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Houle B, Kabudula C, Gareta D, Herbst K, Clark SJ. Household structure, composition and child mortality in the unfolding antiretroviral therapy era in rural South Africa: comparative evidence from population surveillance, 2000-2015. BMJ Open 2023; 13:e070388. [PMID: 36921956 PMCID: PMC10030929 DOI: 10.1136/bmjopen-2022-070388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES The structure and composition of the household has important influences on child mortality. However, little is known about these factors in HIV-endemic areas and how associations may change with the introduction and widespread availability of antiretroviral treatment (ART). We use comparative, longitudinal data from two demographic surveillance sites in rural South Africa (2000-2015) on mortality of children younger than 5 years (n=101 105). DESIGN We use multilevel discrete time event history analysis to estimate children's probability of dying by their matrilineal residential arrangements. We also test if associations have changed over time with ART availability. SETTING Rural South Africa. PARTICIPANTS Children younger than 5 years (n=101 105). RESULTS 3603 children died between 2000 and 2015. Mortality risks differed by co-residence patterns along with different types of kin present in the household. Children in nuclear households with both parents had the lowest risk of dying compared with all other household types. Associations with kin and child mortality were moderated by parental status. Having older siblings lowered the probability of dying only for children in a household with both parents (relative risk ratio (RRR)=0.736, 95% CI (0.633 to 0.855)). Only in the later ART period was there evidence that older adult kin lowered the probability of dying for children in single parent households (RRR=0.753, 95% CI (0.664 to 0.853)). CONCLUSIONS Our findings provide comparative evidence of how differential household profiles may place children at higher mortality risk. Formative research is needed to understand the role of other household kin in promoting child well-being, particularly in one-parent households that are increasingly prevalent.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Acornhoek, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Acornhoek, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, Somkhele, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Somkhele, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Acornhoek, South Africa
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
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Estimating the Risk of Maternal Death at Admission: A Predictive Model from a 5-Year Case Reference Study in Northern Uganda. Obstet Gynecol Int 2022; 2022:4419722. [PMID: 35342429 PMCID: PMC8947917 DOI: 10.1155/2022/4419722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Uganda is one of the countries in the Sub-Saharan Africa with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births. We aimed at exploring the main factors affecting maternal death and designing a predictive model for estimation of the risk of dying at admission at a major referral hospital in northern Uganda. Methods. This was a retrospective matched case-control study, carried out at Lacor Hospital in northern Uganda, including 130 cases and 336 controls, from January 2015 to December 2019. Multivariate logistic regression was used to estimate the net effect of the associated factors. A cumulative risk score for each woman based on the unstandardised canonical coefficients was obtained by the discriminant equation. Results. The average maternal mortality ratio was 328 per 100,000 live births. Direct obstetric causes contributed to 73.8% of maternal deaths; the most common were haemorrhage (42.7%), sepsis (24.0%), hypertensive disorders (18.7%) and complications of abortion (2.1%), whereas malaria (23.5%) and HIV/AIDS (20.6%) were the leading indirect causes. The odds of dying were higher among women who were aged 30 years or more (OR 1.12; 95% CI, 1.04–1.19), did not attend antenatal care (OR 3.11; 95% CI, 1.36–7.09), were HIV positive (OR 3.13; 95% CI, 1.41–6.95), had a caesarean delivery (OR 2.22; 95% CI 1.13–4.37), and were referred from other facilities (OR 5.57; 95% CI 2.83–10.99). Conclusion. Mortality is high among mothers referred late from other facilities who are HIV positive, aged more than 30 years, lack antenatal care attendance, and are delivered by caesarean section. This calls for prompt and better assessment of referred mothers and specific attention to antibiotic therapy before and after caesarean section, especially among HIV-positive women.
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Helleringer S, Liu L, Chu Y, Rodrigues A, Fisker AB. Biases in Survey Estimates of Neonatal Mortality: Results From a Validation Study in Urban Areas of Guinea-Bissau. Demography 2021; 57:1705-1726. [PMID: 32914335 DOI: 10.1007/s13524-020-00911-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neonatal deaths (occurring within 28 days of birth) account for close to one-half of all deaths among children under age 5 worldwide. In most low- and middle-income countries, data on neonatal deaths come primarily from household surveys. We conducted a validation study of survey data on neonatal mortality in Guinea-Bissau (West Africa). We used records from an urban health and demographic surveillance system (HDSS) that monitors child survival prospectively as our reference data set. We selected a stratified sample of 599 women aged 15-49 among residents of the HDSS and collected the birth histories of 422 participants. We cross-tabulated survey and HDSS data. We used a mathematical model to investigate biases in survey estimates of neonatal mortality. Reporting errors in survey data might lead to estimates of the neonatal mortality rate that are too high, which may limit our ability to track progress toward global health objectives.
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Affiliation(s)
- Stéphane Helleringer
- Division of Social Science Program on Social Research and Public Policy, New York University - Abu Dhabi, P.O. Box 129188, Abu Dhabi, United Arab Emirates.
