Burden and cost of inpatient care for HIV-positive paediatric patients - Status in the Cape Town metropole during the second week of March 1999

Objective. To determine the burden of the HIV epidemic on paediatric inpati ent facilities in the teaching hospitals of the Cape metropole and tributar ies to these hospitals. Setting. Second- and third-level hospitals. Method. During the second week of March 1999 a multicentre collaborative ce nsus was performed of all paediatric beds in the teaching hospitals of Cape Town and all facilities draining to and from them. Results. One hundred and six HIV-infected patients were identified from a t otal of 1264 beds. Thirty-nine children were in second-level beds or in a l ong-term residential facility Fifty-six children were in second-level beds designated for acute care, and occupied 12% of all such beds. Ten children were in beds designated for the care of tuberculosis. Thirty-two (56%) of t he acute admissions were for gastro-enteritis, and 13 (23%) were for pneumo nia. In 10 children (18% of all admissions) recognised complications of HIV infection were direct causes of admission. For 29 children (35% of all adm issions) the current admission was the first; the remainder had had a mean of 2.4 previous admissions. Fourteen children (25%) had received oxygen, an d 26 (46%) had received intravenous therapy. Mean lifetime hospitalisation cost per infected child was calculated to be R19 712 The projected cost of a local initiative to reduce mother-to-child transmission is between R8 326 and R10 806 per-vertical infection prevented. Conclusion. The inpatient burden of HIV-infected children in Cape Town refl ects an early stage of the epidemic. Compared with projected lifetime hospi talisation cost for infected children, an intervention to reduce vertical t ransmission cost would be cost effective.