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.
Data from 5 prospective cohort studies conducted at a single research site from 1989 to 2009 were analyzed. In these studies, children born to HIV-infected and -uninfected mothers were enrolled at birth and followed longitudinally for at least 2 years. Information on sociodemographic, 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.
The analysis included 8286 children. From 1989 to 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 to 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.
HIV infection among mothers and children contributed to high levels of child mortality in the African setting in the pretreatment 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.
Departments of *Epidemiology
†International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
‡Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
Correspondence to: Taha E. Taha, MD, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E7138, Baltimore, MD 21205 (e-mail: firstname.lastname@example.org).
The International Collaborative AIDS Research, Preparation for AIDS Vaccine Evaluation, and HIV Network studies were supported by the National Institute of Allergy and Infectious Diseases, National Institutes of Health Grants PO1-AI-26499, R21-AI-33874-01, NO1-CP-33005, and NO1-AI-35173-117. The NVP/zidovudine [ZDV or AZT] study was funded by the Fogarty International Center, National Institutes of Health (AIDS FIRCA Award #5R03TW01199 and Supplement), and the Doris Duke Charitable Foundation, NY. The Post-Exposure Prophylaxis of Infants study was supported by a cooperative agreement from the Centers for Disease Control and Prevention and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, 5-U50-PS022061-05; award U50-CC0222061.
The findings reported in this manuscript represent the conclusions of the authors and do not represent the views of their institutions or of the study sponsors.
The authors have no conflicts of interest to disclose.
Received January 13, 2012
Accepted May 24, 2012