Demographic impact of HIV infection in rural Rakai district, Uganda: results of a population-based cohort study.
OBJECTIVE
To examine HIV-1-related mortality and demographic impact in a high HIV prevalence rural district of Uganda.


METHODS
One-year follow-up (1990-1991) in a population-based rural cohort.


METHODS
Annual enumeration of all consenting residents of 1945 households in 31 randomly selected community clusters in Rakai District. Subjects provided yearly HIV serological samples, behavioral and health information.


METHODS
Mortality in HIV-infected and uninfected persons.


RESULTS
Mortality among HIV-seropositive adults aged > or = 15 years of 118.4 per 1000 person-years (PY) was substantially higher than in HIV-seronegative adults [12.4 per 1000 PY; relative risk (RR), 9.5; 95% confidence interval (CI), 6.0-14.9]. Infant mortality among offspring of HIV-infected mothers was almost double that for uninfected women (210 compared with 111 per 1000 live births; RR, 1.9; 95% CI, 1.0-3.5). Adult HIV-related mortality was associated with HIV prevalence and, in this cohort, with higher education, non-agricultural occupation and residence in roadside trading centers. We estimate that adult HIV prevalence in the district is 13% and adult HIV attributable mortality 52%. For all ages combined, district HIV attributable mortality is 28%.


CONCLUSIONS
HIV is the leading cause of adult death in Rakai. Its effects on mortality are particularly marked in the most economically active sectors. However, the overall crude birth rate in the district (45.7 per 1000 population) remains higher than the crude death rate (28.1 per 1000 population), resulting in continued rapid population growth.
Sewankambo
N K
NK
Department of Medicine, Makerere University, Kampala, Uganda.
Wawer
M J
MJ
Gray
R H
RH
Serwadda
D
D
Li
C
C
Stallings
R Y
RY
Musgrave
S D
SD
Konde-Lule
J
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015981:Epidemiologic Factors; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000401:mortality*; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011158:Population Growth; D011247:Pregnancy; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology