Table 1

Clinical algorithms for diagnosing paediatric HIV

Algorithm

Variables

Diagnostic Criteria


History

Physical findings


Original IMCI† Algorithm for Paediatric HIV

• Chest infection requiring hospital admission in the past 3 months

• Weight below 3rd centile

• Classify as suspected symptomatic HIV infection if 3 positive findings

• > = 2 episodes of diarrhea in the past 3 months

• Poor weight gain (growth monitoring card)

• Episode of persistent diarrhea (lasting 14 days) in the past 3 months

• Any enlarged lymph glands in more than one of the following sites: neck, axillary or groin

• Fever > = 1 month

• Oral thrush extending to the back of the mouth or throat

• Poor appetite

• Chronic ear infection (14 days)

• History or evidence of past or present herpes zoster

• History or evidence of severe seborrheic dermatitis

• History of past or present TB

• Parent or sibling known to have TB

• Parent or sibling known to be HIV-positive


Improved IMCI Algorithm (South Africa adaptation)

• Pneumonia today§

• Weight below 3rd centile

• Classify as suspected symptomatic HIV infection if 3 positive findings

• History of weight loss¶

• Poor weight gain (history or RTH card)

• Persistent diarrhea now or in past 3 months

• Any enlarged lymph glands in more than one of the following; neck, axillae or groin

• Ear discharge now or in the past

• Oral thrush

• Parotid swelling


Action Against Hunger Algorithm

• Ear discharge now or in the past

• When child presents with > = 3 criteria refer for further HIV support/care and health education

• Enlarged lymph glands now

• Pneumonia today or persistent cough > 1 month

• Persistent diarrhea

• Low weight gain¶

• Oral thrush

• Marasmus or Marasmus/Kwashiokor

• Fever for more than one month

• Child is an orphan (one or both parents)

• Child's parents are sick or one of siblings has died


† IMCI = integrated management of childhood illness § Pneumonia was ascertained by asking if the child had breathing abnormalities (fast breathing, chest in-drawing or nasal flaring) and/or severe cough. ¶ All children were assumed to have a history of weight loss/low weight gain.

Bahwere et al. BMC Infectious Diseases 2008 8:106   doi:10.1186/1471-2334-8-106

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