The role of vertical transmission and health care-related factors in HIV infection of children: a community study in rural Uganda.
OBJECTIVE
To determine the probable route of transmission of HIV to children aged 12 years or younger in a rural area of Uganda from 1999 through 2000 and to examine associations between HIV infection and health care-related variables.


METHODS
The HIV infections status for 6991 children was determined from 1 round of an ongoing population surveillance system, and the reported numbers of injections in the past year and blood transfusions were determined for 5922 of these children based on a medical questionnaire. Data from the surveillance system and from an additional survey were used to assess the potential for vertical infection from a mother to her child.


RESULTS
The HIV prevalence among children was 0.4%. Of 23 definite and 4 probable cases of HIV infection in children, vertical transmission was not possible for 1 case, not likely for another case, and possibly not vertical for another case. The population-attributable fraction for vertical transmission was between 90% and 94%. Large numbers of injections in the past year and ever having a blood transfusion were only associated with HIV infection in children exposed to vertical transmission.


CONCLUSIONS
Up to 10% of HIV infections in children in the study area were not attributable to vertical transmission, and thus were possibly attributable to iatrogenic transmission. Associations seen between health care-related variables and HIV were likely to be attributable to treatment for AIDS-related illness in children infected vertically.
Biraro
Samuel
S
Medical Research Council Unit on AIDS, Entebbe, Uganda.
Morison
Linda A
LA
Nakiyingi-Miiro
Jessica
J
Whitworth
James A G
JA
Grosskurth
Heiner
H
D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007267:Injections / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D012423:Rural Health; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology