title: Under-five mortality and maternal HIV status in Tanzania: analysis of trends between 2003 and 2012 using AIDS Indicator Survey data.
abstract: BACKGROUND
  Mortality among children under five remains a significant health challenge across sub-Saharan Africa. HIV/AIDS is one of the leading contributors to the relatively slow decline in under-five mortality in this region. In Tanzania, HIV prevalence among under-five children is high and 90% of all infections are due to mother-to-child transmission.
  
  
  OBJECTIVE
  The study aimed to examine the association between maternal HIV-positive status and under-five mortality in Tanzania. It also aimed to estimate the proportions and trends of under-five mortality attributable to maternal HIV/AIDS in Tanzania between 2003 and 2012.
  
  
  METHODS
  Binomial logistic regression was used to analyze cross-sectional survey data from the Tanzania AIDS Indicator Surveys to examine the association between maternal HIV positivity and under-five mortality between 2003 and 2012.
  
  
  RESULTS
  After controlling for confounders, the adjusted odds ratios were 1.5 (95% CI 1.1-1.9) in 2003-2004, 4.6 (95% CI 2.7-7.8) in 2007-2008, and 2.4 (95% CI 1.2-4.6) in 2011-2012. The maternal HIV-attributable mortality risk percent of under-five children was 3.7 percent in 2003-2004, 11.3 percent in 2007-2008 and 5.6% in 2011-2012.
  
  
  CONCLUSIONS
  Maternal HIV positivity is associated with under-five mortality in Tanzania, making maternal HIV serostatus a relevant determinant of whether a child will survive up to five years of age or not. The impact of maternal HIV/AIDS attributable mortality risk has a significant contribution to the overall under-five mortality in Tanzania. The continued monitoring of HIV and mortality trends is important for policy development and design of interventions.
authors.affiliation: International Master Programme in Public Health, Faculty of Medicine, Lund University, CRC, Jan Waldenströms gata 35, 205 02 Malmö, Sweden; arundamalachi@gmail.com.
authors.forename: Malachi Ochieng
authors.initials: MO
authors.lastname: Arunda
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden.
authors.forename: Vikas
authors.initials: V
authors.lastname: Choudhry
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Ekman
authors.affiliation: Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden.
authors.forename: Benedict Oppong
authors.initials: BO
authors.lastname: Asamoah
keywords: HIV; antiretroviral therapy; cross-sectional design; logistic regression; prevention of mother-to-child transmission; under-five mortality