Predictors and consequences of anaemia among antiretroviral-naïve HIV-infected and HIV-uninfected children in Tanzania.
OBJECTIVE
Predictors and consequences of childhood anaemia in settings with high HIV prevalence are not well known. The aims of the present study were to identify maternal and child predictors of anaemia among children born to HIV-infected women and to study the association between childhood anaemia and mortality.


METHODS
Prospective cohort study. Maternal characteristics during pregnancy and Hb measurements at 3-month intervals from birth were available for children. Information was also collected on malaria and HIV infection in the children, who were followed up for survival status until 24 months after birth.


METHODS
Dar es Salaam, Tanzania.


METHODS
The study sample consisted of 829 children born to HIV-positive women.


RESULTS
Advanced maternal clinical HIV disease (relative risk (RR) for stage > or =2 v. stage 1: 1.31, 95 % CI 1.14, 1.51) and low CD4 cell counts during pregnancy (RR for <350 cells/mm3 v. > or =350 cells/mm3: 1.58, 95 % CI 1.05, 2.37) were associated with increased risk of anaemia among children. Birth weight <2500 g, preterm birth (<34 weeks), malaria parasitaemia and HIV infection in the children also increased the risk of anaemia. Fe-deficiency anaemia in children was an independent predictor of mortality in the first two years of life (hazard ratio 1.99, 95 % CI 1.06, 3.72).


CONCLUSIONS
Comprehensive care including highly active antiretroviral therapy to eligible HIV-infected women during pregnancy could reduce the burden of anaemia in children. Programmes for the prevention of mother-to-child transmission of HIV and antimalarial treatment to children could improve child survival in settings with high HIV prevalence.
Chatterjee
Anirban
A
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. achatterjee24@post.harvard.edu
Bosch
Ronald J
RJ
Kupka
Roland
R
Hunter
David J
DJ
Msamanga
Gernard I
GI
Fawzi
Wafaie W
WW
D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001724:Birth Weight / Q000502:physiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology / Q000635:transmission; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008288:Malaria / Q000150:complications / Q000188:drug therapy; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D012720:Severity of Illness Index; D013636:Tanzania
D044966:Anti-Retroviral Agents; D000962:Antimalarials