title: Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program.
abstract: BACKGROUND
  We sought to compare risk of death among children aged under-2 years born to HIV positive mother (HIV-exposed) and to HIV negative mother (HIV non-exposed), and identify determinants of under-2 mortality among the two groups in Rwanda.
  
  
  METHODS
  In a stratified, two-stage cluster sampling design, we selected mother-child pairs using national Antenatal Care (ANC) registers. Household interview with each mother was conducted to capture socio-demographic data and information related to pregnancy, delivery and post-partum. Data were censored at the date of child death. Using Cox proportional hazard model, we compared the hazard of death among HIV-exposed children and HIV non-exposed children.
  
  
  RESULTS
  Of 1,455 HIV-exposed children, 29 (2.0%; 95% CI: 1.3%-2.7%) died by 6 months compared to 18 children of the 1,565 HIV non-exposed children (1.2%; 95% CI: 0.6%-1.7%). By 9 months, cumulative risks of death were 3.0% (95%; CI: 2.2%-3.9%) and 1.3% (96%; CI: 0.7%-1.8%) among HIV-exposed and HIV non-exposed children, respectively. By 2 years, the hazard of death among HIV-exposed children was more than 3 times higher (aHR:3.5; 95% CI: 1.8-6.9) among HIV-exposed versus non-exposed children. Risk of death by 9-24 months of age was 50% lower among mothers who attended 4 or more antenatal care (ANC) visits (aHR: 0.5, 95% CI: 0.3-0.9), and 26% lower among families who had more assets (aHR: 0.7, 95% CI: 0.5-1.0).
  
  
  CONCLUSIONS
  Infant mortality was independent of perinatal HIV exposure among children by 6 months of age. However, HIV-exposed children were 3.5 times more likely to die by 2 years. Fewer antenatal visits, lower household assets and maternal HIV seropositive status were associated with increased mortality by 9-24 months.
authors.affiliation: Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda.
authors.forename: Placidie
authors.initials: P
authors.lastname: Mugwaneza
authors.forename: Nadine Wa Shema
authors.initials: NW
authors.lastname: Umutoni
authors.forename: Hinda
authors.initials: H
authors.lastname: Ruton
authors.forename: Alphonse
authors.initials: A
authors.lastname: Rukundo
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lyambabaje
authors.forename: Jean de Dieu
authors.initials: Jde D
authors.lastname: Bizimana
authors.forename: Landry
authors.initials: L
authors.lastname: Tsague
authors.forename: Claire M
authors.initials: CM
authors.lastname: Wagner
authors.forename: Elévanie
authors.initials: E
authors.lastname: Nyankesha
authors.forename: Jane
authors.initials: J
authors.lastname: Muita
authors.forename: Vincent
authors.initials: V
authors.lastname: Mutabazi
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Nyemazi
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.forename: Corine
authors.initials: C
authors.lastname: Karema
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D002423:Cause of Death; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012189:Retrospective Studies; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D011795:Surveys and Questionnaires