title: Mortality and health outcomes in HIV-infected and HIV-uninfected mothers at 18-20 months postpartum in Zomba District, Malawi.
abstract: BACKGROUND
  Maternal morbidity and mortality among HIV-infected women is a global concern. This study compared mortality and health outcomes of HIV-infected and HIV-uninfected mothers at 18-20 months postpartum within routine prevention of mother-to-child transmission of HIV (PMTCT) services in a rural district in Malawi.
  
  
  METHODS
  A retrospective cohort study of mother-child dyads at 18-20 months postpartum in Zomba District. Data on socio-demographic characteristics, service uptake, maternal health outcomes and biometric parameters were collected.
  
  
  RESULTS
  173 HIV-infected and 214 HIV-uninfected mothers were included. HIV-specific cohort mortality at 18-20 months postpartum was 42.4 deaths/1000 person-years; no deaths occurred among HIV-uninfected women. Median time to death was 11 months post-partum (range 3-19). Women ranked their health on a comparative qualitative scale; HIV-infected women perceived their health to be poorer than did HIV-uninfected women (RR 2.4; 95% CI 1.6-3.7). Perceived maternal health status was well correlated with an objective measure of functional status (Karnofsky scale; p<0.001). HIV-infected women were more likely to report minor (RR 3.8; 95% CI 2.3-6.4) and major (RR 6.2; 95% CI 2.2-17.7) signs or symptoms of disease. In multivariable analysis, HIV-infected women remained twice as likely to report poorer health [adjusted OR (aOR) 2.3; 95% CI 1.4-3.6], as did women with low BMI (aOR 2.1; 95% CI 1.1-4.0) and scoring lowest on the welfare scale (aOR 2.0; 95% CI 1.1-3.8).
  
  
  CONCLUSIONS
  HIV-infected women show increased mortality and morbidity at 18-20 months postpartum. In our rural Malawian operational setting, where there is documented under-application of ART and poor adherence to PMTCT services, these results support attention to optimizing maternal participation in PMTCT programs.
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Megan
authors.initials: M
authors.lastname: Landes
authors.forename: Monique
authors.initials: M
authors.lastname: van Lettow
authors.forename: Richard
authors.initials: R
authors.lastname: Bedell
authors.forename: Isabell
authors.initials: I
authors.lastname: Mayuni
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.forename: Lyson
authors.initials: L
authors.lastname: Tenthani
authors.forename: Erik
authors.initials: E
authors.lastname: Schouten
mesh_terms: D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006304:Health Status; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008295:Malawi / Q000453:epidemiology; D008430:Maternal-Child Health Centers / Q000706:statistics & numerical data; D009017:Morbidity; D009035:Mothers; D049590:Postpartum Period; D012189:Retrospective Studies