HIV, malaria, and infant anemia as risk factors for postneonatal infant mortality among HIV-seropositive women in Kisumu, Kenya.
BACKGROUND
HIV and malaria in sub-Saharan Africa are associated with poor pregnancy outcome and infant survival. We studied the association of placental malaria, infant malaria and anemia, and infant HIV status with postneonatal infant mortality (PNIM) among infants of HIV-seropositive women.


METHODS
During 1996-2001, infants born to 570 HIV-seropositive mothers in Kisumu, Kenya were monitored monthly for malaria (parasitemia or clinical malaria) and anemia (hemoglobin level <8 g/dL) and vital status.


RESULTS
Thirty-nine deaths occurred among 112 HIV-positive infants (420/1000 live births [LBs] [95% confidence interval {CI}, 318-522 LBs]), and 36 occurred among 458 HIV-negative infants (99/1000 LBs [95% CI, 68-130 LBs]) (P<.001). In multivariate Cox regression analysis among HIV-negative infants, PNIM was associated with infant anemia (adjusted hazard ratio [AHR], 5.03 [95% CI, 1.97-12.81]) but not with placental malaria (AHR, 1.22 [95% CI, 0.50-2.95]) or infant malaria (AHR, 0.35 [95% CI, 0.10-1.21]). Among HIV-positive infants, neither placental malaria (AHR, 0.34 [95% CI, 0.10-1.10]) nor infant malaria (AHR, 0.31 [95% CI, 0.07-1.33]) or anemia (AHR, 1.07 [95% CI, 0.32-3.61]) was significantly associated with PNIM.


CONCLUSIONS
In this study population, placental malaria and infant parasitemia were not risk factors for PNIM among infants of HIV-seropositive women. The prevention of infant anemia may decrease PNIM among HIV-negative infants of HIV-seropositive women.
van Eijk
Anna M
AM
Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, The Netherlands. amvaneijk@yahoo.com
Ayisi
John G
JG
Ter Kuile
Feiko O
FO
Slutsker
Laurence
L
Shi
Ya Ping
YP
Udhayakumar
Venkatachalam
V
Otieno
Juliana A
JA
Kager
Piet A
PA
Lal
Renu B
RB
Steketee
Richard W
RW
Nahlen
Bernard L
BL
D000740:Anemia / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality*; D006679:HIV Seropositivity / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality* / Q000473:pathology; D008297:Male; D010920:Placenta / Q000469:parasitology / Q000473:pathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012307:Risk Factors; D016019:Survival Analysis