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<!DOCTYPE html> <html lang="en" class="no-js"> <head> <meta charset="UTF-8"> <meta http-equiv="X-UA-Compatible" content="IE=edge"> <meta name="applicable-device" content="pc,mobile"> <meta name="viewport" content="width=device-width, initial-scale=1"> <meta name="robots" content="max-image-preview:large"> <meta name="access" content="Yes"> <meta name="360-site-verification" content="1268d79b5e96aecf3ff2a7dac04ad990" /> <title>The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis | Journal of Epidemiology and Global Health</title> <meta name="twitter:site" content="@SpringerLink"/> <meta name="twitter:card" content="summary_large_image"/> <meta name="twitter:image:alt" content="Content cover image"/> <meta name="twitter:title" content="The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis"/> <meta name="twitter:description" content="Journal of Epidemiology and Global Health - Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates..."/> <meta name="twitter:image" content="https://static-content.springer.com/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig1_HTML.png"/> <meta name="journal_id" content="44197"/> <meta name="dc.title" content="The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis"/> <meta name="dc.source" content="Journal of Epidemiology and Global Health 2024"/> <meta name="dc.format" content="text/html"/> <meta name="dc.publisher" content="Springer"/> <meta name="dc.date" content="2024-11-14"/> <meta name="dc.type" content="ReviewPaper"/> <meta name="dc.language" content="En"/> <meta name="dc.copyright" content="2024 The Author(s)"/> <meta name="dc.rights" content="2024 The Author(s)"/> <meta name="dc.rightsAgent" content="journalpermissions@springernature.com"/> <meta name="dc.description" content="Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates have remained unacceptably high. Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia. However, the pooled effect of malnutrition and anemia on HIV-related death related to children receiving ART was not investigated in sub-Saharan Africa. We searched multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, and Web of Science) for observational studies published between January 1, 2010, and April 24, 2024 that reported the risk factors or effects of undernutrition and, anemia on HIV-related mortality among children. Study selection, data extraction, and quality evaluation were carried out separately by two reviewers. A meta-analysis was conducted using random effect models. The review included 27 studies with a combined total of 61,796 study participants. The study findings showed that severe wasting (HR: 2.49; 95% CI: 1.87–3.30), being underweight (HR: 2.11; 95% CI: 1.64–2.72), and Anemia (HR: 2.58; 95% CI: 2.08–3.19) were highly linked to HIV-related death among children. The risk of death due to anemia was greater among children under the age of 5 years than older children. Undernutrition and anemia in sub-Saharan African children increased the risk of HIV-related death. The impact of malnutrition and anemia among under 5 years old children with HIV/AIDS was more pronounced, suggesting that these conditions at this early age can have more serious consequences for a child’s survival. The importance of combining nutrition with HIV treatment programs in sub-Saharan African countries is crucial."/> <meta name="prism.issn" content="2210-6014"/> <meta name="prism.publicationName" content="Journal of Epidemiology and Global Health"/> <meta name="prism.publicationDate" content="2024-11-14"/> <meta name="prism.section" content="ReviewPaper"/> <meta name="prism.startingPage" content="1"/> <meta name="prism.endingPage" content="11"/> <meta name="prism.copyright" content="2024 The Author(s)"/> <meta name="prism.rightsAgent" content="journalpermissions@springernature.com"/> <meta name="prism.url" content="https://link.springer.com/article/10.1007/s44197-024-00321-6"/> <meta name="prism.doi" content="doi:10.1007/s44197-024-00321-6"/> <meta name="citation_pdf_url" content="https://link.springer.com/content/pdf/10.1007/s44197-024-00321-6.pdf"/> <meta name="citation_fulltext_html_url" content="https://link.springer.com/article/10.1007/s44197-024-00321-6"/> <meta name="citation_journal_title" content="Journal of Epidemiology and Global Health"/> <meta name="citation_journal_abbrev" content="J Epidemiol Glob Health"/> <meta name="citation_publisher" content="Springer Netherlands"/> <meta name="citation_issn" content="2210-6014"/> <meta name="citation_title" content="The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis"/> <meta name="citation_online_date" content="2024/11/14"/> <meta name="citation_firstpage" content="1"/> <meta name="citation_lastpage" content="11"/> <meta name="citation_article_type" content="Review Article"/> <meta name="citation_fulltext_world_readable" content=""/> <meta name="citation_language" content="en"/> <meta name="dc.identifier" content="doi:10.1007/s44197-024-00321-6"/> <meta name="DOI" content="10.1007/s44197-024-00321-6"/> <meta name="size" content="146603"/> <meta name="citation_doi" content="10.1007/s44197-024-00321-6"/> <meta name="citation_springer_api_url" content="http://api.springer.com/xmldata/jats?q=doi:10.1007/s44197-024-00321-6&api_key="/> <meta name="description" content="Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates have "/> <meta name="dc.creator" content="Moges, Sisay"/> <meta name="dc.creator" content="Lajore, Bereket Aberham"/> <meta name="dc.creator" content="Oleba, Abera Feyisa"/> <meta name="dc.creator" content="Godebo, Abraham Samuel"/> <meta name="dc.creator" content="Funga, Mengistu Lodebo"/> <meta name="dc.subject" content="Medicine/Public Health, general"/> <meta name="citation_reference" content="citation_journal_title=J Virus Eradication; citation_title=Traversing the cascade: urgent research priorities for implementing the ‘treat all’strategy for children and adolescents living with HIV in sub-saharan Africa; citation_author=LA Enane; citation_volume=4; citation_publication_date=2018; citation_pages=40-6; citation_doi=10.1016/S2055-6640(20)30344-7; citation_id=CR1"/> <meta name="citation_reference" content="citation_journal_title=Lancet HIV; citation_title=Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-saharan Africa, 2000–18: a modelling study; citation_author=B Sartorius; citation_volume=8; citation_issue=6; citation_publication_date=2021; citation_pages=e363-75; citation_doi=10.1016/S2352-3018(21)00051-5; citation_id=CR2"/> <meta name="citation_reference" content="World health Organization(WHO). 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Obesity, undernutrition and the double burden of malnutrition in the urban and rural southern Free State, South Africa. Heliyon. 2018;4(12)."/> <meta name="citation_reference" content="citation_journal_title=Indian J Community Med; citation_title=Nutritional anemia in young children with focus on Asia and India; citation_author=PV Kotecha; citation_volume=36; citation_issue=1; citation_publication_date=2011; citation_pages=8-16; citation_doi=10.4103/0970-0218.80786; citation_id=CR66"/> <meta name="citation_author" content="Moges, Sisay"/> <meta name="citation_author_email" content="Sisaymoges55@gmail.com"/> <meta name="citation_author_institution" content="Department of Family Health, Hossana College of Science, Hosanna, Ethiopia"/> <meta name="citation_author" content="Lajore, Bereket Aberham"/> <meta name="citation_author_institution" content="Department of Family Health, Hossana College of Science, Hosanna, Ethiopia"/> <meta name="citation_author" content="Oleba, Abera Feyisa"/> <meta name="citation_author_institution" content="Department of Clinical Nursing, Hossana College of Science, Hosanna, Ethiopia"/> <meta name="citation_author" content="Godebo, Abraham Samuel"/> <meta name="citation_author_institution" content="Department of Emergency and Critical Care, Hossana College of Science, Hosanna, Ethiopia"/> <meta name="citation_author" content="Funga, Mengistu Lodebo"/> <meta name="citation_author_institution" content="Department of Midwifery, Hossana College of Science, Hosanna, Ethiopia"/> <meta name="format-detection" content="telephone=no"/> <meta property="og:url" content="https://link.springer.com/article/10.1007/s44197-024-00321-6"/> <meta property="og:type" content="article"/> <meta property="og:site_name" content="SpringerLink"/> <meta property="og:title" content="The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis - Journal of Epidemiology and Global Health"/> <meta property="og:description" content="Background Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates have remained unacceptably high. Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia. However, the pooled effect of malnutrition and anemia on HIV-related death related to children receiving ART was not investigated in sub-Saharan Africa. Methods We searched multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, and Web of Science) for observational studies published between January 1, 2010, and April 24, 2024 that reported the risk factors or effects of undernutrition and, anemia on HIV-related mortality among children. Study selection, data extraction, and quality evaluation were carried out separately by two reviewers. A meta-analysis was conducted using random effect models. Results The review included 27 studies with a combined total of 61,796 study participants. The study findings showed that severe wasting (HR: 2.49; 95% CI: 1.87–3.30), being underweight (HR: 2.11; 95% CI: 1.64–2.72), and Anemia (HR: 2.58; 95% CI: 2.08–3.19) were highly linked to HIV-related death among children. The risk of death due to anemia was greater among children under the age of 5 years than older children. Conclusion Undernutrition and anemia in sub-Saharan African children increased the risk of HIV-related death. The impact of malnutrition and anemia among under 5 years old children with HIV/AIDS was more pronounced, suggesting that these conditions at this early age can have more serious consequences for a child’s survival. The importance of combining nutrition with HIV treatment programs in sub-Saharan African countries is crucial."/> <meta property="og:image" content="https://static-content.springer.com/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig1_HTML.png"/> <meta name="format-detection" content="telephone=no"> <link rel="apple-touch-icon" sizes="180x180" href=/oscar-static/img/favicons/darwin/apple-touch-icon-92e819bf8a.png> <link rel="icon" type="image/png" sizes="192x192" href=/oscar-static/img/favicons/darwin/android-chrome-192x192-6f081ca7e5.png> <link rel="icon" type="image/png" sizes="32x32" href=/oscar-static/img/favicons/darwin/favicon-32x32-1435da3e82.png> <link rel="icon" type="image/png" sizes="16x16" href=/oscar-static/img/favicons/darwin/favicon-16x16-ed57f42bd2.png> <link rel="shortcut icon" data-test="shortcut-icon" href=/oscar-static/img/favicons/darwin/favicon-c6d59aafac.ico> <meta name="theme-color" content="#e6e6e6">   <link rel="stylesheet" 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Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia. However, the pooled effect of malnutrition and anemia on HIV-related death related to children receiving ART was not investigated in sub-Saharan Africa. We searched multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, and Web of Science) for observational studies published between January 1, 2010, and April 24, 2024 that reported the risk factors or effects of undernutrition and, anemia on HIV-related mortality among children. Study selection, data extraction, and quality evaluation were carried out separately by two reviewers. A meta-analysis was conducted using random effect models. The review included 27 studies with a combined total of 61,796 study participants. The study findings showed that severe wasting (HR: 2.49; 95% CI: 1.87–3.30), being underweight (HR: 2.11; 95% CI: 1.64–2.72), and Anemia (HR: 2.58; 95% CI: 2.08–3.19) were highly linked to HIV-related death among children. The risk of death due to anemia was greater among children under the age of 5 years than older children. Undernutrition and anemia in sub-Saharan African children increased the risk of HIV-related death. The impact of malnutrition and anemia among under 5 years old children with HIV/AIDS was more pronounced, suggesting that these conditions at this early age can have more serious consequences for a child’s survival. 