title: HIV and mortality of mothers and children: evidence from cohort studies in Uganda, Tanzania, and Malawi.
abstract: BACKGROUND
  The steady decline in child mortality observed in most African countries through the 1960s, 1970s, and 1980s has stalled in many countries in the 1990s because of the AIDS epidemic. However, the census and household survey data that generally are used to produce estimates of child mortality do not permit precise measures of the adverse effect of HIV on child mortality.
  
  
  METHODS
  To calculate excess risks of child mortality as the result of maternal HIV status, we used pooled data from 3 longitudinal community-based studies that classified births by the mother's HIV status. We also estimated excess risks of child death caused by increased mortality among mothers. The joint effects of maternal HIV status and maternal survival were quantified using multivariate techniques in a survival analysis.
  
  
  RESULTS
  Our analysis shows that the excess risk of death associated with having an HIV-positive mother is 2.9 (95% confidence interval = 2.3-3.6), and this effect lasts throughout childhood. The excess risk associated with a maternal death is 3.9 (2.8-5.5) in the 2-year period centered on the mother's death, with children of both infected and uninfected mothers experiencing higher mortality risks at this time.
  
  
  CONCLUSIONS
  HIV impacts on child mortality directly through transmission of the virus to newborns by infected mothers and indirectly through higher child mortality rates associated with a maternal death.
authors.affiliation: Centre for Population Studies, London School of Hygiene & Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK. basia.zaba@lshtm.ac.uk
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
authors.forename: Jimmy
authors.initials: J
authors.lastname: Whitworth
authors.forename: Milly
authors.initials: M
authors.lastname: Marston
authors.forename: Jessica
authors.initials: J
authors.lastname: Nakiyingi
authors.forename: Anthony
authors.initials: A
authors.lastname: Ruberantwari
authors.forename: Mark
authors.initials: M
authors.lastname: Urassa
authors.forename: Raphaeli
authors.initials: R
authors.lastname: Issingo
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mwaluko
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.forename: Andrew
authors.initials: A
authors.lastname: Nyondo
authors.forename: Amelia
authors.initials: A
authors.lastname: Crampin
mesh_terms: D000328:Adult; D017677:Age Distribution; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000145:classification / Q000401:mortality / Q000635:transmission; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009035:Mothers; D015995:Prevalence; D013636:Tanzania / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology