Impact of HIV on Child Mortality: Results from a Multi-Center Study

Basia Zaba, London School of Hygiene and Tropical Medicine
Michael D. Bracher, Royal Netherlands Academy of Arts and Sciences
Sian Floyd, London School of Hygiene and Tropical Medicine
Mia Crampin, London School of Hygiene and Tropical Medicine
Jessica Nakiyingi, Medical Research Council, The Gambia
Mark Urassa, TANESA project
Raphaeli Issingo, TANESA project
Andy Sloggett, London School of Hygiene and Tropical Medicine

Data on 26,000 child-years of observation from longitudinal, community-based studies in Uganda, Tanzania and Malawi, classified by maternal HIV status and survival, were analyzed using multivariate hazard models with time-varying co-variates. Hazard ratios and life-table functions are calculated for each study and for pooled data. Children of HIV+ mothers faced twice the risk of dying as children of HIV- mothers, maternal death increased the risk of child death by a factor of four, independently of HIV status. Elevated mortality risks were experienced in the year preceding the mother's death, as well as when orphaned. Mortality impacts of maternal HIV and survival are concentrated at ages under 3. Child mortality estimates based on retrospective reports by surviving HIV positive mothers under-estimate the mortality of all children born to such women by around 8%. Competing-risk methods are proposed for obtaining estimates of mortality by infection status of the child.