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NEW THIS SATURDAY: UNDER-TWO CHILD MORTALITY ACCORDING TO MATERNAL HIV STATUS IN RWANDA

Thursday, 1st of August 2013

• UNDER-TWO CHILD MORTALITY ACCORDING TO MATERNAL HIV STATUS IN RWANDA

Pan Afr Med J. 2011;9:37. Epub 2011 Aug 3.

Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program.

Mugwaneza P, Umutoni NW, Ruton H, Rukundo A, Lyambabaje A, Bizimana Jde D, Tsague L, Wagner CM, Nyankesha E, Muita J, Mutabazi V, Nyemazi JP, Nsanzimana S, Karema C, Binagwaho A.

Source

Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda.

Abstract below; full text is at http://www.panafrican-med-journal.com/content/article/9/37/full/

INTRODUCTION:

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).

CONCLUSION:

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.