| | - Li Liu
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Yue Chu
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | | | - Ane Barent Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- University of Southern Denmark, Odense, Denmark
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Akobirshoev I, Zandam H, Nandakumar A, Groce N, Blecher M, Mitra M. The compounding effect of having HIV and a disability on child mortality among mothers in South Africa. PLoS One 2021; 16:e0251183. [PMID: 33951108 PMCID: PMC8099123 DOI: 10.1371/journal.pone.0251183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/22/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Previous research on the association between maternal HIV status and child mortality in sub-Saharan Africa was published between 2005-2011. Findings from these studies showed a higher child mortality risk among children born to HIV-positive mothers. While the population of women with disabilities is growing in developing countries, we found no research that examined the association between maternal disability in HIV-positive mothers, and child mortality in sub-Saharan Africa. This study examined the potential compounding effect of maternal disability and HIV status on child mortality in South Africa. METHODS We analyzed data for women age 15-49 years from South Africa, using the nationally representative 2016 South Africa Demographic and Health Survey. We estimated unadjusted and adjusted risk ratios of child mortality indicators by maternal disability and maternal HIV using modified Poisson regressions. RESULTS Children born to disabled mothers compared to their peers born to non-disabled mothers were at a higher risk for neonatal mortality (RR = 1.80, 95% CI:1.31-2.49), infant mortality (RR = 1.69, 95% CI:1.19-2.41), and under-five mortality (RR = 1.78, 95% CI:1.05-3.01). The joint risk of maternal disability and HIV-positive status on the selected child mortality indicators is compounded such that it is more than the sum of the risks from maternal disability or maternal HIV-positive status alone (RR = 3.97 vs. joint RR = 3.67 for neonatal mortality; RR = 3.57 vs. joint RR = 3.25 for infant mortality; RR = 6.44 vs. joint RR = 3.75 for under-five mortality). CONCLUSIONS The findings suggest that children born to HIV-positive women with disabilities are at an exceptionally high risk of premature mortality. Established inequalities faced by women with disabilities may account for this increased risk. Given that maternal HIV and disability amplify each other's impact on child mortality, addressing disabled women's HIV-related needs and understanding the pathways and mechanisms contributing to these disparities is crucial.
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Affiliation(s)
- Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
| | - Hussaini Zandam
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
| | - Allyala Nandakumar
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
| | - Nora Groce
- UCL International Disability Research Centre, University College London, London, United Kingdom
| | | | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
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Alobo G, Ochola E, Bayo P, Muhereza A, Nahurira V, Byamugisha J. Why women die after reaching the hospital: a qualitative critical incident analysis of the 'third delay' in postconflict northern Uganda. BMJ Open 2021; 11:e042909. [PMID: 33753439 PMCID: PMC7986759 DOI: 10.1136/bmjopen-2020-042909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting. DESIGN This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants. SETTING Thirteen primary healthcare centres, one general private-not-for-profit hospital, one regional referral hospital and one teaching hospital in northern Uganda. PARTICIPANTS Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling. RESULTS After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and-forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional. CONCLUSION Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility's emergency readiness and thus improve maternal and neonatal outcomes.
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Affiliation(s)
- Gasthony Alobo
- Obstetrics and Gynecology, Lira University, Lira, Uganda
- Obstetrics and Gynecology, St Mary's Hospital Lacor, Gulu, Uganda
| | - Emmanuel Ochola
- Public Health, St Mary's Hospital Lacor, Gulu, Uganda
- Public Health, Gulu University Faculty of Medicine, Gulu, Uganda
| | - Pontius Bayo
- Obstetrics and Gynecology, Torit State Hospital, Torit, South Sudan
| | - Alex Muhereza
- Maternal and Newborn Care, RHITES - North Acholi, Gulu, Uganda
| | | | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
- Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
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Houle B, Kabudula CW, Stein A, Gareta D, Herbst K, Clark SJ. Linking the timing of a mother's and child's death: Comparative evidence from two rural South African population-based surveillance studies, 2000-2015. PLoS One 2021; 16:e0246671. [PMID: 33556118 PMCID: PMC7869981 DOI: 10.1371/journal.pone.0246671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effect of the period before a mother's death on child survival has been assessed in only a few studies. We conducted a comparative investigation of the effect of the timing of a mother's death on child survival up to age five years in rural South Africa. METHODS We used discrete time survival analysis on data from two HIV-endemic population surveillance sites (2000-2015) to estimate a child's risk of dying before and after their mother's death. We tested if this relationship varied between sites and by availability of antiretroviral therapy (ART). We assessed if related adults in the household altered the effect of a mother's death on child survival. FINDINGS 3,618 children died from 2000-2015. The probability of a child dying began to increase in the 7-11 months prior to the mother's death and increased markedly in the 3 months before (2000-2003 relative risk = 22.2, 95% CI = 14.2-34.6) and 3 months following her death (2000-2003 RR = 20.1; CI = 10.3-39.4). This increased risk pattern was evident at both sites. The pattern attenuated with ART availability but remained even with availability at both sites. The father and maternal grandmother in the household lowered children's mortality risk independent of the association between timing of mother and child mortality. CONCLUSIONS The persistence of elevated mortality risk both before and after the mother's death for children of different ages suggests that absence of maternal care and abrupt breastfeeding cessation might be crucial risk factors. Formative research is needed to understand the circumstances for children when a mother is very ill or dies, and behavioral and other risk factors that increase both the mother and child's risk of dying. Identifying families when a mother is very ill and implementing training and support strategies for other members of the household are urgently needed to reduce preventable child mortality.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
| | - Chodziwadziwa W. Kabudula
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Samuel J. Clark
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- Department of Sociology, The Ohio State University, Columbus, Ohio, United States of America
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Breastfeeding Support Offered at Delivery is Associated with Higher Prevalence of Exclusive Breastfeeding at 6 Weeks Postpartum Among HIV Exposed Infants: A Cross-Sectional Analysis. Matern Child Health J 2020; 23:1308-1316. [PMID: 31214949 DOI: 10.1007/s10995-019-02760-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective HIV-exposed uninfected infants are almost twice as likely to die compared to infants born to HIV-uninfected women. HIV-exposed uninfected children whose mothers are on ART and who are breastfed have the lowest risk of dying by 24 months of age. Interventions to improve breastfeeding among HIV-infected mothers are needed. We aimed to assess the association between support/counseling provided by healthcare workers following delivery and the rate of exclusive breastfeeding (EBF) at 6-week postpartum. Methods This is a secondary analysis of data collected as part of a trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services. Between April 2013 and August 2014, newly diagnosed HIV-infected women, ≤ 32 weeks pregnant, registering for antenatal care (ANC), in 89 clinics in Kinshasa, Democratic Republic of Congo, were recruited and followed through 6 weeks postpartum. At 6-week, participants were asked if they had given anything other than breastmilk to their infant in the 24 h preceding the interview (No = EBF) and whether a nurse or a doctor talked to them about breastfeeding after they gave birth (YES = received breastfeeding support/counseling). Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) measuring the strength of the association between EBF and receiving breastfeeding support/counseling by a healthcare provider following delivery. Results Of 433 women enrolled, 328 attended a 6-week postpartum visit including 320 (97%) with complete information on EBF. Of those 320, 202 (63%) reported giving nothing other than breastmilk to their infant in the previous 24 h; 252 (79%) reported that a healthcare provider came to talk to them about breastfeeding following delivery. Mothers who reported receiveing breastfeeding support/counseling from a healthcare provider were more likely to exclusively breastfeed compared to those who did not (69% vs. 38%, OR 3.74; 95% CI 2.14-6.54). Adjustment for baseline sociodemographic characteristics did not change the association substantially, (adjusted OR 3.72; 95% CI 2.06-6.71). Conclusion for Practice Receipt of breastfeeding support/counseling from a healthcare provider after delivery among HIV-infected mothers in care at 6-weeks postpartum in Kinshasa almost quadrupled the odds of EBF.
