THE IMPACT OF HIV-I INFECTION ON CHILD HEALTH IN SUB-SAHARAN AFRICA -THE BURDEN ON THE HEALTH-SERVICES

HIV-1 infection in sub-Saharan Africa is resulting in substantial chil d mortality and an increase in the number of sick children presenting to health services. Many of the sick children come to health centres a nd hospitals, inflating numbers on paediatric wards. The presentations of childhood HIV-1 infection are many and varied so that HIV-1 infect ion is the new 'great imitator' of other conditions. Some other infect ions are more severe in HIV-1 infected children (specifically bacteria l infections and measles). However, there is no clear evidence of cons equent rises in the incidence of other childhood infections, though th is is likely to be the case for tuberculosis. HIV-1 infected children with other infections often respond to locally available anti-microbia ls, but may require longer courses. Treatment is problematic because o f the impossibility of distinguishing infected from uninfected childre n and because of shortages of medicines, which are being intensified f urther by the child and adult HIV-1 epidemics. Severe HIV disease in a dult family members is adding to child morbidity and creating substant ial orphanhood. Staff fear nosocomial infection, while simultaneously experiencing falling personal incomes and lacking resources to care fo r their patients. Substantial numbers of trained staff are being lost because of HIV-1 caused disease and death. The reality of HIV-1 infect ion through breast-feeding is not yet appreciated. When this becomes g enerally apparent, there is a risk that a lethal increase in bottle fe eding could occur in some areas. Reduction in the number of new paedia tric HIV-1 infections in sub-Saharan Africa can be achieved only by am eliorating the adult HIV-1 epidemic, reducing unnecessary blood transf usions and ensuring a safe blood supply.