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 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. RESULTS: 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. CONCLUSIONS: 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.
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 5 prospective cohort studies conducted at a single research site from 1989 to 2009 were analyzed. In these studies, childrenborn 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. RESULTS: 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-uninfectedchildren 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 childrenborn 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 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.
Authors: Taha E Taha; Qing Li; Donald R Hoover; Linda Mipando; Kondwani Nkanaunena; Michael C Thigpen; Allan Taylor; Johnstone Kumwenda; Mary Glenn Fowler; Lynne M Mofenson; Newton I Kumwenda Journal: J Acquir Immune Defic Syndr Date: 2011-08-01 Impact factor: 3.731
Authors: R L Shapiro; M D Hughes; A Ogwu; D Kitch; S Lockman; C Moffat; J Makhema; S Moyo; I Thior; K McIntosh; E van Widenfelt; J Leidner; K Powis; A Asmelash; E Tumbare; S Zwerski; U Sharma; E Handelsman; K Mburu; O Jayeoba; E Moko; S Souda; E Lubega; M Akhtar; C Wester; R Tuomola; W Snowden; M Martinez-Tristani; L Mazhani; M Essex Journal: N Engl J Med Date: 2010-06-17 Impact factor: 91.245
Authors: Milly Marston; Renaud Becquet; Basia Zaba; Lawrence H Moulton; Glenda Gray; Hoosen Coovadia; Max Essex; Didier K Ekouevi; Debra Jackson; Anna Coutsoudis; Charles Kilewo; Valériane Leroy; Stefan Wiktor; Ruth Nduati; Philippe Msellati; François Dabis; Marie-Louise Newell; Peter D Ghys Journal: Int J Epidemiol Date: 2011-01-18 Impact factor: 7.196
Authors: David Chilongozi; Lei Wang; Lillian Brown; Taha Taha; Megan Valentine; Lynda Emel; Moses Sinkala; George Kafulafula; Ramadhani A Noor; Jennifer S Read; Elizabeth R Brown; Robert L Goldenberg; Irving Hoffman Journal: Pediatr Infect Dis J Date: 2008-09 Impact factor: 2.129
Authors: Newton I Kumwenda; Donald R Hoover; Lynne M Mofenson; Michael C Thigpen; George Kafulafula; Qing Li; Linda Mipando; Kondwani Nkanaunena; Tsedal Mebrahtu; Marc Bulterys; Mary Glenn Fowler; Taha E Taha Journal: N Engl J Med Date: 2008-06-04 Impact factor: 91.245
Authors: Mary G Fowler; Min Qin; Susan A Fiscus; Judith S Currier; Patricia M Flynn; Tsungai Chipato; James McIntyre; Devasena Gnanashanmugam; George K Siberry; Anne S Coletti; Taha E Taha; Karin L Klingman; Francis E Martinson; Maxensia Owor; Avy Violari; Dhayendre Moodley; Gerhard B Theron; Ramesh Bhosale; Raziya Bobat; Benjamin H Chi; Renate Strehlau; Pendo Mlay; Amy J Loftis; Renee Browning; Terence Fenton; Lynette Purdue; Michael Basar; David E Shapiro; Lynne M Mofenson Journal: N Engl J Med Date: 2016-11-03 Impact factor: 91.245
Authors: Veronica Ades; Julia Mwesigwa; Paul Natureeba; Tamara D Clark; Albert Plenty; Edwin Charlebois; Jane Achan; Moses R Kamya; Diane V Havlir; Deborah Cohan; Theodore D Ruel Journal: J Trop Pediatr Date: 2013-06-13 Impact factor: 1.165
Authors: Onalethata Lesetedi; Jose Gaby Tshikuka; Shimeles G Hamda; Mgaywa Gilbert Mjungu Damas Magafu; Roy Tapera; Tiny Masupe; Julius Chacha Mwita Journal: AIDS Res Treat Date: 2022-01-28