The Effect of Human Immunodeficiency Virus Infection on Birthweight, and Infant and Child Mortality in Urban Malawi

• Published in: International journal of epidemiology 1995-10, Vol.24 (5), p.1022-1029
• Main Authors: TAHA, TAHA E T, DALLABETTA, GINA A, CANNER, JOSEPH K, CHIPHANGWI, JOHN D, LIOMBA, GEORGE, HOOVER, DONALD R, MIOTTI, PAOLO G
• Format: Article
• Language: English
• Subjects: Africa; AIDS/HIV; Biological and medical sciences; Birth Weight - physiology; birthweight; Case-Control Studies; Cause of Death; child survival; Female; Fetal Growth Retardation - epidemiology; Fetal Growth Retardation - physiopathology; HIV Seropositivity - epidemiology; HIV Seropositivity - mortality; HIV Seropositivity - physiopathology; HIV-1; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infectious Disease Transmission, Vertical - statistics & numerical data; Malawi - epidemiology; Medical sciences; Multivariate Analysis; Population; Pregnancy; Pregnancy Complications, Infectious; prematurity; Prospective Studies; Risk Factors; Sexually Transmitted Diseases - transmission; Survival Analysis; Tropical medicine
• ISSN: 0300-5771; 1464-3685
• DOI: 10.1093/ije/24.5.1022

Background Low birthweight, prematurity and Intra-uterine growth retardation (IUGR) are major determinants of child survival. Therefore, it is important to assess excess mortality due to human immunodeficiency virus (HIV) infection in populations where low birthweight is common. Methods A prospective study was conducted on 1385 children born to seropositive and seronegative women in urban Malawi. Children were regularly examined and tested for HIV. Results The mortality rate of children of HIV seropositive mothers was substantially higher (223/1000 at 12 months, 317/1000 at 24 months and 360/1000 at 30 months) than that of children of seronegative mothers (68/1000 at 12 months, 106/1000 at 24 months and 118/1000 at 30 months). The Incidence of prematurity and IUGR was also higher in infants of HIV seropositive mothers than in infants of seronegative mothers (12.7% versus 3.8%, P < 0.001 for premature and 7.7% versus 4.4%, P= 0.02 for IUGR infants). The mother-to-infant HIV-1 transmission rate was 35.1%. After 12 months of age, HIV infected children showed the highest mortality; however, unInfected children of HIV seropositive and children of HIV seronegative mothers had similar mortality. The mean birthweight of HIV infected and uninfected children was not significantly different. In HIV infected children the most frequent causes of death were diarrhoea, pneumonia and failure to thrive. Less common risk factors for child mortality included active maternal syphilis and cervicitis/vaginitis. Conclusions The substantlal difference in survival among children of HIV infected and uninfected mothers suggests that mortality could be reduced if HIV infection were not a risk factor. To decrease childhood mortality, a combination of interventions such as treatment of sexually transmitted infections during pregnancy and measures to reduce mother-to-infant transmission should be adopted.