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Abraha A, Myléus A, Byass P, Kahsay A, Kinsman J. The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study. AIDS Care 2019; 31:1271-1281. [PMID: 30957540 DOI: 10.1080/09540121.2019.1601670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.
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Affiliation(s)
- Atakelti Abraha
- a Tigray Health Bureau , Tigray , Ethiopia.,b Ethiopian Health Insurance Agency , Addis Ababa , Ethiopia
| | - Anna Myléus
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Peter Byass
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden.,d Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen , Aberdeen , UK.,e MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
| | | | - John Kinsman
- c Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden.,g Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet , Stockholm , Sweden
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Infectious Morbidity, Mortality and Nutrition in HIV-exposed, Uninfected, Formula-fed Infants: Results From the HPTN 040/PACTG 1043 Trial. Pediatr Infect Dis J 2018; 37:1271-1278. [PMID: 29750766 PMCID: PMC6226320 DOI: 10.1097/inf.0000000000002082] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-exposed uninfected (HEU) infants are a growing population with potentially poor health outcomes. We evaluated morbidity and mortality in HEU formula-fed infants enrolled in the NICHD HPTN 040/PACTG 1043 trial. METHODS Infectious morbidity, mortality and undernutrition were evaluated within a cohort of 1000 HEU infants enrolled between April 2004 and April 2010 in Brazil (n = 766) and South Africa (n = 234) as part of the NICHD/HPTN 040 trial of 3 different antiretroviral regimens to decrease intrapartum HIV vertical transmission. RESULTS Twenty-three percent of infants had at least 1 infectious serious adverse effect. Infants born to mothers with <12 years of education [adjusted odds ratio (AOR), 2.6; 95% confidence interval [CI], 1.2-5.9), with maternal viral load of >1,000,000 copies/mL at delivery (AOR, 9.9; 95% CI, 1.6-63.1) were more likely to have infectious serious adverse effects. At 6 months, the infant mortality rate per 1000 live births overall was 22 ± 2.6, 9.1 ± 1.8 in Brazil and 64.1 ± 3 in South Africa. Undernutrition and stunting peaked at 1 month of age with 18% having a weight-for-age Z score ≤-2, and 22% with height for Z score ≤-2. The likelihood of infant mortality was greater among infants born in South Africa compared with Brazil (AOR, 6.2; 95% CI, 2.5-15.8), high maternal viral load (AOR, 1.7; 95% CI, 1.01-2.9) and birth weight-for-age Z score ≤-2 (AOR, 5.2; 95% CI, 1.8-14.8). CONCLUSIONS There were high rates of undernutrition, stunting and infectious serious adverse effect in this study's formula-fed HEU population. Suppressing maternal HIV viral load during the peripartum period may be a modifiable risk factor to decrease infant mortality.
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Breastfeeding mitigates the effects of maternal HIV on infant infectious morbidity in the Option B+ era. AIDS 2018; 32:2383-2391. [PMID: 30134300 DOI: 10.1097/qad.0000000000001974] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The effects of in-utero HIV-exposure on infectious morbidity and mortality in settings with universal maternal treatment and high breastfeeding rates are unclear. Further, the benefits of exclusive feeding options have not been assessed in the Option B+ era. We investigated these in two African settings with high breastfeeding uptake and good HIV treatment infrastructure during the first year of life. METHODS Cox regression with time-changing variables in a birth cohort of 749 HIV-exposed uninfected and HIV-unexposed uninfected infants from Cape Town, South Africa and Jos, Nigeria. RESULTS There was no difference in infectious morbidity incidence between HIV-exposed uninfected and HIV-unexposed uninfected infants (hazard ratio 1.01; 95% CI 0.78-1.32) after adjusting for confounding variables. Formula-fed infants had significantly higher infectious morbidity incidence when compared with exclusively breastfed infants (hazard ratio 1.64; 95% CI 1.03-2.63) and mixed-breastfed infants (hazard ratio 1.42; 95% CI 1.00-2.02) after adjusting for potential confounding variables. There was no significant difference in mortality among HIV-exposed infants and HIV-unexposed infants during the first year of life in this cohort (2.04 versus 0.94%, P = 0.38). Notably, exclusive breastfeeding for only 4 months had protective effects on morbidity up to 1 year. CONCLUSION In settings with universal antiretroviral coverage and high breastfeeding rates, breastfeeding mitigates the effects of in-utero HIV exposure among infants during the first year of life. These findings support previous recommendations for exclusive breastfeeding among HIV-infected women and highlight the role that breastfeeding plays on the health of infants in settings where exclusive breastfeeding is not always feasible or where replacement feeding is recommended.
