BACKGROUND: Under-five mortality is decreasing but with little change in neonatal mortality rates. We examined the effect of maternal HIV status on under-five mortality and cause of death since widespread availability of antiretroviral therapy in rural Malawi. METHODS: Children born in 2006-2011 in the Karonga demographic surveillance area were included. Maternal HIV status was available from HIV serosurveys. Age-specific mortality rate ratios for children born to HIV-positive and HIV-negative mothers were obtained by fitting a Poisson model accounting for child clustering by mother and adjusting for potential confounders. Cause of death was ascertained by verbal autopsy. FINDINGS: There were 352 deaths among 6913 under-five singleton children followed for 20,754 person-years (py), giving a mortality rate of 17.0/1000 py overall, 218/1000 py (16.5/1000 live births) in neonates, 20/1000 py (17.4/1000 live births) in postneonatal infants, and 8/1000 py in 1-4 years old. Comparing those born to HIV-positive and HIV-negative mothers, the rate ratio adjusted for child age, sex, maternal age, parity, and drinking water source was 1.5 (95% confidence interval [CI]: 0.6 to 3.7) in neonates, 11.5 (95% CI: 7.2 to 18.5) in postneonatal infants, and 4.6 (95% CI: 2.7 to 7.9) in 1-4 years old. Birth injury/asphyxia, neonatal sepsis, and prematurity contributed >70% of neonatal deaths, whereas acute infections, malaria, diarrhea, and pneumonia accounted for most deaths in older children. CONCLUSIONS: Maternal HIV status had little effect on neonatal mortality but was associated with much higher mortality in the postneonatal period and among older children. Greater attention to HIV care in pregnant women and mothers should help improve child survival, but broader interventions are needed to reduce neonatal mortality.
BACKGROUND: Under-five mortality is decreasing but with little change in neonatal mortality rates. We examined the effect of maternal HIV status on under-five mortality and cause of death since widespread availability of antiretroviral therapy in rural Malawi. METHODS: Children born in 2006-2011 in the Karonga demographic surveillance area were included. Maternal HIV status was available from HIV serosurveys. Age-specific mortality rate ratios for children born to HIV-positive and HIV-negative mothers were obtained by fitting a Poisson model accounting for child clustering by mother and adjusting for potential confounders. Cause of death was ascertained by verbal autopsy. FINDINGS: There were 352 deaths among 6913 under-five singleton children followed for 20,754 person-years (py), giving a mortality rate of 17.0/1000 py overall, 218/1000 py (16.5/1000 live births) in neonates, 20/1000 py (17.4/1000 live births) in postneonatal infants, and 8/1000 py in 1-4 years old. Comparing those born to HIV-positive and HIV-negative mothers, the rate ratio adjusted for child age, sex, maternal age, parity, and drinking water source was 1.5 (95% confidence interval [CI]: 0.6 to 3.7) in neonates, 11.5 (95% CI: 7.2 to 18.5) in postneonatal infants, and 4.6 (95% CI: 2.7 to 7.9) in 1-4 years old. Birth injury/asphyxia, neonatal sepsis, and prematurity contributed >70% of neonatal deaths, whereas acute infections, malaria, diarrhea, and pneumonia accounted for most deaths in older children. CONCLUSIONS: Maternal HIV status had little effect on neonatal mortality but was associated with much higher mortality in the postneonatal period and among older children. Greater attention to HIV care in pregnant women and mothers should help improve child survival, but broader interventions are needed to reduce neonatal mortality.
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: Andreas Jahn; Sian Floyd; Nuala McGrath; Amelia C Crampin; Lackson Kachiwanda; Venance Mwinuka; Basia Zaba; Paul E M Fine; Judith R Glynn Journal: PLoS One Date: 2010-06-28 Impact factor: 3.240
Authors: Amelia C Crampin; Sian Floyd; Judith R Glynn; Nyovani Madise; Andrew Nyondo; Masiya M Khondowe; Chance L Njoka; Huxley Kanyongoloka; Bagrey Ngwira; Basia Zaba; Paul E Fine Journal: AIDS Date: 2003-02-14 Impact factor: 4.177
Authors: Renaud Becquet; Milly Marston; François Dabis; Lawrence H Moulton; Glenda Gray; Hoosen M Coovadia; Max Essex; Didier K Ekouevi; Debra Jackson; Anna Coutsoudis; Charles Kilewo; Valériane Leroy; Stefan Z Wiktor; Ruth Nduati; Philippe Msellati; Basia Zaba; Peter D Ghys; Marie-Louise Newell Journal: PLoS One Date: 2012-02-23 Impact factor: 3.240
Authors: Amelia C Crampin; Albert Dube; Sebastian Mboma; Alison Price; Menard Chihana; Andreas Jahn; Angela Baschieri; Anna Molesworth; Elnaeus Mwaiyeghele; Keith Branson; Sian Floyd; Nuala McGrath; Paul E M Fine; Neil French; Judith R Glynn; Basia Zaba Journal: Int J Epidemiol Date: 2012-06-22 Impact factor: 7.196
Authors: Sian Floyd; Anna Molesworth; Albert Dube; Amelia C Crampin; Rein Houben; Menard Chihana; Alison Price; Ndoliwe Kayuni; Jacqueline Saul; Neil French; Judith R Glynn Journal: AIDS Date: 2013-01-14 Impact factor: 4.177
Authors: Eric Remera; Frédérique Chammartin; Sabin Nsanzimana; Jamie Ian Forrest; Gerald E Smith; Placidie Mugwaneza; Samuel S Malamba; Muhammed Semakula; Jeanine U Condo; Nathan Ford; David J Riedel; Marie Paul Nisingizwe; Agnes Binagwaho; Edward J Mills; Heiner Bucher Journal: BMJ Glob Health Date: 2021-05
Authors: Naor Bar-Zeev; Khuzwayo C Jere; Aisleen Bennett; Louisa Pollock; Jacqueline E Tate; Osamu Nakagomi; Miren Iturriza-Gomara; Anthony Costello; Charles Mwansambo; Umesh D Parashar; Robert S Heyderman; Neil French; Nigel A Cunliffe Journal: Clin Infect Dis Date: 2016-05-01 Impact factor: 9.079
Authors: Kevin Mortimer; Chifundo B Ndamala; Andrew W Naunje; Jullita Malava; Cynthia Katundu; William Weston; Deborah Havens; Daniel Pope; Nigel G Bruce; Moffat Nyirenda; Duolao Wang; Amelia Crampin; Jonathan Grigg; John Balmes; Stephen B Gordon Journal: Lancet Date: 2016-12-07 Impact factor: 79.321