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class="c-context-bar__title"> The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis </div> <div data-test="inCoD" data-track-context="sticky banner"> <div class="c-pdf-container"> <div class="c-pdf-download u-clear-both u-mb-16"> <a href="/content/pdf/10.1007/s44197-024-00321-6.pdf" class="u-button u-button--full-width u-button--primary u-justify-content-space-between c-pdf-download__link" data-article-pdf="true" data-readcube-pdf-url="true" data-test="pdf-link" data-draft-ignore="true" data-track="content_download" data-track-type="article pdf download" data-track-action="download pdf" data-track-label="button" data-track-external download> <span class="c-pdf-download__text">Download PDF</span> <svg aria-hidden="true" focusable="false" width="16" height="16" class="u-icon"><use xlink:href="#icon-eds-i-download-medium"/></svg> </a> </div> </div> </div> </div> </div> <div class="c-article-header"> <header> <ul class="c-article-author-list c-article-author-list--short" data-test="authors-list" data-component-authors-activator="authors-list"><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Sisay-Moges-Aff1" data-author-popup="auth-Sisay-Moges-Aff1" data-author-search="Moges, Sisay" data-corresp-id="c1">Sisay Moges<svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-mail-medium"></use></svg></a><sup class="u-js-hide"><a href="#Aff1">1</a></sup>, </li><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Bereket_Aberham-Lajore-Aff1" data-author-popup="auth-Bereket_Aberham-Lajore-Aff1" data-author-search="Lajore, Bereket Aberham">Bereket Aberham Lajore</a><sup class="u-js-hide"><a href="#Aff1">1</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Abera_Feyisa-Oleba-Aff2" data-author-popup="auth-Abera_Feyisa-Oleba-Aff2" data-author-search="Oleba, Abera Feyisa">Abera Feyisa Oleba</a><sup class="u-js-hide"><a href="#Aff2">2</a></sup>, </li><li class="c-article-author-list__item c-article-author-list__item--hide-small-screen"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Abraham_Samuel-Godebo-Aff3" data-author-popup="auth-Abraham_Samuel-Godebo-Aff3" data-author-search="Godebo, Abraham Samuel">Abraham Samuel Godebo</a><sup class="u-js-hide"><a href="#Aff3">3</a></sup> & </li><li class="c-article-author-list__show-more" aria-label="Show all 5 authors for this article" title="Show all 5 authors for this article">…</li><li class="c-article-author-list__item"><a data-test="author-name" data-track="click" data-track-action="open author" data-track-label="link" href="#auth-Mengistu_Lodebo-Funga-Aff4" data-author-popup="auth-Mengistu_Lodebo-Funga-Aff4" data-author-search="Funga, Mengistu Lodebo">Mengistu Lodebo Funga</a><sup class="u-js-hide"><a href="#Aff4">4</a></sup> </li></ul><button aria-expanded="false" class="c-article-author-list__button"><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-down-medium"></use></svg><span>Show authors</span></button> <div data-test="article-metrics"> <ul class="app-article-metrics-bar u-list-reset"> <li class="app-article-metrics-bar__item"> <p class="app-article-metrics-bar__count"><svg class="u-icon app-article-metrics-bar__icon" width="24" height="24" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-accesses-medium"></use> </svg>215 <span class="app-article-metrics-bar__label">Accesses</span></p> </li> <li class="app-article-metrics-bar__item app-article-metrics-bar__item--metrics"> <p class="app-article-metrics-bar__details"><a href="/article/10.1007/s44197-024-00321-6/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Explore all metrics <svg class="u-icon app-article-metrics-bar__arrow-icon" width="24" height="24" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-arrow-right-medium"></use> </svg></a></p> </li> </ul> </div> <div class="u-mt-32"> </div> </header> </div> <div data-article-body="true" data-track-component="article body" class="c-article-body"> <section aria-labelledby="Abs1" data-title="Abstract" lang="en"><div class="c-article-section" id="Abs1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Abs1">Abstract</h2><div class="c-article-section__content" id="Abs1-content"><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Background</h3><p>Although there have been significant advancements in providing HIV-infected children with access to antiretroviral therapy (ART), the mortality rates have remained unacceptably high. Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia. However, the pooled effect of malnutrition and anemia on HIV-related death related to children receiving ART was not investigated in sub-Saharan Africa.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Methods</h3><p>We searched multiple electronic databases (PubMed/MEDLINE, Embase, CINAHL, and Web of Science) for observational studies published between January 1, 2010, and April 24, 2024 that reported the risk factors or effects of undernutrition and, anemia on HIV-related mortality among children. Study selection, data extraction, and quality evaluation were carried out separately by two reviewers. A meta-analysis was conducted using random effect models.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Results</h3><p>The review included 27 studies with a combined total of 61,796 study participants. The study findings showed that severe wasting (HR: 2.49; 95% CI: 1.87–3.30), being underweight (HR: 2.11; 95% CI: 1.64–2.72), and Anemia (HR: 2.58; 95% CI: 2.08–3.19) were highly linked to HIV-related death among children. The risk of death due to anemia was greater among children under the age of 5 years than older children.</p><h3 class="c-article__sub-heading" data-test="abstract-sub-heading">Conclusion</h3><p>Undernutrition and anemia in sub-Saharan African children increased the risk of HIV-related death. The impact of malnutrition and anemia among under 5 years old children with HIV/AIDS was more pronounced, suggesting that these conditions at this early age can have more serious consequences for a child’s survival. The importance of combining nutrition with HIV treatment programs in sub-Saharan African countries is crucial.</p></div></div></section> <div data-test="cobranding-download"> </div> <section aria-labelledby="inline-recommendations" data-title="Inline Recommendations" class="c-article-recommendations" data-track-component="inline-recommendations"> <h3 class="c-article-recommendations-title" id="inline-recommendations">Similar content being viewed by others</h3> <div class="c-article-recommendations-list"> <div class="c-article-recommendations-list__item"> <article class="c-article-recommendations-card" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="c-article-recommendations-card__img"><img src="https://media.springernature.com/w215h120/springer-static/image/art%3A10.1186%2Fs41182-020-00267-y/MediaObjects/41182_2020_267_Fig1_HTML.png" loading="lazy" alt=""></div> <div class="c-article-recommendations-card__main"> <h3 class="c-article-recommendations-card__heading" itemprop="name headline"> <a class="c-article-recommendations-card__link" itemprop="url" href="https://link.springer.com/10.1186/s41182-020-00267-y?fromPaywallRec=false" data-track="select_recommendations_1" data-track-context="inline recommendations" data-track-action="click recommendations inline - 1" data-track-label="10.1186/s41182-020-00267-y">Mortality and its association with CD4 cell count and hemoglobin level among children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis </a> </h3> <div class="c-article-meta-recommendations" data-test="recommendation-info"> <span class="c-article-meta-recommendations__item-type">Article</span> <span class="c-article-meta-recommendations__access-type">Open access</span> <span class="c-article-meta-recommendations__date">21 September 2020</span> </div> </div> </article> </div> <div class="c-article-recommendations-list__item"> <article class="c-article-recommendations-card" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="c-article-recommendations-card__img"><img src="https://media.springernature.com/w215h120/springer-static/image/art%3A10.1186%2Fs13690-021-00785-z/MediaObjects/13690_2021_785_Fig1_HTML.png" loading="lazy" alt=""></div> <div class="c-article-recommendations-card__main"> <h3 class="c-article-recommendations-card__heading" itemprop="name headline"> <a class="c-article-recommendations-card__link" itemprop="url" href="https://link.springer.com/10.1186/s13690-021-00785-z?fromPaywallRec=false" data-track="select_recommendations_2" data-track-context="inline recommendations" data-track-action="click recommendations inline - 2" data-track-label="10.1186/s13690-021-00785-z">Under-nutrition and associated factors among children infected with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis </a> </h3> <div class="c-article-meta-recommendations" data-test="recommendation-info"> <span class="c-article-meta-recommendations__item-type">Article</span> <span class="c-article-meta-recommendations__access-type">Open access</span> <span class="c-article-meta-recommendations__date">05 January 2022</span> </div> </div> </article> </div> <div class="c-article-recommendations-list__item"> <article class="c-article-recommendations-card" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="c-article-recommendations-card__img"><img src="https://media.springernature.com/w215h120/springer-static/image/art%3A10.1186%2Fs12879-019-4656-1/MediaObjects/12879_2019_4656_Fig1_HTML.png" loading="lazy" alt=""></div> <div class="c-article-recommendations-card__main"> <h3 class="c-article-recommendations-card__heading" itemprop="name headline"> <a class="c-article-recommendations-card__link" itemprop="url" href="https://link.springer.com/10.1186/s12879-019-4656-1?fromPaywallRec=false" data-track="select_recommendations_3" data-track-context="inline recommendations" data-track-action="click recommendations inline - 3" data-track-label="10.1186/s12879-019-4656-1">Burden of anemia and its association with HAART in HIV infected children in Ethiopia: a systematic review and meta-analysis </a> </h3> <div class="c-article-meta-recommendations" data-test="recommendation-info"> <span class="c-article-meta-recommendations__item-type">Article</span> <span class="c-article-meta-recommendations__access-type">Open access</span> <span class="c-article-meta-recommendations__date">04 December 2019</span> </div> </div> </article> </div> </div> </section> <script> window.dataLayer = window.dataLayer || []; window.dataLayer.push({ recommendations: { recommender: 'semantic', model: 'specter', policy_id: 'NA', timestamp: 1732381415, embedded_user: 'null' } }); </script> <div class="app-card-service" data-test="article-checklist-banner"> <div> <a class="app-card-service__link" data-track="click_presubmission_checklist" data-track-context="article page top of reading companion" data-track-category="pre-submission-checklist" data-track-action="clicked article page checklist banner test 2 old version" data-track-label="link" href="https://beta.springernature.com/pre-submission?journalId=44197" data-test="article-checklist-banner-link"> <span class="app-card-service__link-text">Use our pre-submission checklist</span> <svg class="app-card-service__link-icon" aria-hidden="true" focusable="false"><use xlink:href="#icon-eds-i-arrow-right-small"></use></svg> </a> <p class="app-card-service__description">Avoid common mistakes on your manuscript.</p> </div> <div class="app-card-service__icon-container"> <svg class="app-card-service__icon" aria-hidden="true" focusable="false"> <use xlink:href="#icon-eds-i-clipboard-check-medium"></use> </svg> </div> </div> <div class="main-content"> <section data-title="Background"><div class="c-article-section" id="Sec1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec1"><span class="c-article-section__title-number">1 </span>Background</h2><div class="c-article-section__content" id="Sec1-content"><p>The HIV/AIDS epidemic continues to be a significant public health challenge in sub-Saharan Africa, with children being particularly vulnerable to its impacts [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 1" title="Enane LA, et al. Traversing the cascade: urgent research priorities for implementing the ‘treat all’strategy for children and adolescents living with HIV in sub-saharan Africa. J Virus Eradication. 2018;4:40–6." href="/article/10.1007/s44197-024-00321-6#ref-CR1" id="ref-link-section-d155691737e367">1</a>]. Although there has been significant advancement in providing HIV-infected children in this area with access to antiretroviral therapy (ART), the mortality rates have remained unacceptably high [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 2" title="Sartorius B, et al. Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-saharan Africa, 2000–18: a modelling study. Lancet HIV. 2021;8(6):e363–75." href="/article/10.1007/s44197-024-00321-6#ref-CR2" id="ref-link-section-d155691737e370">2</a>]. According to the World Health Organization (WHO), in the African region, an estimated 1.3 million children aged 0–14 were living with HIV at the end of 2022, and approximately 69,000 children died of AIDS-related illnesses [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 3" title="World health Organization(WHO). HIV/AIDS WHO Africa Report. 2023 [cited 2024 April 22]; 
