Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata.
BACKGROUND
As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.


RESULTS
As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.


CONCLUSIONS
In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest.
Jahn
Andreas
A
Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Floyd
Sian
S
McGrath
Nuala
N
Crampin
Amelia C
AC
Kachiwanda
Lackson
L
Mwinuka
Venance
V
Zaba
Basia
B
Fine
Paul E M
PE
Glynn
Judith R
JR
D000293:Adolescent; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D016012:Poisson Distribution; D011159:Population Surveillance; D012424:Rural Population; D012923:Social Class