Association Between Finger Clubbing And Chronic Lung Disease In Hiv Infected Children At Kenyatta National Hospital
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Date
2013Author
Odionyi, Justine Jelagat
Type
ThesisLanguage
enMetadata
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Background: Finger clubbing in HIV infected children is associated with pulmonary
diseases like bronchiectasis, TB, and LIP. Pulmonary involvement is responsible for great
morbidity and mortality in HIV infected children. Finger clubbing is a clinical sign that is
easy and quick to detect without sophisticated equipment. Therefore, finger clubbing could
provide simple screening tool to identify children for further evaluation for chronic lung
disease and hence timely intervention which may result in lower morbidity and mortality.
Objective: To determine the association of finger clubbing and chronic lung diseases in HIV
infected children. Secondary objective was to determine clinical correlates (in terms of WHO
clinical staging, CD4 counts/ percentage, antiretroviral therapy duration and pulmonary
hypertension) of finger clubbing among HIV infected children.
Methodology: Hospital based prospective case control study was conducted at KNH
Paediatric wards and CCC. Cases were 60 HIV positive children with finger clubbing and
controls were 60 HIV infected children without finger clubbing. A total of 120 HIV infected
children upto 18 years whose parents gave consent were recruited into the study between
February 2012 and January 2013. Baseline characteristics and physical examination,
laboratory tests, chest radiographs and echocardiography were undertaken and recorded in
questionnaires. Diagnosis of presence or absence of chronic lung disease was then made.
Data was recorded daily in questionnaires by the investigator. The obtained data was entered
into the Statistical Package Social Sciences (SPSS) data entry programme and analyzed using
SPSS/PC+ version 9 programme. The data was then summarized in frequency tables. The
differences between cases and controls were determined using Chi square test for categorical
variables.
Continuous variables was analyzed and presented as medians with interquartile ranges (IQR)
then compared between cases and controls using Mann Whitney U test. Odds ratios were
calculated for categorical data to estimate the magnitude of risk among the cases. All the
statistical tests were performed at 95% confidence interval (5% level of significance).
2
Results: Diagnosis of chronic lung disease was six times more common among the finger
clubbed, 33 (55%) than the non finger clubbed patient, 10 (16.7%), OR 6.1 [95% CI 2.6-
14.3], p<0.001. Finger clubbed patients had 2.6 times risk of being diagnosed with
hypoxemia, 28 (46.7%), OR 2.6 (95% CI 1.2-5.7), p=0.013, and 4.4 times risk of pulmonary
hypertension, 28 (46.7%), OR 4.4 (95% CI 1.9-10.2), p=0.001 as compared to the controls.
Those with finger clubbing had advanced disease in WHO stage III/ IV (91.7%) compared to
non finger clubbed patients (68.3%), OR 6.4 [95% CI 2.0-20.2], p<0.001. Patients with
finger clubbing had lower CD4 cells count and percent (median 369cells, 13%) compared to
non clubbed patients (median 861cells, 28%), p<0.001. Duration of ART use was shorter in
the finger clubbed patients (5.5 months) compared to non finger clubbed patients (median 40
months) p<0.001.
Conclusion: The diagnosis of chronic lung disease was more common in patients with finger
clubbing than those without it and the presence of finger clubbing in HIV infected children
was associated with advanced WHO stage III or IV, lower CD4 counts and percentage and
shorter duration of ART use. There is a higher risk of developing pulmonary hypertension in
HIV infected children with finger clubbing.
Recommendations: All HIV infected children should be examined for the presence of finger
clubbing and those found with it should have pulse oximetry, chest radiolograph and
echocardiography to assess for the presence of chronic lung disease and its complications.
Citation
Masters Of Medicine In Paediatrics And Child Health (m Med Paediatrics), University Of Nairobi, 2013.Publisher
University of Nairobi Department Paediatrics And Child Health