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Gaydosh L. Beyond Orphanhood: Parental Nonresidence and Child Well-being in Tanzania. JOURNAL OF MARRIAGE AND THE FAMILY 2017; 79:1369-1387. [PMID: 29033464 PMCID: PMC5635828 DOI: 10.1111/jomf.12422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/11/2017] [Indexed: 05/17/2023]
Abstract
This article used data from the Rufiji Health and Demographic Surveillance System in Tanzania to examine the influence of parental non-residence on child survival and school entry. Using survival analysis methods, the article tested variations by parent and by cause, examining parental death, non-residence due to parental relationship status, and migration. In general, maternal non-residence was more consequential for child survival, while paternal non-residence influences school entry. This is consistent with gendered parenting patterns in the setting. There was important variation by cause and by outcome, particularly for paternal non-residence. Paternal non-residence due to non-marital birth was associated with increased risk of child death, while paternal migration was associated with improved survival. Paternal death and migration were associated with lower odds of school entry. This article moves beyond orphanhood to consider multiple causes of parental non-residence simultaneously, demonstrating that parental non-residence is not uniformly deleterious for children.
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Affiliation(s)
- Lauren Gaydosh
- Carolina Population Center, University of North Carolina at Chapel Hill, Campus Box 8120, Chapel Hill, NC 27599, T: 919-962-6144, F: 919-445-0740,
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12
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Goldberg RE, Short SE. What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature. AIDS Care 2017; 28 Suppl 2:130-41. [PMID: 27392008 PMCID: PMC4991228 DOI: 10.1080/09540121.2016.1176684] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long-term effects of adult HIV on children's needs and circumstances will be important to ongoing discussions about equity in policies and interventions.
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Affiliation(s)
- Rachel E Goldberg
- a Department of Sociology , University of California Irvine , Irvine , CA , USA
| | - Susan E Short
- b Department of Sociology and Population Studies and Training Center , Brown University , Providence , RI , USA
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Scott S, Kendall L, Gomez P, Howie SRC, Zaman SMA, Ceesay S, D’Alessandro U, Jasseh M. Effect of maternal death on child survival in rural West Africa: 25 years of prospective surveillance data in The Gambia. PLoS One 2017; 12:e0172286. [PMID: 28225798 PMCID: PMC5321282 DOI: 10.1371/journal.pone.0172286] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/02/2017] [Indexed: 12/04/2022] Open
Abstract
Background The death of a mother is a tragedy in itself but it can also have devastating effects for the survival of her children. We aim to explore the impact of a mother’s death on child survival in rural Gambia, West Africa. Methods We used 25 years of prospective surveillance data from the Farafenni Health and Demographic surveillance system (FHDSS). Mortality rates per 1,000 child-years up to ten years of age were estimated and Kaplan-Meier survival curves plotted by maternal vital status. Cox proportional hazard models were used to examine factors associated with child survival. Findings Between 1st April 1989 and 31st December 2014, a total of 2, 221 (7.8%) deaths occurred during 152,906 child-years of follow up. Overall mortality rate was 14.53 per 1,000 child-years (95% CI: 13.93–15.14). Amongst those whose mother died, the rate was 25.89 (95% CI: 17.99–37.25) compared to 14.44 (95% CI: 13.84–15.06) per 1,000 child-years for those whose mother did not die. Children were 4.66 (95% CI: 3.15–6.89) times more likely to die if their mother died compared to those with a surviving mother. Infants whose mothers died during delivery or shortly after were up to 7 times more likely to die within the first month of life compared to those whose mothers survived. Maternal vital status was significantly associated with the risk of dying within the first 2 years of life (p-value <0.05), while this was no longer observed for children over 2 years of age (P = 0.872). Other factors associated with an increased risk of dying were living in more rural areas, and birth spacing and year of birth. Conclusions Mother’s survival is strongly associated with child survival. Our findings highlight the importance of the continuum of care for both the mother and child not only throughout pregnancy, and childbirth but beyond 6 weeks post-partum.
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Affiliation(s)
- Susana Scott
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Lindsay Kendall
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Pierre Gomez
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Stephen R. C. Howie
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Syed M. A. Zaman
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samba Ceesay
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Umberto D’Alessandro
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Momodou Jasseh
- Medical Research Council, The Gambia Unit, Fajara, The Gambia
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Pérez-Moreno S, Blanco-Arana MC, Bárcena-Martín E. Economic cycles and child mortality: A cross-national study of the least developed countries. ECONOMICS AND HUMAN BIOLOGY 2016; 22:14-23. [PMID: 26998938 DOI: 10.1016/j.ehb.2016.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
This paper examines the effects of growth and recession periods on child mortality in the Least Developed Countries (LDCs) during the period 1990-2010. We provide empirical evidence of uneven effects of variations in Gross Domestic Product (GDP) per capita on the evolution of child mortality rate in periods of economic recession and expansion. A decrease in GDP per capita entails a significant rise in child mortality rates, whereas an increase does not affect child mortality significantly. In this context, official development assistance seems to play a crucial role in counteracting the increment in child mortality rates in recession periods, at least in those LDCs receiving greater aid.
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Affiliation(s)
- Salvador Pérez-Moreno
- Department of Applied Economics (Economic Policy), University of Malaga, Campus El Ejido, E-29071 Malaga, Spain.
| | - María C Blanco-Arana
- PhD candidate, PhD Program in Economics and Business, University of Malaga, Campus El Ejido, E-29071 Malaga, Spain.
| | - Elena Bárcena-Martín
- Department of Applied Economics (Statistics and Econometrics), University of Malaga, Campus El Ejido, E-29071 Malaga, Spain.
