The impact of HIV-1 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 child mortality and an increase in the number of sick children presenting to health services. Many of the sick children come to health centres and hospitals, inflating numbers on paediatric wards. The presentations of childhood HIV-1 infection are many and varied so that HIV-1 infection is the new "great imitator' of other conditions. Some other infections are more severe in HIV-1 infected children (specifically bacterial infections and measles). However, there is no clear evidence of consequent rises in the incidence of other childhood infections, though this is likely to be the case of tuberculosis. HIV-1 infected children with other infections often respond to locally available anti-microbials, but may require longer courses. Treatment is problematic because of the impossibility of distinguishing infected from uninfected children and because of shortages of medicines, which are being intensified further by the child and adult HIV-1 epidemics. Severe HIV disease in adult family members is adding to child morbidity and creating substantial orphanhood. Staff fear nosocomial infection, while simultaneously experiencing falling personal incomes and lacking resources to care for their patients. Substantial numbers of trained staff are being lost because of HIV-1 caused disease and death. The reality of HIV-1 infection through breast-feeding is not yet appreciated. When this becomes generally apparent, there is a risk that a lethal increase in bottle feeding could occur in some areas. Reduction in the number of new paediatric HIV-1 infections in sub-Saharan Africa can be achieved only by ameliorating the adult HIV-1 epidemic, reducing unnecessary blood transfusions and ensuring a safe blood supply.