title: Recent upturn in mortality in rural Zimbabwe: evidence for an early demographic impact of HIV-1 infection?
abstract: OBJECTIVE
  To describe recent mortality trends in rural Zimbabwe and to assess the impact of HIV-1 infection.
  
  
  METHODS
  Comparative, cross-sectional, retrospective, demographic survey with 1-year follow-up. Parallel HIV-1 surveillance. Comparison of results with 1992 national census and vital registration data and results from mathematical model-based population projections.
  
  
  METHODS
  Residents of 929 (745 revisited in 1995) households in two rural areas of Manicaland Province, Zimbabwe, with contrasting HIV-1 prevalence: Honde and Rusitu valleys. Subjects gave information on parental survival for 2320 resident children. Female residents aged 13-49 years (n = 1237) provided information on birth histories and child survival. Consenting women attending local antenatal clinics (n = 487) provided blood samples for HIV-1 screening and demographic information.
  
  
  METHODS
  HIV-1 prevalence in pregnant women; per capita death registration rates; incidence of parental death for children aged under 8 years; infant mortality and age-specific death probabilities.
  
  
  RESULTS
  HIV-1 prevalence was high in each study area. Death registration and age-specific mortality have begun to rise. The largest increases were seen in the area of higher HIV-1 prevalence (Honde) and among younger adults, particularly men. Incidence of parental death was observed to be rising. Increases in registered deaths were concentrated among HIV-1-associated causes.
  
  
  CONCLUSIONS
  The observed increases in mortality by age, sex and cause of death were consistent with those expected early in a severe HIV-1 epidemic, on the basis of mathematical model projections and observations elsewhere in Africa. Further rises in mortality, particularly among women and young children, and consequent increases in orphanhood, are to be expected in rural areas of Zimbabwe.
authors.affiliation: Wellcome Trust Centre for the Epidemiology of Infectious Disease, Zoology Department, Oxford University, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gregson
authors.forename: R M
authors.initials: RM
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Ndlovu
authors.forename: T
authors.initials: T
authors.lastname: Zhuwau
authors.forename: S K
authors.initials: SK
authors.lastname: Chandiwana
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003644:Death Certificates; D003710:Demography; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010290:Parents; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015995:Prevalence; D012424:Rural Population; D012737:Sex Factors; D012725:Sexual Behavior; D016019:Survival Analysis; D015030:Zimbabwe / Q000453:epidemiology