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

The Pan African Medical Journal

Sabin Nsanzimana¹  Vincent Mutabazi¹  Jean Pierre Nyemazi¹  Nadine Umutoni Wa Shema¹  Alphonse Rukundo¹  Corine Karema¹  Hinda Ruton¹  Placidie Mugwaneza¹  Alexandre Lyambabaje²  Agnes Binagwaho³  Claire M Wagner³  Jean de Dieu Bizimana⁴  Landry Tsague⁵  Jane Muita⁵  El"vanie Nyankesha⁵ 

[1] Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda;Department of Applied Mathematics, National University of Rwanda, Butare, Rwanda;Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA;Development Research Group, World Bank, Washington DC, USA;UNICEF Rwanda, Kigali, Rwanda;

关键词: hiv;    pmtct;    maternal hiv infection;    infant mortality;    child mortality;    under-five mortality;    rwanda;   

DOI  :  10.11604/pamj.2011.9.37.850

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown