.1177\/2050312119838957","article-title":"Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: a facility-based retrospective cohort.","volume":"7","author":"G Arage","year":"2019","journal-title":"SAGE open medicine."},{"key":"pone.0288475.ref036","author":"Ethiopiamoh Fdro","year":"2018","journal-title":"National consolidated guidelines for comprehensive hiv prevention,care and treatmenT."},{"issue":"2","key":"pone.0288475.ref037","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MPG.0b013e318298003f","article-title":"World health organization 2006 child growth standards and 2007 growth reference charts: a discussion paper by the committee on nutrition of the European society for pediatric gastroenterology, hepatology, and nutrition.","volume":"57","author":"D Turck","year":"2013","journal-title":"Journal of pediatric gastroenterology and nutrition."},{"key":"pone.0288475.ref038","doi-asserted-by":"crossref","first-page":"19696","DOI":"10.7448\/IAS.17.4.19696","article-title":"Morbidity and mortality in HIV\u2010exposed under\u2010five children in a rural Malawi setting: a cohort study","volume":"17","author":"O Divala","year":"2014","journal-title":"Journal of the International AIDS Society"},{"issue":"1","key":"pone.0288475.ref039","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1186\/s12887-022-03693-5","article-title":"Survival time and predictors of death among HIV infected under five children after initiation of anti -retroviral therapy in West Amhara Referral Hospitals, Northwest Ethiopia.","volume":"22","author":"GG Alemu","year":"2022","journal-title":"BMC Pediatrics"},{"issue":"3","key":"pone.0288475.ref040","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1086\/524686","article-title":"Current CD4 cell count and the short-term risk of AIDS and death before the availability of effective antiretroviral therapy in HIV-infected children and adults","volume":"197","author":"D Dunn","year":"2008","journal-title":"The Journal of infectious diseases"},{"issue":"1","key":"pone.0288475.ref041","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1471-2431-10-33","article-title":"Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort","volume":"10","author":"DC Wamalwa","year":"2010","journal-title":"BMC Pediatrics"},{"issue":"4","key":"pone.0288475.ref042","doi-asserted-by":"crossref","DOI":"10.2989\/16085906.2017.1386219","article-title":"Predictors of survival among HIV-positive children on ART in Swaziland","volume":"16","author":"P Shabangu","year":"2017","journal-title":"African Journal of AIDS Research"},{"issue":"4","key":"pone.0288475.ref043","first-page":"89","article-title":"Predictors on mortality of human immunodeficiency virus infected children after initiation of antiretroviral treatment in Wolaita zone health facilities, Ethiopia: retrospective cohort study","volume":"9","author":"S Bitew","year":"2017","journal-title":"Journal of AIDS and HIV Research"},{"issue":"3","key":"pone.0288475.ref044","article-title":"Factors affecting survival of HIV positive children taking antiretroviral therapy at Adama Referral Hospital and Medical College, Ethiopia.","volume":"5","author":"AK Adem","year":"2014","journal-title":"Journal of AIDS and Clinical Research"},{"issue":"2","key":"pone.0288475.ref045","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1177\/2325957413500852","article-title":"Nutritional Status and Other Baseline Predictors of Mortality among HIV-Infected Children Initiating Antiretroviral Therapy in Tanzania.","volume":"14","author":"RS Mwiru","year":"2015","journal-title":"Journal of the International Association of Providers of AIDS Care (JIAPAC)."},{"key":"pone.0288475.ref046","article-title":"Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study.","volume":"38","author":"E Tachbele","year":"2016","journal-title":"Epidemiology and health."},{"issue":"6","key":"pone.0288475.ref047","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1165\/rcmb.2011-0186TR","article-title":"Arc of a vicious circle: pathways activated by Mycobacterium tuberculosis that target the HIV-1 long terminal repeat","volume":"45","author":"JV Falvo","year":"2011","journal-title":"American journal of respiratory cell and molecular biology"},{"issue":"10","key":"pone.0288475.ref048","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1086\/652147","article-title":"HIV-associated tuberculosis: clinical update","volume":"50","author":"S Swaminathan","year":"2010","journal-title":"Clinical Infectious Diseases"},{"issue":"4","key":"pone.0288475.ref049","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5897\/JAHR2018.0459","article-title":"Survival time of human immunodeficiency virus (HIV) infected children under 15 years of age after initiation of antiretroviral therapy in the University of Gondar Comprehensive Specialized Hospital, Ethiopia.","volume":"10","author":"AA Andargie","year":"2018","journal-title":"Journal of AIDS and HIV Research"},{"issue":"5","key":"pone.0288475.ref050","doi-asserted-by":"crossref","first-page":"e0197145","DOI":"10.1371\/journal.pone.0197145","article-title":"Survival and predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A retrospective follow-up study","volume":"13","author":"KA Atalell","year":"2018","journal-title":"PloS one."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T17:43:15Z","timestamp":1689874995000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288475"}},"subtitle":[],"editor":[{"given":"Daniel Bekele","family":"Ketema","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,20]]},"references-count":50,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0288475","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,20]]}}}