22692091

PMC3458133

Introduction

Continuous evaluation of child survival is needed in sub-Saharan Africa where HIV prevalence among women of reproductive age continues to be high. We examined mortality levels and trends over a period of ~20 years among HIV-unexposed and exposed children in Blantyre, Malawi.

Methods

Data from five prospective cohort studies conducted at a single research site from 1989-2009 were analyzed. In these studies, children born to HIV-infected and uninfected mothers were enrolled at birth and followed longitudinally for at least two years. Information on socio-demographic, HIV infection status, survival and associated risk factors was collected in all studies. Mortality rates were estimated using birth-cohort analyses stratified by maternal and infant HIV status. Multivariate Cox regression models were used to determine risk factors associated with mortality.

Results

The analysis included 8,286 children. From 1989-1995, overall mortality rates (per 100 person-years) in these clinic-based cohorts remained comparable among HIV-uninfected children born to HIV-uninfected mothers (range 3.3-6.9) or to HIV-infected mothers (range 2.5-7.5). From 1989-2009, overall mortality remained high among all children born to HIV-infected mothers (range 6.3-19.3), and among children who themselves became infected (range 15.6-57.4, 1994-2009). Only lower birth weight was consistently and significantly (P<0.05) associated with higher child mortality.

Conclusions

HIV infection among mothers and children contributed to high levels of child mortality in the African setting in the pre-treatment era. In addition to services that prevent mother-to-child transmission of HIV, other programs are needed to improve child survival by lowering HIV-unrelated mortality through innovative interventions that strengthen health infrastructure.

CDC Public Access

5-U50-PS022061-05/PS/NCHHSTP CDC HHS/United States
5R03TW01199/TW/FIC NIH HHS/United States
N01 AI035173/AI/NIAID NIH HHS/United States
N01 CP033005/CP/NCI NIH HHS/United States
N01-AI-35173-117/AI/NIAID NIH HHS/United States
N01-CP-33005/CP/NCI NIH HHS/United States
P01 AI026499/AI/NIAID NIH HHS/United States
P01-AI-26499/AI/NIAID NIH HHS/United States
R03 TW001199/TW/FIC NIH HHS/United States
R21-AI-33874-01/AI/NIAID NIH HHS/United States
U50-CC0222061/CC/ODCDC CDC HHS/United States