title: The long-term impact of HIV and orphanhood on the mortality and physical well-being of children in rural Malawi.
abstract: OBJECTIVE
  To assess the influence of maternal HIV status and orphanhood on child mortality and physical well-being.
  
  
  METHODS
  Retrospective cohort study with > 10 years of follow-up.
  
  
  METHODS
  From population-based surveys in Karonga District, Malawi in the 1980s, 197 individuals were identified as HIV-positive. These individuals and 396 HIV-negative individuals matched for age and sex, and their spouses and offspring, were sought in 1998-2000.
  
  
  RESULTS
  All but 11 of the index individuals were traced, identifying 2520 offspring; of these, 1106 offspring were included in analyses. Among those with HIV-positive mothers, mortality was 27% [95% confidence interval (CI), 17-38] in infants (1-30 days), 46% (95% CI, 34-58) in those under 5 years and 49% (95% CI, 38-61) in those under 10 years. The corresponding figures for those with HIV-negative mothers were 11% (95% CI, 8-13), 16% (95% CI, 13-19) and 17% (95% CI, 14-20). Death of HIV-positive mothers, but not of HIV-negative mothers or of fathers, was associated with increased child mortality. Among survivors who were still resident in the district, neither maternal HIV status nor orphanhood was associated with stunting, being wasted, or reported ill-health.
  
  
  CONCLUSIONS
  Mortality in children under 5 years is much higher in children born to HIV-positive mothers than in those born to HIV-negative mothers. With 10% of pregnant women HIV-positive, we estimate that approximately 18% of under-5 deaths in this population are attributable to HIV. Most of the excess is attributable to vertical transmission of HIV. Our findings suggest that, in terms of physical well-being, the extended family in this society has not discriminated against surviving children whose parents have been ill or have died as a result of HIV/AIDS.
authors.affiliation: Karonga Prevention Study, Chilumba, Karonga, Malawi.
authors.forename: Amelia C
authors.initials: AC
authors.lastname: Crampin
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Judith R
authors.initials: JR
authors.lastname: Glynn
authors.forename: Nyovani
authors.initials: N
authors.lastname: Madise
authors.forename: Andrew
authors.initials: A
authors.lastname: Nyondo
authors.forename: Masiya M
authors.initials: MM
authors.lastname: Khondowe
authors.forename: Chance L
authors.initials: CL
authors.lastname: Njoka
authors.forename: Huxley
authors.initials: H
authors.lastname: Kanyongoloka
authors.forename: Bagrey
authors.initials: B
authors.lastname: Ngwira
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
authors.forename: Paul E
authors.initials: PE
authors.lastname: Fine
mesh_terms: D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005581:Foster Home Care; D006130:Growth Disorders / Q000401:mortality / Q000821:virology; D015658:HIV Infections / Q000401:mortality*; D006679:HIV Seropositivity / Q000401:mortality; D006304:Health Status; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012423:Rural Health; D015996:Survival Rate