 https://www.afro.who.int/health-topics/hivaids#:~:text=Treatment%20and%20care%20in%20children,died%20of%20AIDS%2Drelated%20illnesses
 
 " href="/article/10.1007/s44197-024-00321-6#ref-CR3" id="ref-link-section-d155691737e373">3</a>]; a mortality rate of 7.9% was reported in sub-Saharan African countries [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 4" title="Ahmed I, Lemma S. Mortality among pediatric patients on HIV treatment in sub-saharan African countries: a systematic review and meta-analysis. BMC Public Health. 2019;19(1):149." href="/article/10.1007/s44197-024-00321-6#ref-CR4" id="ref-link-section-d155691737e376">4</a>]. Although ART has greatly increased the survival rates and quality of life of HIV-infected individuals, its effectiveness in children is frequently impacted by factors such as undernutrition and anemia [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 5" title="Muenchhoff M, et al. Malnutrition in HIV-infected children is an indicator of severe disease with an impaired response to antiretroviral therapy. AIDS Res Hum Retroviruses. 2018;34(1):46–55." href="/article/10.1007/s44197-024-00321-6#ref-CR5" id="ref-link-section-d155691737e379">5</a>].</p><p>Inadequate nutrient intake or absorption is a widespread problem in several African nations, resulting in undernutrition and anemia [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 6" title="Elmighrabi NF, et al. A systematic review and meta-analysis of the prevalence of childhood undernutrition in North Africa. PLoS ONE. 2023;18(4):e0283685." href="/article/10.1007/s44197-024-00321-6#ref-CR6" id="ref-link-section-d155691737e385">6</a>]. Undernutrition in the presence of HIV can worsen the disease, weaken the immune system, and decrease the effectiveness of antiretroviral medications [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 7" title="Fuseini H, et al. Undernutrition and HIV infection in sub-saharan Africa: health outcomes and therapeutic interventions. Curr HIV/AIDS Rep. 2021;18:87–97." href="/article/10.1007/s44197-024-00321-6#ref-CR7" id="ref-link-section-d155691737e388">7</a>]. The complex interplay between HIV and undernutrition forms a harmful cycle, with each condition worsening the effects of the other, possibly resulting in higher rates of illness and death [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 8" title="Thimmapuram R, et al. Correlation of nutrition with immune status in human immunodeficiency virus outpatients. Mo Med. 2019;116(4):336." href="/article/10.1007/s44197-024-00321-6#ref-CR8" id="ref-link-section-d155691737e391">8</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 9" title="Sashindran VK, Thakur R. Malnutrition in HIV/AIDS: aetiopathogenesis. Nutrition and HIV/AIDS-Implication for treatment. Prevention and Cure [series online]; 2020." href="/article/10.1007/s44197-024-00321-6#ref-CR9" id="ref-link-section-d155691737e394">9</a>]. However, malnutrition and anemia are not the sole causes of HIV-related mortality among children but serve as critical markers in a complex interplay of factors. They indicate underlying vulnerabilities, such as weakened immune systems and poor overall health, which make children more susceptible to opportunistic infections and hinder their response to antiretroviral therapy (ART) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Mulugeta A, et al. Determinants of survival among HIV positive children on antiretroviral therapy in public hospitals, Addis Ababa, Ethiopia. Qual Prim Care. 2017;25(4):235–41." href="#ref-CR10" id="ref-link-section-d155691737e397">10</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Nlend AEN, Loussikila AB. Predictors of mortality among HIV-infected children receiving highly active antiretroviral therapy. Med et maladies Infectieuses. 2017;47(1):32–7." href="#ref-CR11" id="ref-link-section-d155691737e397_1">11</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 12" title="Nyandiko W et al. Predictors of mortality among children and adolescents living with HIV on Antiretroviral Therapy in Western Kenya. JAIDS J Acquir Immune Defic Syndr, 2022: pp. 10–1097." href="/article/10.1007/s44197-024-00321-6#ref-CR12" id="ref-link-section-d155691737e401">12</a>]. This interplay involves co-existing infections, delayed ART initiation, and inadequate healthcare access, all contributing to higher mortality risks [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Sidamo N et al. Incidence and predictors of mortality among children on anti-retroviral therapy in public health facilities of Arba Minch town, Gamo Gofa Zone, southern Ethiopia; retrospective cohort study. Clin Mother Child Health. 2017;14(3)." href="/article/10.1007/s44197-024-00321-6#ref-CR13" id="ref-link-section-d155691737e404">13</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 14" title="Wamalwa DC, et al. Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort. BMC Pediatr. 2010;10(1):33." href="/article/10.1007/s44197-024-00321-6#ref-CR14" id="ref-link-section-d155691737e407">14</a>]. While malnutrition and anemia reflect these broader issues, they are part of a multifaceted web of clinical and socio-economic factors driving poor health outcomes in HIV-infected children. Anemia, a frequent coexisting condition in children with HIV, is defined by a lower amount of hemoglobin in the bloodstream, which can lead to tiredness, lack of strength, and decreased cognitive abilities [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 15" title="Cao G et al. Prevalence of anemia among people living with HIV: a systematic review and meta-analysis. EClinicalMedicine 2022;44." href="/article/10.1007/s44197-024-00321-6#ref-CR15" id="ref-link-section-d155691737e410">15</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 16" title="Obeagu EI, Obeagu GU. Anemia in HIV: The Role of Erythropoietin in Disease Progression. Elite Journal of Haematology, 2024;2(4):51–67." href="/article/10.1007/s44197-024-00321-6#ref-CR16" id="ref-link-section-d155691737e413">16</a>]. Anemia in HIV-infected children has diverse causes, including decreased red blood cell production, increased rates of blood cell destruction, and a lack of nutrients [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 17" title="Wagnew F, et al. Burden of anemia and its association with HAART in HIV infected children in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis. 2019;19:1–9." href="/article/10.1007/s44197-024-00321-6#ref-CR17" id="ref-link-section-d155691737e416">17</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 18" title="Duffy C, et al. Multiple concurrent illnesses associated with anemia in HIV-infected and HIV-exposed uninfected children aged 6–59 months, hospitalized in Mozambique. Am J Trop Med Hyg. 2020;102(3):605." href="/article/10.1007/s44197-024-00321-6#ref-CR18" id="ref-link-section-d155691737e420">18</a>].</p><p>Previous studies in Africa have inconsistent across different settings. For example studies, such as [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Sidamo N et al. Incidence and predictors of mortality among children on anti-retroviral therapy in public health facilities of Arba Minch town, Gamo Gofa Zone, southern Ethiopia; retrospective cohort study. Clin Mother Child Health. 2017;14(3)." href="/article/10.1007/s44197-024-00321-6#ref-CR13" id="ref-link-section-d155691737e426">13</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 19" title="Ebonyi AO et al. Predictors of mortality in a clinic cohort of HIV-1 infected children initiated on antiretroviral therapy in Jos. Nigeria J AIDS Clin Res. 2014;5(12)." href="/article/10.1007/s44197-024-00321-6#ref-CR19" id="ref-link-section-d155691737e429">19</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 20" title="Molla M, et al. Effects of Undernutrition and predictors on the Survival Status of HIV-Positive children after started antiretroviral therapy (ART) in Northwest Ethiopia. Int J Pediatr. 2022;2022(1):1046220." href="/article/10.1007/s44197-024-00321-6#ref-CR20" id="ref-link-section-d155691737e432">20</a>], reported a non-significant association between malnutrition and HIV-related mortality among children, while others found a significant link, highlighting the variability in outcomes across different settings [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Alebel A, et al. Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study. BMC Public Health. 2020;20(1):1–11." href="#ref-CR21" id="ref-link-section-d155691737e435">21</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Marie BT, Argaw WS, Bazezew BY. Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya Liyu Zone, Amhara region, Ethiopia: a retrospective cohort study. BMC Pediatr. 2022;22:1–9." href="#ref-CR22" id="ref-link-section-d155691737e435_1">22</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 23" title="Mekonnen E, et al. Time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Addis Ababa, Ethiopia, a retrospective follow up study. PLoS ONE. 2023;18(7):e0288475." href="/article/10.1007/s44197-024-00321-6#ref-CR23" id="ref-link-section-d155691737e438">23</a>]. Similarly, for anemia, certain studies [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 24" title="Bitew S, Mekonen A, Assegid M. Predictors on mortality of human immunodeficiency virus infected children after initiation of antiretroviral treatment in Wolaita Zone health facilities, Ethiopia: retrospective cohort study. J AIDS HIV Res. 2017;9(4):89–97." href="/article/10.1007/s44197-024-00321-6#ref-CR24" id="ref-link-section-d155691737e442">24</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Oumer A, Kubsa ME, Mekonnen BA. Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis. BMC Pediatr. 2019;19:1–10." href="/article/10.1007/s44197-024-00321-6#ref-CR25" id="ref-link-section-d155691737e445">25</a>] observed no significant association with mortality, whereas others demonstrated a strong correlation between anemia and increased risk of death in children with HIV [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Alebel A, et al. Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study. BMC Public Health. 2020;20(1):1–11." href="/article/10.1007/s44197-024-00321-6#ref-CR21" id="ref-link-section-d155691737e448">21</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 22" title="Marie BT, Argaw WS, Bazezew BY. Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya Liyu Zone, Amhara region, Ethiopia: a retrospective cohort study. BMC Pediatr. 2022;22:1–9." href="/article/10.1007/s44197-024-00321-6#ref-CR22" id="ref-link-section-d155691737e451">22</a>]. These mixed findings emphasize the need to interpret the results within the specific contexts and populations studied. Nevertheless, it is uncertain how applicable these results are to the wider sub-Saharan African setting and how they specifically relate to children receiving ART. This issue becomes more complex due to the socioeconomic conditions in sub-Saharan Africa. Poverty, lack of food, and restricted healthcare access are common issues that can worsen undernourishment and anemia and make managing HIV difficult [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 26" title="Shimanda PP, Amukugo HJ, Norström F. Socioeconomic factors associated with anemia among children aged 6–59 months in Namibia. J Public Health Afr. 2020;11(1)." href="/article/10.1007/s44197-024-00321-6#ref-CR26" id="ref-link-section-d155691737e454">26</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 27" title="Yang F, Liu X, Zha P. Trends in socioeconomic inequalities and prevalence of anemia among children and nonpregnant women in low-and middle-income countries. JAMA Netw open. 2018;1(5):e182899–182899." href="/article/10.1007/s44197-024-00321-6#ref-CR27" id="ref-link-section-d155691737e457">27</a>]. Therefore, this review.provide valuable insights into the role of malnutrition and anemia in HIV-related mortality among children, highlighting key knowledge gaps and guiding evidence-based interventions and policies. The findings have the potential to inform clinical practice, support program development, and shape policy creation in this critical area of child health.</p></div></div></section><section data-title="Methods and Materials"><div class="c-article-section" id="Sec2-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec2"><span class="c-article-section__title-number">2 </span>Methods and Materials</h2><div class="c-article-section__content" id="Sec2-content"><h3 class="c-article__sub-heading" id="Sec3"><span class="c-article-section__title-number">2.1 </span>Eligibility Criteria</h3><p>Studies were included based on predefined criteria regarding population, comparators, outcomes, study design, settings, period, and language. The target population comprised HIV-infected children (aged 0–15 years) receiving ART, and studies must have included participants from one or more countries in sub-Saharan Africa. Undernutrition, including wasting and underweight, as well as anemia (hemoglobin < 10 g/dL), were considered key exposure factors. The primary outcome was all-cause mortality, used to assess and compare the risk of death associated with these specific exposures. The eligible studies included retrospective cohort, case-control, and cross-sectional studies. Moreover, theses and dissertations were also included. Studies involving both study participants with TB and HIV infection simultaneously, single case reports, case series, reviews, commentaries, editorials, studies not reporting the association between malnutriton and/or anemia with HIV related mortality, and studies with insufficient data to calculate effect estimates were excluded. Studies carried out in countries in sub-Saharan Africa after 2010 until now and released in the English language were included. Furthermore, any studies that could not be accessed after two attempts at communication with the main author or corresponding author were also not included in the review. The inclusion and exclusion criteria aimed to pinpoint important and high-quality research focused on risk factors in pediatric patients with HIV infection.</p><h3 class="c-article__sub-heading" id="Sec4"><span class="c-article-section__title-number">2.2 </span>Search Strategy and Information Sources</h3><p>We searched multiple electronic databases such as PubMed/MEDLINE, Hinari CINAHL, Embase, Google Scholar, African Journals Online (AJOL), OpenGray and Science Direct databases for peer-reviewed articles published from January 1, 2010, to April 24, 2024. We selected the period from January 2010 to April 24, 2024, because 2010 marks the introduction of more robust and effective ART combinations by the WHO, along with a significant shift in treatment strategies. Furthermore, prospective articles of interest were manually searched through the reference lists of eligible studies. Two authors (SM and BAL) independently searched. The search strategy was developed in consultation with a medical librarian and will include a combination of Medical Subject Headings (MeSH) terms and free-text keywords. The search terms were grouped into four main categories: 1) population: HIV-infected children; 2) exposure: undernutrition and anemia; 3) outcome: mortality; and 4) setting: sub-Saharan Africa. The following keywords were used: HIV/AIDS; death OR survival; predictor OR associated factor OR risk factors; OR determinants; effect of undernutrition; effect of anemia; antiretroviral therapy OR ART; pediatrics OR children; under five years OR 15 years [African countries]. Methodological terms such as prospective, retrospective, cohort, and cross-sectional studies were also included. Using Boolean operators (AND, OR), these keywords were combined to generate extensive search strings that will find pertinent research in a variety of databases. For example, the following search strategy was employed in the PubMed database: (HIV[MeSH] OR HIV Infections [MeSH] OR HIV [tiab] OR Human Immunodeficiency Virus[tiab] OR AIDS [tiab]) AND (Child[MeSH] OR Pediatrics[MeSH] OR Child * [tiab] OR Pediatric* [tiab] OR Pediatrics* [tiab]) AND (Malnutrition[MeSH] OR Nutritional Status [MeSH] OR Anemia [MeSH] OR Malnutrition [tiab] OR Undernutrition[tiab] OR Nutritional Deficiency* [tiab] OR Anemia [tiab] OR Anemia[tiab]) AND (Mortality[MeSH] OR Death[MeSH] OR Mortality* [tiab] OR Death* [tiab] OR Survival [tiab]) AND (Antiretroviral Therapy, Highly Active [MeSH] OR Anti-Retroviral Agents[MeSH] OR Antiretroviral Therapy* [tiab] OR ART [tiab] OR HAART[tiab]) AND (Africa South of the Sahara” [MeSH] OR Sub-Saharan Africa* [tiab] OR names of individual sub-Saharan African countries). The retrieved studies were imported and managed using EndNote XX reference management software. The search was conducted between January 2024 and April 2024 to identify potentially eligible studies for the systematic review and meta-analysis. This search strategy will be adapted for use in other databases, taking into account their specific indexing systems and search functionalities.</p><h3 class="c-article__sub-heading" id="Sec5"><span class="c-article-section__title-number">2.3 </span>Screen and Selection Process</h3><p>The screening and selection of studies followed systematic and rigorous approaches. Two reviewers (SM and BAL) independently reviewed the titles and abstracts of all retrieved records from the databases and manually searched them against the predefined eligibility criteria. All identified articles were entered into the EndNote XX database, and any duplicated entries were eliminated. Documentation of the reasons for exclusion was completed at this point. Any discrepancies or disagreements in selection between the two reviewers were resolved through discussion and consensus.</p><h3 class="c-article__sub-heading" id="Sec6"><span class="c-article-section__title-number">2.4 </span>Risk of Bias and Quality Assessment</h3><p>The risk of bias and quality of the studies included in our review were meticulously evaluated by two independent reviewers utilizing the Newcastle‒Ottawa Scale (NOS) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Alebel A, et al. Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study. BMC Public Health. 2020;20(1):1–11." href="/article/10.1007/s44197-024-00321-6#ref-CR21" id="ref-link-section-d155691737e496">21</a>] for observational studies. The NOS assesses the risk of bias in three domains, including the selection of the study groups, the comparability of the groups, and the ascertainment of the outcome of interest. The NOS framework allows for a comprehensive assessment, allocating up to four stars for ‘Selection,’ two for ‘Comparability,’ and three for ‘Outcome’ categories. The results are presented in the ‘Summary of Findings’ table.</p><h3 class="c-article__sub-heading" id="Sec7"><span class="c-article-section__title-number">2.5 </span>Data Extraction</h3><p>A Microsoft Excel spreadsheet was used for data extraction. Two authors (SM and BAL) independently extracted data from the included studies using a predefined checklist. The following data were extracted from each primary study: first author’s name, publication year, study country, and sample size. To ensure consistency in the data extraction process, both reviewers independently extracted data from the first three eligible articles. Any discrepancies or disagreements in selection between the two reviewers were resolved through discussion and consensus. Subsequently, they met to compare results, clarify any discrepancies, and refine the abstraction form if necessary. After this initial calibration, one reviewer extracted data from the remaining articles, and the second reviewer verified the extracted information.</p><h3 class="c-article__sub-heading" id="Sec8"><span class="c-article-section__title-number">2.6 </span>Outcome Variables and Effect Measures</h3><p>This research focused on the pooled impact of severely wasting, underweight and anemia on HIV related mortality, as documented in primary studies among children on ART in sub-Saharan African nations. Severe wasting is defined as a weight for height (WHZ) measurement of < -3 SD, underweight is defined as a weight for age (WHZ) measurement of < -2 SD [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 28" title="WHO, Assessing and Managing Children at Primary Health-Care. Facilities to prevent overweight and obesity in the context of the double burden of Malnutrition: updates for the Integrated Management of Childhood Illness (IMCI). Table 1, World Health Organization (WHO) classification of nutritional status of infants and children. World Health Organization.: Geneva; 2017." href="/article/10.1007/s44197-024-00321-6#ref-CR28" id="ref-link-section-d155691737e516">28</a>], and anemia is defined as a hemoglobin level of less than 10 g/dl [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 29" title="World Health Organization. Iron deficiency anemia: assessment, prevention, and control: a guide for program managers. 2001." href="/article/10.1007/s44197-024-00321-6#ref-CR29" id="ref-link-section-d155691737e519">29</a>]. The hazard ratio (HR) was a suitable measure of effect for our study. A random-effects model was used to combine the mortality risk for each selected exposure variable from various studies, taking into account potential heterogeneity between the studies.</p><h3 class="c-article__sub-heading" id="Sec9"><span class="c-article-section__title-number">2.7 </span>Data Synthesis and Analysis</h3><p>A narrative synthesis summarized the study characteristics, populations, study countries, outcome assessments, and key findings. A meta-analysis was conducted using Stata software version 17 to estimate the role of undernutrition and anemia on HIV-related mortality. The hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. Hazard ratio (HRs) from primary studies were log-transformed (logHR) to obtain the effect sizes and corresponding standard errors. Forest plots visually display the pooled estimates. Heterogeneity was assessed using Cochran’s Q statistic, the I2 statistic, and the chi-square test (<i>P</i> < 0.05). Heterogeneity levels were classified as low (I<sup>2</sup>: 0–25%), moderate (I<sup>2</sup>: 25–50%), or high (I<sup>2</sup>: ≥50%) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 30" title="Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58." href="/article/10.1007/s44197-024-00321-6#ref-CR30" id="ref-link-section-d155691737e539">30</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 31" title="Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10(1):101–29." href="/article/10.1007/s44197-024-00321-6#ref-CR31" id="ref-link-section-d155691737e543">31</a>]. The DerSimonian‒Laird method was used to estimate variance in random effects models. Subgroup analyses explored potential sources of heterogeneity, considering study countries and study participant age. The report is presented in the text, tables and figures.