HIV infection and in-hospital mortality at an academic hospital in South Africa

Aim-To document the impact that rapid increases in HIV infection in hospita lised children at Chris Hani Baragwanath Hospital has had on in-hospital mo rtality. Methods-Hospital discharge summaries from January 1992 to the end of 1996 w ere reviewed. Results-There were 20 733 admissions in the five year period; 7985 (39%) we re tested for HIV. In tested admissions above 15 months of age, 4.9% were H IV infected in 1992, increasing to 35% in 1996. Under 15 months of age, 9% of tested admissions were positive in 1992, increasing to 46% in 1996. The proportion of all hospital deaths occurring in children considered HIV infe cted (ELISA testing together with clinical features if 15 months or younger ) increased from 6.7% in 1992 to 46.1% in 1996 (p < 0.001). In-hospital mor tality for all children increased by 21% from 4.3% in 1992 to 5.2% in 1996. Mortality rates declined in uninfected children from 5.4% in 1992 to 4.5% in 1996 (chi(2) trend 3.3; p = 0.06). Conclusion-The mortality rate of children has increased at Chris Hani Barag wanath Hospital as a result of HIV infection. Almost half the deaths were H IV related in 1996. HIV infection is threatening the advances that have bee n made on child survival in South Africa over the last few decades.