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Ásbjörnsdóttir KH, Slyker JA, Maleche-Obimbo E, Wamalwa D, Otieno P, Gichuhi CM, John-Stewart G. Breastfeeding Is Associated with Decreased Risk of Hospitalization among HIV-Exposed, Uninfected Kenyan Infants. J Hum Lact 2016; 32:NP61-6. [PMID: 26423513 PMCID: PMC4814344 DOI: 10.1177/0890334415607854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/26/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance. OBJECTIVES We sought to describe the burden and identify predictors of hospitalization among HEU infants in the first year of life. METHODS Using a retrospective cohort of HIV-infected mothers and their HEU infants in Nairobi, Kenya, we identified infants who were HIV-uninfected at birth and were followed monthly until their last negative HIV test, death, loss to follow-up, or study exit at 1 year of age. Incidence, timing, and reason for hospitalization was assessed overall as well as stratified by feeding method. Predictors of first infectious disease hospitalization were identified using competing risk regression, with HIV acquisition and death as competing risks. RESULTS Among 388 infants, 113 hospitalizations were reported (35/100 infant-years [the combined years of observation contributed by all infants in the study]; 95% confidence interval [CI], 29-42). Ninety hospitalizations were due to 1 or more infectious diseases (26/100 infant-years; 95% CI, 21-32)-primarily pneumonia (n = 40), gastroenteritis (n = 17), and sepsis (n = 14). Breastfeeding was associated with decreased risk of infectious disease hospitalization (subhazard ratio = 0.39; 95% CI, 0.24-0.64), as was time-updated nutrition status (subhazard ratio = 0.73; 95% CI, 0.61-0.89). Incidence of infectious disease hospitalization among formula-fed infants was 51/100 infant-years (95% CI, 37-70) compared to 19/100 infant-years (95% CI, 14-25) among breastfed infants. CONCLUSION Among HEU infants, breastfeeding and nutrition status were associated with reduced hospitalization during the first year of life.
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Affiliation(s)
| | - Jennifer A Slyker
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Dalton Wamalwa
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Christine M Gichuhi
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA
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16
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The Effects of Maternal Mortality on Infant and Child Survival in Rural Tanzania: A Cohort Study. Matern Child Health J 2016; 19:2393-402. [PMID: 26100131 DOI: 10.1007/s10995-015-1758-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The full impact of a maternal death includes consequences faced by orphaned children. This analysis adds evidence to a literature on the magnitude of the association between a woman's death during or shortly after childbirth, and survival outcomes for her children. METHODS The Ifakara and Rufiji Health and Demographic Surveillance Sites in rural Tanzania conduct longitudinal, frequent data collection of key demographic events at the household level. Using a subset of the data from these sites (1996-2012), this survival analysis compared outcomes for children who experienced a maternal death (42 and 365 days definitions) during or near birth to those children whose mothers survived. RESULTS There were 111 maternal deaths (or 229 late maternal deaths) during the study period, and 46.28 % of the index children also subsequently died (40.73 % of children in the late maternal death group) before their tenth birthday-a much higher prevalence of child mortality than in the population of children whose mothers survived (7.88 %, p value <0.001). Children orphaned by early maternal deaths had a 51.54 % chance of surviving to their first birthday, compared to a 94.42 % probability for children of surviving mothers. A significant, but lesser, child survival effect was also found for paternal deaths in this study period. CONCLUSIONS The death of a mother compromises the survival of index children. Reducing maternal mortality through improved health care-especially provision of high-quality skilled birth attendance, emergency obstetric services and neonatal care-will also help save children's lives.
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17
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Arunda MO, Choudhry V, Ekman B, Asamoah BO. Under-five mortality and maternal HIV status in Tanzania: analysis of trends between 2003 and 2012 using AIDS Indicator Survey data. Glob Health Action 2016; 9:31676. [PMID: 27329937 PMCID: PMC4916291 DOI: 10.3402/gha.v9.31676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/04/2016] [Accepted: 05/24/2016] [Indexed: 12/25/2022] Open
Abstract
Background Mortality among children under five remains a significant health challenge across sub-Saharan Africa. HIV/AIDS is one of the leading contributors to the relatively slow decline in under-five mortality in this region. In Tanzania, HIV prevalence among under-five children is high and 90% of all infections are due to mother-to-child transmission. Objectives The study aimed to examine the association between maternal HIV-positive status and under-five mortality in Tanzania. It also aimed to estimate the proportions and trends of under-five mortality attributable to maternal HIV/AIDS in Tanzania between 2003 and 2012. Design Binomial logistic regression was used to analyze cross-sectional survey data from the Tanzania AIDS Indicator Surveys to examine the association between maternal HIV positivity and under-five mortality between 2003 and 2012. Results After controlling for confounders, the adjusted odds ratios were 1.5 (95% CI 1.1–1.9) in 2003–2004, 4.6 (95% CI 2.7–7.8) in 2007–2008, and 2.4 (95% CI 1.2–4.6) in 2011–2012. The maternal HIV-attributable mortality risk percent of under-five children was 3.7 percent in 2003–2004, 11.3 percent in 2007–2008 and 5.6% in 2011–2012. Conclusion Maternal HIV positivity is associated with under-five mortality in Tanzania, making maternal HIV serostatus a relevant determinant of whether a child will survive up to five years of age or not. The impact of maternal HIV/AIDS attributable mortality risk has a significant contribution to the overall under-five mortality in Tanzania. The continued monitoring of HIV and mortality trends is important for policy development and design of interventions.
