World Journal of AIDS, 2013, 3, 350-356
Published Online December 2013 (http://www.scirp.org/journal/wja)
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.
Received August 22nd, 2013; revised September 22nd, 2013; accepted September 29th, 2013
Copyright © 2013 A. Sudawa et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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;
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 . 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 . Stud-
ies from Federal Capital Abuja reported mother to child
transmission at (93.02%), blood transfusion (4.6%) and
unidentified route (2.3%) . Reports from Zaria, North-
Western Nigeria showed vertical transmission of 88.6%,
blood transfusion 8.6%, and unknown routes 2.8% .
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 . 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
. Rates of 30% - 40% of MTCT have been reported in
African countries . A transmission rate of 45% was
found in a study conducted at UCH Ibadan .
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 . Mortality as high as 92.8% below the age of
two years among HIV infected children has been re-
ported . 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 .
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 . 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 .
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
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 .
Open Access WJA
HIV Infection among Under-Five Malnourished Children in Kano State
Open Access WJA
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.
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
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-
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 (%)
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-
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
No. of HIV − ve
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
Type of Malnutrition 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.
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
children respectively . Motayo et al.,  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 . 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
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  and also as
reported in Ibadan by Babatunde et al.,  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.,
 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
Studies reported from Ife, South-Western Nigeria,
showed more females than males while in another study
from India there was a male preponderance . Since
behavioral factors do not come to play in paediatric HIV
infection, gender variations most probably occur by
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 , while a similar retrospective study from
Zaria in the same year showed blood transfusion ac-
counting for 8.6% and unknown route 2.8% . Denis et
al.,  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.,  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-
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
, 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 . Similarly
in Enugu, Eastern Nigeria, children with oral candidiasis
recorded the highest seropositivity followed by severe
malnutrition . In the Niger-Delta children with bron-
chopneumonia, septicemia and Pulmunary Tuberculosis
had the highest incidence of HIV seropositivity . 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 . 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
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
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-
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
Open Access WJA
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these need to be addressed within the context of the laws
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