</p></div></div></section><section data-title="Results and Discussion"><div class="c-article-section" id="Sec10-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec10"><span class="c-article-section__title-number">3 </span>Results and Discussion</h2><div class="c-article-section__content" id="Sec10-content"><h3 class="c-article__sub-heading" id="Sec11"><span class="c-article-section__title-number">3.1 </span>Selection of Studies</h3><p>A comprehensive literature search across multiple databases yielded 275 relevant publications: 101 from PubMed, 86 from Google Scholar, and 78 from other sources. After removing duplicates and screening titles, 152 articles were excluded. Review of 81 abstracts led to the exclusion of 42 more. A full-text assessment of the remaining studies, focusing on predictors of mortality in children under 15, resulted in 27 articles meeting eligibility criteria. Twenty-four studies were excluded due to missing outcomes or data. Finally, 29 studies were included in the systematic review and meta-analysis. The selection process, guided by a PRISMA flow diagram, involved several stages of refinement [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 32" title="Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906." href="/article/10.1007/s44197-024-00321-6#ref-CR32" id="ref-link-section-d155691737e559">32</a>] (Fig. <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/article/10.1007/s44197-024-00321-6#Fig1">1</a>).</p><div class="c-article-section__figure js-c-reading-companion-figures-item" data-test="figure" data-container-section="figure" id="figure-1" data-title="Fig. 1"><figure><figcaption><b id="Fig1" class="c-article-section__figure-caption" data-test="figure-caption-text">Fig. 1</b></figcaption><div class="c-article-section__figure-content"><div class="c-article-section__figure-item"><a class="c-article-section__figure-link" data-test="img-link" data-track="click" data-track-label="image" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/1" rel="nofollow"><picture><source type="image/webp" srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig1_HTML.png?as=webp"><img aria-describedby="Fig1" src="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig1_HTML.png" alt="figure 1" loading="lazy" width="685" height="361"></picture></a></div><div class="c-article-section__figure-description" data-test="bottom-caption" id="figure-1-desc"><p>PRISMA flow diagram of the selection of studies, a systematic review of the role of malnutrition and anemia on mortality among Children on ART in sub-Saharan Africa</p></div></div><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="article-link" data-track="click" data-track-label="button" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/1" data-track-dest="link:Figure1 Full size image" aria-label="Full size image figure 1" rel="nofollow"><span>Full size image</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><h3 class="c-article__sub-heading" id="Sec12"><span class="c-article-section__title-number">3.2 </span>Characteristics of the Studies</h3><p>This systematic review included 27 studies that were conducted across various sub-Saharan African countries between 2010 and the present(2024) and involved a total of 61,796 patients. All studies employed a retrospective cohort design. This review analyzed the impact of severe wasting in 15 studies, underweight in 8 studies and, anemia in 22 studies on HIV mortality. The reviewed studies encompassed a diverse range of sub-Saharan African countries. Ethiopia was the most represented, with 20 studies [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 10" title="Mulugeta A, et al. Determinants of survival among HIV positive children on antiretroviral therapy in public hospitals, Addis Ababa, Ethiopia. Qual Prim Care. 2017;25(4):235–41." href="/article/10.1007/s44197-024-00321-6#ref-CR10" id="ref-link-section-d155691737e592">10</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Sidamo N et al. Incidence and predictors of mortality among children on anti-retroviral therapy in public health facilities of Arba Minch town, Gamo Gofa Zone, southern Ethiopia; retrospective cohort study. Clin Mother Child Health. 2017;14(3)." href="/article/10.1007/s44197-024-00321-6#ref-CR13" id="ref-link-section-d155691737e595">13</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Molla M, et al. Effects of Undernutrition and predictors on the Survival Status of HIV-Positive children after started antiretroviral therapy (ART) in Northwest Ethiopia. Int J Pediatr. 2022;2022(1):1046220." href="#ref-CR20" id="ref-link-section-d155691737e598">20</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Alebel A, et al. Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study. BMC Public Health. 2020;20(1):1–11." href="#ref-CR21" id="ref-link-section-d155691737e598_1">21</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Marie BT, Argaw WS, Bazezew BY. Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya Liyu Zone, Amhara region, Ethiopia: a retrospective cohort study. BMC Pediatr. 2022;22:1–9." href="#ref-CR22" id="ref-link-section-d155691737e598_2">22</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Mekonnen E, et al. Time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Addis Ababa, Ethiopia, a retrospective follow up study. PLoS ONE. 2023;18(7):e0288475." href="#ref-CR23" id="ref-link-section-d155691737e598_3">23</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Bitew S, Mekonen A, Assegid M. Predictors on mortality of human immunodeficiency virus infected children after initiation of antiretroviral treatment in Wolaita Zone health facilities, Ethiopia: retrospective cohort study. J AIDS HIV Res. 2017;9(4):89–97." href="#ref-CR24" id="ref-link-section-d155691737e598_4">24</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Oumer A, Kubsa ME, Mekonnen BA. Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis. BMC Pediatr. 2019;19:1–10." href="/article/10.1007/s44197-024-00321-6#ref-CR25" id="ref-link-section-d155691737e601">25</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Adem AK, Alem D, Girmatsion F. Factors affecting survival of HIV positive children taking antiretroviral therapy at Adama Referral Hospital and Medical College, Ethiopia. J AIDS Clin Res. 2014;5(3)." href="#ref-CR33" id="ref-link-section-d155691737e604">33</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Alemu GG, et al. Survival time and predictors of death among HIV infected under five children after initiation of anti-retroviral therapy in West Amhara Referral hospitals, Northwest Ethiopia. BMC Pediatr. 2022;22(1):670." href="#ref-CR34" id="ref-link-section-d155691737e604_1">34</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Andargie AA, Asmleash Y. Survival time of human immunodeficiency virus (HIV) infected children under 15 years of age after initiation of antiretroviral therapy in the University of Gondar Comprehensive Specialized Hospital, Ethiopia. J AIDS HIV Res. 2018;10(4):49–55." href="#ref-CR35" id="ref-link-section-d155691737e604_2">35</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Arage G, et al. Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: a facility-based retrospective cohort. SAGE open Med. 2019;7:2050312119838957." href="#ref-CR36" id="ref-link-section-d155691737e604_3">36</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Belachew A. Predictors of Survival Time among children on antiretroviral therapy in Dilchora Referral Hospital. East Ethiopia: Dire Dawa; 2019." href="#ref-CR37" id="ref-link-section-d155691737e604_4">37</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Biyazin Y, et al. Survival and predictors of mortality among HIV-positive children on antiretroviral therapy in public hospitals. J Pharm Policy Pract. 2022;15(1):48." href="#ref-CR38" id="ref-link-section-d155691737e604_5">38</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Chekole B, et al. Survival status and predictors of mortality among HIV-positive children initiated antiretroviral therapy in Bahir Dar town public health facilities Amhara region, Ethiopia, 2020. SAGE Open Med. 2022;10:20503121211069477." href="#ref-CR39" id="ref-link-section-d155691737e604_6">39</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Ebissa G, Deyessa N, Biadgilign S. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia. AIDS Care. 2015;27(6):723–30." href="#ref-CR40" id="ref-link-section-d155691737e604_7">40</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Edessa D, Asefa F, Sheikahmed J. Early mortality among HIV-positive children initiated anti-retroviral therapy in eastern Ethiopia: a retrospective cohort study. Sci Technol Arts Res J. 2015;4(2):157–63." href="#ref-CR41" id="ref-link-section-d155691737e604_8">41</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Gebremedhin A, et al. Predictors of mortality among HIV infected children on anti-retroviral therapy in Mekelle Hospital, Northern Ethiopia: a retrospective cohort study. BMC Public Health. 2013;13:1–6." href="#ref-CR42" id="ref-link-section-d155691737e604_9">42</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" title="Koye DN, Ayele TA, Zeleke BM. Predictors of mortality among children on antiretroviral therapy at a referral hospital, Northwest Ethiopia: a retrospective follow up study. BMC Pediatr. 2012;12(1):1–7." href="#ref-CR43" id="ref-link-section-d155691737e604_10">43</a>,<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 44" title="Tagesse N, Abebe W. Predictors of Mortality in children and adolescents living with HIV on antiretroviral therapy, Ethiopia: a retrospective cohort study. Ethiop J Pediatr Child Health. 2020;15(2)." href="/article/10.1007/s44197-024-00321-6#ref-CR44" id="ref-link-section-d155691737e608">44</a>], two from Kenya [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 12" title="Nyandiko W et al. Predictors of mortality among children and adolescents living with HIV on Antiretroviral Therapy in Western Kenya. JAIDS J Acquir Immune Defic Syndr, 2022: pp. 10–1097." href="/article/10.1007/s44197-024-00321-6#ref-CR12" id="ref-link-section-d155691737e611">12</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 14" title="Wamalwa DC, et al. Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort. BMC Pediatr. 2010;10(1):33." href="/article/10.1007/s44197-024-00321-6#ref-CR14" id="ref-link-section-d155691737e614">14</a>], and one from South Africa [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 45" title="Abrams EJ, et al. Despite access to antiretrovirals for prevention and treatment, high rates of mortality persist among HIV-infected infants and young children. Pediatr Infect Dis J. 2017;36(6):595–601." href="/article/10.1007/s44197-024-00321-6#ref-CR45" id="ref-link-section-d155691737e617">45</a>]; multicounty studies were also included: one encompassing Malawi, Uganda, and Kenya [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 46" title="Ben-Farhat J, et al. Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001–2010. Tropical Med Int Health. 2017;22(3):340–50." href="/article/10.1007/s44197-024-00321-6#ref-CR46" id="ref-link-section-d155691737e620">46</a>]; another covering Malawi, South Africa, Zambia, and Zimbabwe [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 47" title="Davies M-A, et al. Prognosis of children with HIV-1 infection starting antiretroviral therapy in Southern Africa: a collaborative analysis of treatment programs. Pediatr Infect Dis J. 2014;33(6):608–16." href="/article/10.1007/s44197-024-00321-6#ref-CR47" id="ref-link-section-d155691737e623">47</a>]; and single-country studies conducted in Cote d’Ivoire [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 48" title="Auld AF, et al. Temporal trends in mortality and loss to follow-up among children enrolled in Cote D’ivoire’s national antiretroviral therapy program. Pediatr Infect Dis J. 2014;33(11):1134–40." href="/article/10.1007/s44197-024-00321-6#ref-CR48" id="ref-link-section-d155691737e627">48</a>], Tanzania [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 49" title="Mwiru RS, et al. Nutritional status and other baseline predictors of mortality among HIV-infected children initiating antiretroviral therapy in Tanzania. J Int Association Providers AIDS Care (JIAPAC). 2015;14(2):172–9." href="/article/10.1007/s44197-024-00321-6#ref-CR49" id="ref-link-section-d155691737e630">49</a>], the Democratic Republic of Congo (DRC) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 50" title="Nugent J, et al. Predicting mortality in HIV-infected children initiating highly active antiretroviral therapy in a resource-deprived setting. Pediatr Infect Dis J. 2014;33(11):1148–55." href="/article/10.1007/s44197-024-00321-6#ref-CR50" id="ref-link-section-d155691737e633">50</a>], Nigeria [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 51" title="Anigilaje EA, Aderibigbe SA. Mortality in a cohort of HIV-infected children: a 12‐month outcome of antiretroviral therapy in Makurdi, Nigeria. Adv Med. 2018;20181:6409134." href="/article/10.1007/s44197-024-00321-6#ref-CR51" id="ref-link-section-d155691737e636">51</a>], and Zimbabwe [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 52" title="McHugh G et al. Clinical outcomes in children and adolescents initiating antiretroviral therapy in decentralized healthcare settings in Zimbabwe. Afr J Reprod Gynaecol Endoscopy. 2017;20(1)." href="/article/10.1007/s44197-024-00321-6#ref-CR52" id="ref-link-section-d155691737e639">52</a>] (Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/article/10.1007/s44197-024-00321-6#Tab1">1</a>).</p><div class="c-article-table" data-test="inline-table" data-container-section="table" id="table-1"><figure><figcaption class="c-article-table__figcaption"><b id="Tab1" data-test="table-caption">Table 1 Characteristics of the studies included in the review, a systematic review of the role of malnutrition and anemia on mortality among children on ART in sub-saharan Africa</b></figcaption><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="table-link" data-track="click" data-track-action="view table" data-track-label="button" rel="nofollow" href="/article/10.1007/s44197-024-00321-6/tables/1" aria-label="Full size table 1"><span>Full size table</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><h3 class="c-article__sub-heading" id="Sec13"><span class="c-article-section__title-number">3.3 </span>Quality Assessment and Risk of Bias</h3><p>Two independent reviewers evaluated the risk of bias in the included studies using the Newcastle‒Ottawa Scale (NOS) for observational studies [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 53" title="Herzog R, et al. Newcastle-Ottawa scale adapted for cross-sectional studies. BMC Public Health. 2013;13:154." href="/article/10.1007/s44197-024-00321-6#ref-CR53" id="ref-link-section-d155691737e1583">53</a>]. The NOS rates research based on three areas selection (up to 4 stars), comparability (up to 2 stars), and outcome (up to 3 stars)—for a total maximum score of 9 stars. High NOS scores indicate stronger methodological quality, with better control for biases such as selection and confounding. In terms of the selection area, the majority of research papers received a rating of 3 out of 4 stars, showing overall satisfactory representativeness and selection methods. Nevertheless, certain studies, such as the one by Ebissa et al. [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 40" title="Ebissa G, Deyessa N, Biadgilign S. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia. AIDS Care. 2015;27(6):723–30." href="/article/10.1007/s44197-024-00321-6#ref-CR40" id="ref-link-section-d155691737e1586">40</a>], received a lower rating (2 stars) because of possible selection bias, which could impact the representativeness of the study population, indicating potential problems with sample selection or representativeness. Studies with a 3-star rating, such as Koye et al. [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 43" title="Koye DN, Ayele TA, Zeleke BM. Predictors of mortality among children on antiretroviral therapy at a referral hospital, Northwest Ethiopia: a retrospective follow up study. BMC Pediatr. 2012;12(1):1–7." href="/article/10.1007/s44197-024-00321-6#ref-CR43" id="ref-link-section-d155691737e1589">43</a>] and Alebel et al. [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 21" title="Alebel A, et al. Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study. BMC Public Health. 2020;20(1):1–11." href="/article/10.1007/s44197-024-00321-6#ref-CR21" id="ref-link-section-d155691737e1592">21</a>], likely had stronger methods for assessing outcomes and, longer tracking periods, whereas some studies [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 10" title="Mulugeta A, et al. Determinants of survival among HIV positive children on antiretroviral therapy in public hospitals, Addis Ababa, Ethiopia. Qual Prim Care. 2017;25(4):235–41." href="/article/10.1007/s44197-024-00321-6#ref-CR10" id="ref-link-section-d155691737e1595">10</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 13" title="Sidamo N et al. Incidence and predictors of mortality among children on anti-retroviral therapy in public health facilities of Arba Minch town, Gamo Gofa Zone, southern Ethiopia; retrospective cohort study. Clin Mother Child Health. 2017;14(3)." href="/article/10.1007/s44197-024-00321-6#ref-CR13" id="ref-link-section-d155691737e1599">13</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 22" title="Marie BT, Argaw WS, Bazezew BY. Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya Liyu Zone, Amhara region, Ethiopia: a retrospective cohort study. BMC Pediatr. 2022;22:1–9." href="/article/10.1007/s44197-024-00321-6#ref-CR22" id="ref-link-section-d155691737e1602">22</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 24" title="Bitew S, Mekonen A, Assegid M. Predictors on mortality of human immunodeficiency virus infected children after initiation of antiretroviral treatment in Wolaita Zone health facilities, Ethiopia: retrospective cohort study. J AIDS HIV Res. 2017;9(4):89–97." href="/article/10.1007/s44197-024-00321-6#ref-CR24" id="ref-link-section-d155691737e1605">24</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 36" title="Arage G, et al. Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: a facility-based retrospective cohort. SAGE open Med. 2019;7:2050312119838957." href="/article/10.1007/s44197-024-00321-6#ref-CR36" id="ref-link-section-d155691737e1608">36</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 40" title="Ebissa G, Deyessa N, Biadgilign S. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia. AIDS Care. 2015;27(6):723–30." href="/article/10.1007/s44197-024-00321-6#ref-CR40" id="ref-link-section-d155691737e1611">40</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 42" title="Gebremedhin A, et al. Predictors of mortality among HIV infected children on anti-retroviral therapy in Mekelle Hospital, Northern Ethiopia: a retrospective cohort study. BMC Public Health. 2013;13:1–6." href="/article/10.1007/s44197-024-00321-6#ref-CR42" id="ref-link-section-d155691737e1614">42</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 44" title="Tagesse N, Abebe W. Predictors of Mortality in children and adolescents living with HIV on antiretroviral therapy, Ethiopia: a retrospective cohort study. Ethiop J Pediatr Child Health. 2020;15(2)." href="/article/10.1007/s44197-024-00321-6#ref-CR44" id="ref-link-section-d155691737e1618">44</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 49" title="Mwiru RS, et al. Nutritional status and other baseline predictors of mortality among HIV-infected children initiating antiretroviral therapy in Tanzania. J Int Association Providers AIDS Care (JIAPAC). 2015;14(2):172–9." href="/article/10.1007/s44197-024-00321-6#ref-CR49" id="ref-link-section-d155691737e1621">49</a>] were given 2 stars, suggesting varying measurements of outcomes, particularly for anemia. In general, most studies were deemed high quality, receiving a score of 7 stars or higher.</p><h3 class="c-article__sub-heading" id="Sec14"><span class="c-article-section__title-number">3.4 </span>The Association Between Severe Wasting and HIV-Related Mortality</h3><p>The impact of severe wasting was assessed in 15 studies involving 9,162 participants. A random-effects meta-analysis was conducted due to moderate heterogeneity (I²=44.16%), showing that severe wasting was associated with more than a twofold increase in the risk of HIV-related death (HR: 2.49; 95% CI: 1.87–3.30). Subgroup analysis by age revealed a higher risk of mortality for children under 5 years (HR: 3.40) compared to those under 15 years (HR: 2.17). Country-based subgroup analysis indicated the greatest effect size in Tanzania (HR: 3.36), followed by Ethiopia (HR: 2.80) and South Africa (HR: 2.43). However, Kenya, Nigeria, and Zimbabwe showed nonsignificant effect sizes. Meta-regression showed that sample size did not significantly influence the pooled estimate (<i>P</i> = 0.57), suggesting that heterogeneity was mainly due to age and country differences. Publication bias was assessed through a funnel plot, Begg’s test, and Egger’s test. The funnel plot indicated some studies outside the 95% CI, but with both positive and negative effect sizes. Begg’s and Egger’s tests suggested the presence of publication bias, with p-values < 0.05, indicating small study effects and potential bias (Fig. <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/article/10.1007/s44197-024-00321-6#Fig2">2</a>).</p><div class="c-article-section__figure js-c-reading-companion-figures-item" data-test="figure" data-container-section="figure" id="figure-2" data-title="Fig. 2"><figure><figcaption><b id="Fig2" class="c-article-section__figure-caption" data-test="figure-caption-text">Fig. 2</b></figcaption><div class="c-article-section__figure-content"><div class="c-article-section__figure-item"><a class="c-article-section__figure-link" data-test="img-link" data-track="click" data-track-label="image" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/2" rel="nofollow"><picture><source type="image/webp" srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig2_HTML.png?as=webp"><img aria-describedby="Fig2" src="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig2_HTML.png" alt="figure 2" loading="lazy" width="685" height="361"></picture></a></div><div class="c-article-section__figure-description" data-test="bottom-caption" id="figure-2-desc"><p>The association between severe wasting and HIV-related mortality, a systematic review of the role of malnutrition and anemia on mortality among Children on ART in sub-Saharan Africa</p></div></div><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="article-link" data-track="click" data-track-label="button" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/2" data-track-dest="link:Figure2 Full size image" aria-label="Full size image figure 2" rel="nofollow"><span>Full size image</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><h3 class="c-article__sub-heading" id="Sec15"><span class="c-article-section__title-number">3.5 </span>The Association Between Underweight and HIV-Related Mortality</h3><p>The association between underweight and HIV-related mortality was evaluated in 8 studies [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 12" title="Nyandiko W et al. Predictors of mortality among children and adolescents living with HIV on Antiretroviral Therapy in Western Kenya. JAIDS J Acquir Immune Defic Syndr, 2022: pp. 10–1097." href="/article/10.1007/s44197-024-00321-6#ref-CR12" id="ref-link-section-d155691737e1666">12</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 20" title="Molla M, et al. Effects of Undernutrition and predictors on the Survival Status of HIV-Positive children after started antiretroviral therapy (ART) in Northwest Ethiopia. Int J Pediatr. 