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Affiliation(s)
- Malachi Ochieng Arunda
- International Master Programme in Public Health, Faculty of Medicine, Lund University, CRC, Jan Waldenströms gata 35, 205 02 Malmö, Sweden;
| | - Vikas Choudhry
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden
| | - Björn Ekman
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Sweden
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18
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Arikawa S, Rollins N, Newell M, Becquet R. Mortality risk and associated factors in HIV-exposed, uninfected children. Trop Med Int Health 2016; 21:720-34. [PMID: 27091659 PMCID: PMC5021152 DOI: 10.1111/tmi.12695] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE With increasing maternal antiretroviral treatment (ART), the number of children newly infected with HIV has declined. However, the possible increased mortality in the large number of HIV-exposed, uninfected (HEU) children may be of concern. We quantified mortality risks among HEU children and reviewed associated factors. METHODS Systematic search of electronic databases (PubMed, Scopus). We included all studies reporting mortality of HEU children to age 60 months and associated factors. Relative risk of mortality between HEU and HIV-unexposed, uninfected (HUU) children was extracted where relevant. Inverse variance methods were used to adjust for study size. Random-effects models were fitted to obtain pooled estimates. RESULTS A total of 14 studies were included in the meta-analysis and 13 in the review of associated factors. The pooled cumulative mortality in HEU children was 5.5% (95% CI: 4.0-7.2; I(2) = 94%) at 12 months (11 studies) and 11.0% (95% CI: 7.6-15.0; I(2) = 93%) at 24 months (four studies). The pooled risk ratios for the mortality in HEU children compared to HUU children in the same setting were 1.9 (95% CI: 0.9-3.8; I(2) = 93%) at 12 months (four studies) and 2.4 (95% CI: 1.1-5.1; I(2) = 93%) at 24 months (three studies). CONCLUSION Compared to HUU children, mortality risk in HEU children was about double at both age points, although the association was not statistically significant at 12 months. Interpretation of the pooled estimates is confounded by considerable heterogeneity between studies. Further research is needed to characterise the impact of maternal death and breastfeeding on the survival of HEU infants in the context of maternal ART, where current evidence is limited.
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Affiliation(s)
- Shino Arikawa
- Inserm U1219, Bordeaux Population Health Research CentreBordeaux UniversityBordeauxFrance
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent HealthWorld Health OrganizationGenevaSwitzerland
| | - Marie‐Louise Newell
- Human Health and DevelopmentFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Renaud Becquet
- Inserm U1219, Bordeaux Population Health Research CentreBordeaux UniversityBordeauxFrance
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Reniers G, Wamukoya M, Urassa M, Nyaguara A, Nakiyingi-Miiro J, Lutalo T, Hosegood V, Gregson S, Gómez-Olivé X, Geubbels E, Crampin AC, Wringe A, Waswa L, Tollman S, Todd J, Slaymaker E, Serwadda D, Price A, Oti S, Nyirenda MJ, Nabukalu D, Nyamukapa C, Nalugoda F, Mugurungi O, Mtenga B, Mills L, Michael D, McLean E, McGrath N, Martin E, Marston M, Maquins S, Levira F, Kyobutungi C, Kwaro D, Kasamba I, Kanjala C, Kahn K, Kabudula C, Herbst K, Gareta D, Eaton JW, Clark SJ, Church K, Chihana M, Calvert C, Beguy D, Asiki G, Amri S, Abdul R, Zaba B. Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network). Int J Epidemiol 2016; 45:83-93. [PMID: 26968480 DOI: 10.1093/ije/dyv343] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Georges Reniers
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa,
| | | | - Mark Urassa
- Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania
| | - Amek Nyaguara
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda
| | - Vicky Hosegood
- Africa Centre for Population Health, Mtubatuba, South Africa, Department of Social Statistics and Demography, Southampton University, Southampton, UK
| | - Simon Gregson
- Manicaland Centre for Public Health Research, Harare, Zimbabwe, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Xavier Gómez-Olivé
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Amelia C Crampin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laban Waswa
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Stephen Tollman
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umea° University, Umea°, Sweden
| | - Jim Todd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Slaymaker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Serwadda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda, School of Public Health, Makerere University, Kampala, Uganda
| | - Alison Price
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Samuel Oti
- African Population and Health Research Center, Nairobi, Kenya
| | - Moffat J Nyirenda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Dorean Nabukalu
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda
| | - Constance Nyamukapa
- Manicaland Centre for Public Health Research, Harare, Zimbabwe, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Fred Nalugoda
- Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda
| | - Owen Mugurungi
- Manicaland Centre for Public Health Research, Harare, Zimbabwe, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Baltazar Mtenga
- Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania
| | - Lisa Mills
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya, Division of HIV/AIDS Prevention, CDC, Atlanta GA, USA and
| | - Denna Michael
- Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania
| | - Estelle McLean
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Nuala McGrath
- Africa Centre for Population Health, Mtubatuba, South Africa, Department of Social Statistics and Demography, Southampton University, Southampton, UK
| | - Emmanuel Martin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Milly Marston
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sewe Maquins
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya
| | | | | | - Daniel Kwaro
- Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya
| | - Ivan Kasamba
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Chifundo Kanjala
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umea° University, Umea°, Sweden
| | - Chodziwadziwa Kabudula
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Centre for Population Health, Mtubatuba, South Africa
| | - Dickman Gareta
- Africa Centre for Population Health, Mtubatuba, South Africa
| | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Samuel J Clark
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Department of Sociology, University of Washington, Seattle WA, USA
| | - Kathryn Church
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Menard Chihana
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donatien Beguy
- African Population and Health Research Center, Nairobi, Kenya
| | - Gershim Asiki
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Shamte Amri
- Ifakara Health Institute, Dar-Es-Salaam, Tanzania
| | | | - Basia Zaba
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Children Living with HIV-Infected Adults: Estimates for 23 Countries in sub-Saharan Africa. PLoS One 2015; 10:e0142580. [PMID: 26575484 PMCID: PMC4648531 DOI: 10.1371/journal.pone.0142580] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/24/2015] [Indexed: 02/07/2023] Open
Abstract
Background In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children’s health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children’s health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children. Methods Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households. Results The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent. Conclusion Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children.
