This article is available in: PDF HTML EPUB XML

Morbidity and mortality in HIV-exposed under-five children in a rural Malawi setting: a cohort study

Oscar Divala, Charles Michelo, Bagrey Ngwira

Abstract


Introduction: Paediatric HIV infection significantly contributes to child morbidity and mortality in southern Africa. In Malawi as in most countries in the region, care of HIV-exposed children is constrained by the lack of area-specific information on their risk to dying and morbidity. This research estimates and compares morbidity and mortality events between HIV-exposed and -unexposed under-five children in a rural Malawian setting.

Methods: Data for children under the age of five collected from January 2009 to June 2011 at a demographic and health site in Karonga district of northern Malawi were analyzed. Morbidity and mortality rates among HIV-exposed and -unexposed children were calculated and compared using Kaplan-Meier survival analysis and Cox proportional hazard regression.

Results: Overall (n=7,929) cohort data of under-five children born in a demographic and health site represented 12380.8 person years of observation (PYO) of which 3.1% were contributed by HIV-exposed infants. Females accounted for half of the sample, and the overall mean age was 18.4 months (SD 13.4) with older children in the HIV – unexposed group. All-cause morbidity rate was 337.6/1000 PYO (95% CI 327.5/1000–348.0/1000) and HIV-exposed children morbidity rate was 1.34 times higher (p<0.001) compared to HIV-unexposed children. integrated management of childhood illness (IMCI) pneumonia was the most common diagnosis (39.3%) in this cohort. Child mortality rate was 16.6/1000 PYO (95% CI 14.5–19.1) from 206 deaths. HIV-exposed children had 4.5 times higher (p<0.001) mortality rate compared to the HIV-unexposed children. Higher mortality rates were observed in children under one year (129.2/1000 PYO) compared to older age groups.

Conclusion: HIV exposure at birth has a greater impact on child morbidity and mortality especially in the first year of life. This underscores the need for targeted and synergetic interventions that included focused prevention of mother-to-child transmission (PMTCT) which could reduce HIV transmission to children in their infancy in this setting.

(Published: 2 November 2014)

Citation: Divala O et al. Journal of the International AIDS Society 2014, 17(Suppl 3):19696

http://www.jiasociety.org/index.php/jias/article/view/19696 | http://dx.doi.org/10.7448/IAS.17.4.19696




Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Journal of the International AIDS Society | eISSN 1758-2652 | Editors-in-Chief: Susan Kippax and Kenneth Mayer

*2016 Journal Citation Reports® Science Edition - a Clarivate Analytics product.

Disclaimer: The Journal of the International AIDS Society is an official journal of and is published by the International AIDS Society. The costs of the Journal of the International AIDS Society are secured by the International AIDS Society. This support does not in any way affect the editorial independency of the Journal of the International AIDS Society. Material published in the journal is entirely independent of the opinion of external sponsors and the society.