2022;2022(1):1046220." href="/article/10.1007/s44197-024-00321-6#ref-CR20" id="ref-link-section-d155691737e1669">20</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 25" title="Oumer A, Kubsa ME, Mekonnen BA. Malnutrition as predictor of survival from anti-retroviral treatment among children living with HIV/AIDS in Southwest Ethiopia: survival analysis. BMC Pediatr. 2019;19:1–10." href="/article/10.1007/s44197-024-00321-6#ref-CR25" id="ref-link-section-d155691737e1672">25</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 33" title="Adem AK, Alem D, Girmatsion F. Factors affecting survival of HIV positive children taking antiretroviral therapy at Adama Referral Hospital and Medical College, Ethiopia. J AIDS Clin Res. 2014;5(3)." href="/article/10.1007/s44197-024-00321-6#ref-CR33" id="ref-link-section-d155691737e1675">33</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 37" title="Belachew A. Predictors of Survival Time among children on antiretroviral therapy in Dilchora Referral Hospital. East Ethiopia: Dire Dawa; 2019." href="/article/10.1007/s44197-024-00321-6#ref-CR37" id="ref-link-section-d155691737e1678">37</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 46" title="Ben-Farhat J, et al. Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001–2010. Tropical Med Int Health. 2017;22(3):340–50." href="/article/10.1007/s44197-024-00321-6#ref-CR46" id="ref-link-section-d155691737e1682">46</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 47" title="Davies M-A, et al. Prognosis of children with HIV-1 infection starting antiretroviral therapy in Southern Africa: a collaborative analysis of treatment programs. Pediatr Infect Dis J. 2014;33(6):608–16." href="/article/10.1007/s44197-024-00321-6#ref-CR47" id="ref-link-section-d155691737e1685">47</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 50" title="Nugent J, et al. Predicting mortality in HIV-infected children initiating highly active antiretroviral therapy in a resource-deprived setting. Pediatr Infect Dis J. 2014;33(11):1148–55." href="/article/10.1007/s44197-024-00321-6#ref-CR50" id="ref-link-section-d155691737e1688">50</a>] involving 1,010 participants. A random-effects meta-analysis was used due to heterogeneity (I²=58.54%). The analysis showed that underweight children had a twofold increased risk of HIV-related mortality (HR: 2.11; 95% CI: 1.64–2.72) (Fig. <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/article/10.1007/s44197-024-00321-6#Fig3">3</a>). Subgroup analysis revealed the highest effect in multicounty studies from Malawi, South Africa, Zambia, and Zimbabwe, followed by other regions. Meta-regression showed no significant effect of sample size (<i>P</i> = 0.126). Publication bias was not indicated by the funnel plot, Begg’s test (<i>P</i> = 0.6398), or Egger’s test (<i>P</i> = 0.9015), showing no evidence of small-study effects or bias.</p><div class="c-article-section__figure js-c-reading-companion-figures-item" data-test="figure" data-container-section="figure" id="figure-3" data-title="Fig. 3"><figure><figcaption><b id="Fig3" class="c-article-section__figure-caption" data-test="figure-caption-text">Fig. 3</b></figcaption><div class="c-article-section__figure-content"><div class="c-article-section__figure-item"><a class="c-article-section__figure-link" data-test="img-link" data-track="click" data-track-label="image" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/3" rel="nofollow"><picture><source type="image/webp" srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig3_HTML.png?as=webp"><img aria-describedby="Fig3" src="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig3_HTML.png" alt="figure 3" loading="lazy" width="685" height="361"></picture></a></div><div class="c-article-section__figure-description" data-test="bottom-caption" id="figure-3-desc"><p>Effect of underweight on HIV-related mortality, a systematic review of the role of malnutrition and anemia on mortality among Children on ART in sub-Saharan Africa</p></div></div><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="article-link" data-track="click" data-track-label="button" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/3" data-track-dest="link:Figure3 Full size image" aria-label="Full size image figure 3" rel="nofollow"><span>Full size image</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div><h3 class="c-article__sub-heading" id="Sec16"><span class="c-article-section__title-number">3.6 </span>The Association Between of Anemia and HIV Related Mortality</h3><p>Anemia was analyzed in 22 studies involving 26,842 participants using a random-effects model due to significant heterogeneity (I²=53.72%). The analysis revealed that children with anemia had more than twice the risk of mortality (HR: 2.58; 95% CI: 2.08–3.19) (Fig. <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/article/10.1007/s44197-024-00321-6#Fig4">4</a>). Subgroup analysis showed a higher risk of death in children under 5 years (HR: 3.31) compared to those under 15 years (HR: 2.45). The largest effect was reported in Kenya (HR: 3.00), followed by Côte d’Ivoire (HR: 2.95) and Ethiopia (HR: 2.83). Meta-regression indicated that smaller sample sizes significantly increased the pooled estimate of mortality risk (<i>P</i> = 0.002). Publication bias was assessed through a funnel plot, Begg’s test, and Egger’s test. The funnel plot suggested minimal risk of bias, although a few studies fell outside the 95% CI. Egger’s test indicated publication bias (<i>P</i> = 0.0000), while Begg’s test did not show statistical significance (<i>P</i> = 0.2363). Since Egger’s test has greater power, it suggests the presence of some publication bias despite Begg’s test showing otherwise.</p><div class="c-article-section__figure js-c-reading-companion-figures-item" data-test="figure" data-container-section="figure" id="figure-4" data-title="Fig. 4"><figure><figcaption><b id="Fig4" class="c-article-section__figure-caption" data-test="figure-caption-text">Fig. 4</b></figcaption><div class="c-article-section__figure-content"><div class="c-article-section__figure-item"><a class="c-article-section__figure-link" data-test="img-link" data-track="click" data-track-label="image" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/4" rel="nofollow"><picture><source type="image/webp" srcset="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig4_HTML.png?as=webp"><img aria-describedby="Fig4" src="//media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs44197-024-00321-6/MediaObjects/44197_2024_321_Fig4_HTML.png" alt="figure 4" loading="lazy" width="685" height="361"></picture></a></div><div class="c-article-section__figure-description" data-test="bottom-caption" id="figure-4-desc"><p>The association between anemia and HIV-related mortality, a systematic review of the role of malnutrition and anemia on mortality among Children on ART in sub-Saharan Africa</p></div></div><div class="u-text-right u-hide-print"><a class="c-article__pill-button" data-test="article-link" data-track="click" data-track-label="button" data-track-action="view figure" href="/article/10.1007/s44197-024-00321-6/figures/4" data-track-dest="link:Figure4 Full size image" aria-label="Full size image figure 4" rel="nofollow"><span>Full size image</span><svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-chevron-right-small"></use></svg></a></div></figure></div></div></div></section><section data-title="Discussion"><div class="c-article-section" id="Sec17-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec17"><span class="c-article-section__title-number">4 </span>Discussion</h2><div class="c-article-section__content" id="Sec17-content"><p>The review indicated that undernutrition, such as severe wasting and underweight, as well as anemia, was a significant predictor of HIV-related mortality among children. The present analysis revealed a significant association between severe wasting and an increased risk of HIV-related mortality among children on ART in Africa, with a hazard ratio (HR) of 2.49 (95% CI: 1.87–3.30), and underweight, with a twofold increased risk of death (95% CI: 1.64–2.72). These findings underscore the critical impact of malnutrition on the survival of HIV-infected children, especially those under five years old. Several studies corroborate these findings. For instance, a study conducted in India [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 54" title="Washington R et al. Nutrition, morbidity and mortality status in a cohort of children (0–14 years) exposed to maternal HIV in south India. 2023." href="/article/10.1007/s44197-024-00321-6#ref-CR54" id="ref-link-section-d155691737e1773">54</a>] and other countries [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 55" title="Savadogo LGB et al. Impact of HIV/AIDS on mortality and nutritional recovery among hospitalized severely malnourished children before starting antiretroviral treatment. Open Journal of Pediatrics. 2013;2013." href="/article/10.1007/s44197-024-00321-6#ref-CR55" id="ref-link-section-d155691737e1776">55</a>] revealed that severe wasting significantly increased the risk of mortality in HIV-infected children. Similarly, this finding is supported by evidence from East Africa [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 56" title="Abate BB, Aragie TG, Tesfaw G. Magnitude of underweight, wasting and stunting among HIV positive children in East Africa: a systematic review and meta-analysis. PLoS ONE. 2020;15(9):e0238403." href="/article/10.1007/s44197-024-00321-6#ref-CR56" id="ref-link-section-d155691737e1779">56</a>], where the pooled prevalence of underweight among HIV-positive children was 41.63%. Malnutrition can be linked to increased HIV-related mortality due to its negative effects on the immune system, treatment effectiveness, and vulnerability to infections. Children who are extremely malnourished and thin typically have a weakened immune system, which hinders their ability to effectively fight viruses and heal from infections [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 7" title="Fuseini H, et al. Undernutrition and HIV infection in sub-saharan Africa: health outcomes and therapeutic interventions. Curr HIV/AIDS Rep. 2021;18:87–97." href="/article/10.1007/s44197-024-00321-6#ref-CR7" id="ref-link-section-d155691737e1782">7</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 57" title="Haider BA, et al. Anemia, iron deficiency, and iron supplementation in relation to mortality among HIV-infected patients receiving highly active antiretroviral therapy in Tanzania. Am J Trop Med Hyg. 2019;100(6):1512." href="/article/10.1007/s44197-024-00321-6#ref-CR57" id="ref-link-section-d155691737e1786">57</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 58" title="Huibers MHW, et al. Severe anaemia complicating HIV in Malawi; multiple co-existing aetiologies are associated with high mortality. PLoS ONE. 2020;15(2):e0218695." href="/article/10.1007/s44197-024-00321-6#ref-CR58" id="ref-link-section-d155691737e1789">58</a>]. These consistent results highlight the universal impact of malnutrition on the mortality of HIV-infected children, regardless of geographic location. The study’s findings underscore the significant role of malnutrition in increasing HIV-related mortality among children in sub-Saharan Africa, particularly through severe wasting and underweight. Malnutrition compromises the immune system, making HIV-infected children more vulnerable to opportunistic infections and reducing the effectiveness of antiretroviral therapy (ART). This indicates that the challenges of providing malnutrition care among HIV-infected children receiving antiretroviral treatment in Africa are still critical issues, as malnutrition can affect the immunity of the affected children [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 59" title="Jesson J, Leroy V. Challenges of malnutrition care among HIV-infected children on antiretroviral treatment in Africa. Med et maladies Infectieuses. 