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Kishamawe C, Isingo R, Mtenga B, Zaba B, Todd J, Clark B, Changalucha J, Urassa M. Health & Demographic Surveillance System Profile: The Magu Health and Demographic Surveillance System (Magu HDSS). Int J Epidemiol 2015; 44:1851-61. [PMID: 26403815 PMCID: PMC4911678 DOI: 10.1093/ije/dyv188] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/25/2022] Open
Abstract
The Magu Health and Demographic Surveillance System (Magu HDSS) is part of Kisesa OpenCohort HIV Study located in a rural area of North-Western Tanzania. Since its establishment in 1994, information on pregnancies, births, marriages, migrations and deaths have been monitored and updated between one and three times a year by trained fieldworkers. Other research activities implemented in the cohort include: sero surveys which have been conducted every 2–3 years to collect socioeconomic data, HIV sero status and health knowledge attitude and behaviour in adults aged 15 years or more living in the area; verbal autopsy (VA) interviews conducted to establish cause of death in all deaths encountered in the area; Llnking data collected at health facilities to community-based data; monitoring voluntary counselling and testing (VCT); and assessing uptake of antiretroviral treatment (ART). In addition, within the community, qualitative studies have been conducted to address issues linked to HIV stigma, the perception of ART access and adherence. In 2014, the population was over 35 000 individuals. Magu HDSS has contributed to Tanzanian estimates of fertility and mortality, and is a member of the INDEPTH network. Demographic data for Magu HDSS are available via the INDEPTH Network’s Sharing and Accessing Repository (iSHARE) and applications to access HDSS data for collaborative analysis are encouraged.
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Affiliation(s)
- Coleman Kishamawe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania and
| | - Raphael Isingo
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania and
| | - Baltazar Mtenga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania and
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Clark
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - John Changalucha
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania and
| | - Mark Urassa
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania and
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Thorne C, Idele P, Chamla D, Romano S, Luo C, Newell ML. Morbidity and mortality in HIV-exposed uninfected children. Future Virol 2015. [DOI: 10.2217/fvl.15.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Approximately 1.5 million HIV-positive women become pregnant annually. Antiretroviral therapy (ART) is central to prevention of mother-to-child transmission and maternal ART continued postpartum allows breastfeeding for at least 1 year of life, with important benefits for the child. In the pre-ART era, it was suggested that HIV-exposed uninfected (HEU) children may be at higher morbidity and mortality risk than children of HIV-negative mothers, associated with maternal illness and death and the lack, or limited duration, of breastfeeding as recommended for preventing mother-to-child transmission at that time. This review summarizes the evidence on morbidity and mortality risk in HEU children compared with HIV-unexposed children, and assesses the likely impact of roll-out of ART, which prolongs maternal survival and allows breastfeeding.
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Affiliation(s)
- Claire Thorne
- Population, Policy & Practice Programme, UCL Institute of Child Health, University College London, London, WC1E 6BT, UK
| | - Priscilla Idele
- Data & Analytics Section, UNICEF New York, New York, NY, USA
| | - Dick Chamla
- Health Section, UNICEF New York, New York, NY, USA
| | | | - Chewe Luo
- HIV/AIDS Section, UNICEF New York, New York, NY, USA
| | - Marie-Louise Newell
- Faculty of Medicine/Faculty of Social & Human Sciences, University of Southampton, Southampton, SO17 1BJ, UK
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Adams JW, Brady KA, Michael YL, Yehia BR, Momplaisir FM. Postpartum Engagement in HIV Care: An Important Predictor of Long-term Retention in Care and Viral Suppression. Clin Infect Dis 2015; 61:1880-7. [DOI: 10.1093/cid/civ678] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/28/2015] [Indexed: 01/21/2023] Open
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Momplaisir FM, Brady KA, Fekete T, Thompson DR, Diez Roux A, Yehia BR. Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV. PLoS One 2015; 10:e0132262. [PMID: 26132142 PMCID: PMC4489492 DOI: 10.1371/journal.pone.0132262] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/11/2015] [Indexed: 11/23/2022] Open
Abstract
Background HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required. Methodology We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery. Results Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care. Conclusions Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.
