The long-term impact of HIV and orphanhood on the mortality and physical well-being of children in rural Malawi.
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.
Crampin
Amelia C
AC
Karonga Prevention Study, Chilumba, Karonga, Malawi.
Floyd
Sian
S
Glynn
Judith R
JR
Madise
Nyovani
N
Nyondo
Andrew
A
Khondowe
Masiya M
MM
Njoka
Chance L
CL
Kanyongoloka
Huxley
H
Ngwira
Bagrey
B
Zaba
Basia
B
Fine
Paul E
PE
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