2015;45(5):149–56." href="/article/10.1007/s44197-024-00321-6#ref-CR59" id="ref-link-section-d155691737e1792">59</a>]. The context of undernutrition in HIV-infected children is often exacerbated by poverty, food insecurity, and limited healthcare access, all of which make it difficult to provide the necessary nutritional support. Current interventions, such as nutritional rehabilitation and supplementation, integrated with ART, have shown promise in improving survival outcomes [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 60" title="Morales F, et al. Effects of malnutrition on the immune system and infection and the role of nutritional strategies regarding improvements in children’s health status: a literature review. Nutrients. 2023;16(1):1." href="/article/10.1007/s44197-024-00321-6#ref-CR60" id="ref-link-section-d155691737e1795">60</a>]. However, challenges in scaling these interventions persist, particularly in rural areas [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 61" title="Prendergast AJ, Evans C. Children who are HIV-exposed and uninfected: evidence for action. Aids. 2023;37(2):205–15." href="/article/10.1007/s44197-024-00321-6#ref-CR61" id="ref-link-section-d155691737e1798">61</a>]. Further research is required to assess the long-term benefits of integrating nutritional care into routine HIV treatment and to identify the most effective strategies for combating malnutrition in these vulnerable populations.</p><p>The current study showed that anemia was a strong indicator of HIV-related death in children, and the risk of death was 2.5 times greater in HIV-infected children with baseline hemoglobin levels less than 10 g/dl than in those with hemoglobin levels greater than or equal to 10 g/dl (HR: 2.52; 95% CI: 2.08–3.19). Studies from multiple centers in Europe have confirmed this discovery [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 62" title="Mocroft A, et al. Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe. Aids. 1999;13(8):943–50." href="/article/10.1007/s44197-024-00321-6#ref-CR62" id="ref-link-section-d155691737e1807">62</a>]. Furthermore, consistent with this report, previous reviews [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 63" title="Ambarwati D, Dewi YLR, Murti B. The Effect of Iron Deficiency Anemia on the child death related to HIV/AIDS infection: Meta-Analysis. J Epidemiol Public Health. 2021;6(2):158–69." href="/article/10.1007/s44197-024-00321-6#ref-CR63" id="ref-link-section-d155691737e1810">63</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 64" title="Wubneh CA, Belay GM. Mortality and its association with CD4 cell count and hemoglobin level among children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. Trop Med Health. 2020;48:1–11." href="/article/10.1007/s44197-024-00321-6#ref-CR64" id="ref-link-section-d155691737e1813">64</a>] revealed that children with HIV infection who also had anemia had a doubled chance of dying. Anemia is common during the course of HIV infection. This condition further weakens the body’s ability to fight infections, complicating HIV management and worsening health outcomes. In the context of HIV treatment, anemia makes it more difficult for children to recover and respond to ART, increasing the likelihood of poor survival outcomes [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 29" title="World Health Organization. Iron deficiency anemia: assessment, prevention, and control: a guide for program managers. 2001." href="/article/10.1007/s44197-024-00321-6#ref-CR29" id="ref-link-section-d155691737e1816">29</a>]. It may result directly from being infected with HIV, or it could be caused by nutritional deficiencies, other infections such as systemic fungal and mycobacterium infections, and opportunistic diseases such as lymphoma. Moreover, adverse reactions to antiretrovirals and other drugs can inhibit bone marrow function, causing anemia, thrombocytopenia, and leukopenia [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 16" title="Obeagu EI, Obeagu GU. Anemia in HIV: The Role of Erythropoietin in Disease Progression. Elite Journal of Haematology, 2024;2(4):51–67." href="/article/10.1007/s44197-024-00321-6#ref-CR16" id="ref-link-section-d155691737e1820">16</a>, <a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 65" title="Tydeman-Edwards R, Van Rooyen FC, Walsh CM. Obesity, undernutrition and the double burden of malnutrition in the urban and rural southern Free State, South Africa. Heliyon. 2018;4(12)." href="/article/10.1007/s44197-024-00321-6#ref-CR65" id="ref-link-section-d155691737e1823">65</a>]. This makes it more difficult for HIV-positive children to survive while receiving antiretroviral therapy (ART). Furthermore, the results show that younger children, especially those under five years old, face a much greater chance of death when suffering from severe malnourishment or anemia. One possible explanation is that younger children have weaker immune systems than older children, making them more vulnerable to the combined impact of HIV, malnutrition, and anemia. The initial five years of life are critical for both physical and cognitive growth [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 66" title="Kotecha PV. Nutritional anemia in young children with focus on Asia and India. Indian J Community Med. 2011;36(1):8–16." href="/article/10.1007/s44197-024-00321-6#ref-CR66" id="ref-link-section-d155691737e1826">66</a>]. Malnutrition and anemia during this period can have more severe and lasting impacts on a child’s overall health and survival. Therefore, studies should explore the role of micronutrient supplementation and anemia treatment in improving survival outcomes. There is also a pressing need to understand the socioeconomic barriers that prevent malnourished HIV-positive children from receiving comprehensive care. Addressing these gaps will be key to improving the survival and quality of life for children living with HIV in sub-Saharan Africa.</p><h3 class="c-article__sub-heading" id="Sec18"><span class="c-article-section__title-number">4.1 </span>Limitation of the Study</h3><p>This review is limited to certain forms of malnutrition, such as severe wasting and undernutrition, while the impact of stunting on HIV-related mortality was not included, potentially reducing the comprehensiveness of the findings. Additionally, since all the included studies were observational, establishing a causal relationship between malnutrition, anemia, and mortality remains challenging.</p></div></div></section><section data-title="Conclusion"><div class="c-article-section" id="Sec19-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Sec19"><span class="c-article-section__title-number">5 </span>Conclusion</h2><div class="c-article-section__content" id="Sec19-content"><p>This comprehensive analysis, which examined 27 studies in sub-Saharan Africa, offers compelling evidence of the impact of malnutrition and anemia on HIV-related death in children. According to the analysis, severe malnutrition and underweight status had a notable impact on HIV-related death rates. Additionally, anemia was found to be a key factor in predicting HIV-related deaths. Young children under 5 years old were at greater risk of death, showing that malnutrition and anemia during this time could have longer-lasting and more severe consequences on a child’s health and chances of survival. Therefore, the significant link between nutritional status and HIV-related death highlights the importance of combined nutrition and HIV treatment programs in sub-Saharan African countries. Policies should emphasize nutritional support in HIV treatment plans, especially for children under five years of age. Furthermore, health resources need to be used to address both HIV treatment and nutritional support.</p></div></div></section> </div> <section data-title="Data Availability"><div class="c-article-section" id="data-availability-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="data-availability">Data Availability</h2><div class="c-article-section__content" id="data-availability-content"> <p>All the data analyzed during this study are included in this published article.</p> </div></div></section><div id="MagazineFulltextArticleBodySuffix"><section aria-labelledby="Bib1" data-title="References"><div class="c-article-section" id="Bib1-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="Bib1">References</h2><div class="c-article-section__content" id="Bib1-content"><div data-container-section="references"><ol class="c-article-references" data-track-component="outbound reference" data-track-context="references section"><li class="c-article-references__item js-c-reading-companion-references-item" data-counter="1."><p class="c-article-references__text" id="ref-CR1">Enane LA, et al. 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SM prepared and edited the final draft of the manuscript, which was subsequently read and approved by the all author.</p><h3 class="c-article__sub-heading" id="corresponding-author">Corresponding author</h3><p id="corresponding-author-list">Correspondence to <a id="corresp-c1" href="mailto:Sisaymoges55@gmail.com">Sisay Moges</a>.</p></div></div></section><section data-title="Ethics declarations"><div class="c-article-section" id="ethics-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="ethics">Ethics declarations</h2><div class="c-article-section__content" id="ethics-content"> <h3 class="c-article__sub-heading" id="FPar1">Ethics Approval and Consent to Participate</h3> <p>This section is not applicable because it was conducted using secondary data.</p> <h3 class="c-article__sub-heading" id="FPar2">Consent for Publication</h3> <p>Not applicable.</p> <h3 class="c-article__sub-heading" id="FPar3">Competing Interests</h3> <p>The authors declare no competing interests.</p> </div></div></section><section data-title="Additional information"><div class="c-article-section" id="additional-information-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="additional-information">Additional information</h2><div class="c-article-section__content" id="additional-information-content"><h3 class="c-article__sub-heading">Publisher’s Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></div></div></section><section data-title="Rights and permissions"><div class="c-article-section" id="rightslink-section"><h2 class="c-article-section__title js-section-title js-c-reading-companion-sections-item" id="rightslink">Rights and permissions</h2><div class="c-article-section__content" id="rightslink-content"> <p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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id="citeas">Cite this article</h3><p class="c-bibliographic-information__citation">Moges, S., Lajore, B.A., Oleba, A.F. <i>et al.</i> The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. <i>J Epidemiol Glob Health</i> (2024). https://doi.org/10.1007/s44197-024-00321-6</p><p class="c-bibliographic-information__download-citation u-hide-print"><a data-test="citation-link" data-track="click" data-track-action="download article citation" data-track-label="link" data-track-external="" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1007/s44197-024-00321-6?format=refman&flavour=citation">Download citation<svg width="16" height="16" focusable="false" role="img" aria-hidden="true" class="u-icon"><use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="#icon-eds-i-download-medium"></use></svg></a></p><ul class="c-bibliographic-information__list" 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