Eur J Pediatr (1995) 154:299-303 9 Springer-Verlag 1995 B. H. M. Wolf M. O. Ikeogu E. T. Vos Effect of nutritional and HIV status on bacteraemia in Zimbabwean children who died at home Received: 30 May 1994 Accepted: 19 September 1994 B. H. M. Wolf. M. O. Ikeogu Department of Paediatrics, Mpilo Central Hospital, Bulawayo, Zimbabwe B. H. M. Wolf (N:~) Department Paediatrics, St. Lucas Ziekenhuis, 164 Jan Tooropstraat, 1061 AE Amsterdam, The Netherlands Fax: (20) 5108168 E. T. Vos Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine, UK Abstract From July 1992 to May 1993 a study was performed of the relationship between bacteraemia, nutritional status and HIV status in 212 out of 334 consecutive infants and children aged 0-5 years, who had died at home in Bulawayo, Zim- babwe. The remainding 122 children were excluded because the time pe- riod between death and arrival at the hospital was over 3 h. A pathogen was isolated from 92 (43%) children and KIebsiella species were most commonly isolated. A positive HIV- 1 serology was found in 122 (58%) children and 110 (52%) children were malnourished. Malnutrition was significantly associated with bacter- aemia at death after adjustment for the confounding effect of age and HIV status (odds ratio 4.28; 95% CI 2.27-8.07; P < 0.001). No associa- tion was found between either HIV serostatus or proven HIV infection and bacteraemia, which could not be attributed to nutritional status. Key words Bacteraemia 9 HIV 9 Malnutrition. Mortality. Children. Africa Introduction Bacterial infections with common pathogenic bacteria, es- pecially Haemophilus influenza, Streptococcus pneumo- nia, Staphylococcus aureus and Salmonella are prominent features of paediatric human immunodeficiency virus (HIV-1) disease in the industrialized world [4, 14, 16]. Little is known about the prevalence of bacterial infec- tions and bacteraemia in HIV-infected children in devel- oping countries [17]. This may be due to several circum- stances. Many children die at home [19]. Critically ill children, especially HIV-seropositive patients, often have no blood cultures taken and immediately receive antimi- crobial treatment on admission. Moreover, a strict aseptic technique for taking blood cultures is not always applied. Studies in Africa have shown that children with malnutri- tion have a high prevalence of bacteraemia with a high mortality [2, 3], probably a result of numerous defects in the host defences in these children [7]. In order to assess the prevalence of bacteraemia and its relation to HIV serology and nutritional status in children, a prospective study was undertaken amongst children who were brought to the hospital after dying at home. The study took place at Mpilo Central Hospital, a tertiary re- ferral hospital in Bulawayo, Zimbabwe which serves mainly a low socio-economic population of approximate- ly 800000 people [11]. Materials and methods Patients In Zimbabwe a death certificate is mandatory before burial can take place. In Bulawayo all deaths in the community are taken to the casualty department of the central hospital for certification. From July 1992 to May 1993, all children aged 0-5 years who were brought to the casualty department of Mpilo Central Hospital after dying at home, were seen by one of the authors (B.W. or M.I.). Every day the number of deceased children were checked in the mortuary to make sure that all deaths were brought to the at-