HIV and mortality of mothers and children: evidence from cohort studies in Uganda, Tanzania, and Malawi.
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.
Zaba
Basia
B
Centre for Population Studies, London School of Hygiene & Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK. basia.zaba@lshtm.ac.uk
Whitworth
Jimmy
J
Marston
Milly
M
Nakiyingi
Jessica
J
Ruberantwari
Anthony
A
Urassa
Mark
M
Issingo
Raphaeli
R
Mwaluko
Gabriel
G
Floyd
Sian
S
Nyondo
Andrew
A
Crampin
Amelia
A
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