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Affiliation(s)
- Florence M. Momplaisir
- Division of Infectious Diseases and HIV Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Kathleen A. Brady
- AIDS Activities and Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Thomas Fekete
- Division of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania, United States of America
| | - Dana R. Thompson
- Center for Women’s and Children’s Health Research, Christiana Care Health System, Greenville, Delaware, United States of America
| | - Ana Diez Roux
- Drexel University School of Public Health, Philadelphia, Pennsylvania, United States of America
| | - Baligh R. Yehia
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Houle B, Clark SJ, Kahn K, Tollman S, Yamin AE. The impacts of maternal mortality and cause of death on children's risk of dying in rural South Africa: evidence from a population based surveillance study (1992-2013). Reprod Health 2015; 12 Suppl 1:S7. [PMID: 26000547 PMCID: PMC4423728 DOI: 10.1186/1742-4755-12-s1-s7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Maternal mortality, the HIV/AIDS pandemic, and child survival are closely linked. This study contributes evidence on the impact of maternal death on children's risk of dying in an HIV-endemic population in rural South Africa. METHODS We used data for children younger than 10 years from the Agincourt health and socio-demographic surveillance system (1992 - 2013). We used discrete time event history analysis to estimate children's risk of dying when they experienced a maternal death compared to children whose mother survived (N=3,740,992 child months). We also examined variation in risk due to cause of maternal death. We defined mother's survival status as early maternal death (during pregnancy, childbirth, or within 42 days of most recent childbirth or identified cause of death), late maternal death (within 43-365 days of most recent childbirth), any other death, and mothers who survived. RESULTS Children who experienced an early maternal death were at 15 times the risk of dying (RRR 15.2; 95% CI 8.3-27.9) compared to children whose mother survived. Children under 1 month whose mother died an early (p=0.002) maternal death were at increased risk of dying compared to older children. Children whose mothers died of an HIV/AIDS or TB-related early maternal death were at 29 times the risk of dying compared to children with surviving mothers (RRR 29.2; 95% CI 11.7-73.1). The risk of these children dying was significantly higher than those children whose mother died of a HIV/AIDS or TB-related non-maternal death (p=0.017). CONCLUSIONS This study contributes further evidence on the impact of a mother's death on child survival in a poor, rural setting with high HIV prevalence. The intersecting epidemics of maternal mortality and HIV/AIDS - especially in sub-Saharan Africa - have profound implications for maternal and child health and well-being. Such evidence can help guide public and primary health care practice and interventions.
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Affiliation(s)
- Brian Houle
- Australian Demographic and Social Research Institute, The Australian National University, Canberra, Australia
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel J Clark
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, University of Washington, Seattle, Washington, USA
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Alicia Ely Yamin
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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Chihana ML, Price A, Floyd S, Mboma S, Mvula H, Branson K, Saul J, Zaba B, French N, Crampin AC, Glynn JR. Maternal HIV status associated with under-five mortality in rural Northern Malawi: a prospective cohort study. J Acquir Immune Defic Syndr 2015; 68:81-90. [PMID: 25321177 PMCID: PMC4338582 DOI: 10.1097/qai.0000000000000405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Under-five mortality is decreasing but with little change in neonatal mortality rates. We examined the effect of maternal HIV status on under-five mortality and cause of death since widespread availability of antiretroviral therapy in rural Malawi. METHODS Children born in 2006-2011 in the Karonga demographic surveillance area were included. Maternal HIV status was available from HIV serosurveys. Age-specific mortality rate ratios for children born to HIV-positive and HIV-negative mothers were obtained by fitting a Poisson model accounting for child clustering by mother and adjusting for potential confounders. Cause of death was ascertained by verbal autopsy. FINDINGS There were 352 deaths among 6913 under-five singleton children followed for 20,754 person-years (py), giving a mortality rate of 17.0/1000 py overall, 218/1000 py (16.5/1000 live births) in neonates, 20/1000 py (17.4/1000 live births) in postneonatal infants, and 8/1000 py in 1-4 years old. Comparing those born to HIV-positive and HIV-negative mothers, the rate ratio adjusted for child age, sex, maternal age, parity, and drinking water source was 1.5 (95% confidence interval [CI]: 0.6 to 3.7) in neonates, 11.5 (95% CI: 7.2 to 18.5) in postneonatal infants, and 4.6 (95% CI: 2.7 to 7.9) in 1-4 years old. Birth injury/asphyxia, neonatal sepsis, and prematurity contributed >70% of neonatal deaths, whereas acute infections, malaria, diarrhea, and pneumonia accounted for most deaths in older children. CONCLUSIONS Maternal HIV status had little effect on neonatal mortality but was associated with much higher mortality in the postneonatal period and among older children. Greater attention to HIV care in pregnant women and mothers should help improve child survival, but broader interventions are needed to reduce neonatal mortality.
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Affiliation(s)
- Menard L Chihana
- *Karonga Prevention Study, Karonga, Malawi; †London School of Hygiene and Tropical Medicine, Faculty of Infectious Disease Epidemiology, London, United Kingdom; and ‡University of Liverpool, Institute of Infection and Global Health, Department of Clinical Infection, Microbiology and Immunology, Liverpool, United Kingdom
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Individualizing the WHO HIV and infant feeding guidelines: optimal breastfeeding duration to maximize infant HIV-free survival. AIDS 2014; 28 Suppl 3:S287-99. [PMID: 24991902 DOI: 10.1097/qad.0000000000000337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine how infant feeding recommendations can maximize HIV-free survival (HFS) among HIV-exposed, uninfected African infants, balancing risks of breast milk-associated HIV infection with setting-specific risks of illness and death associated with replacement feeding. DESIGN Validated mathematical model of HIV-exposed, uninfected infants, with published data from Africa. METHODS We projected 24-month HFS using combinations of: maternal CD4, antiretroviral drug availability, and relative risk of mortality among replacement-fed compared to breastfed infants ('RR-RF', range 1.0-6.0). For each combination, we identified the 'optimal' breastfeeding duration (0-24 months) maximizing HFS. We compared HFS under an 'individualized' approach, based on the above parameters, to the WHO 'public health approach' (12 months breastfeeding for all HIV-infected women). RESULTS Projected HFS was 65-93%. When the value of RR-RF is 1.0, replacement feeding from birth maximized HFS. At a commonly reported RR-RF value (2.0), optimal breastfeeding duration was 3-12 months, depending on maternal CD4 and antiretroviral drug availability. As the value of RR-RF increased, optimal breastfeeding duration increased. Compared to the public health approach, an individualized approach improved absolute HFS by less than 1% if RR-RF value was 2.0-4.0, by 3% if RR-RF value was 1.0 or 6.0, and by greater amounts if access to antiretroviral drugs was limited. CONCLUSION Tailoring breastfeeding duration to maternal CD4, antiretroviral drug availability, and local replacement feeding safety can optimize HFS among HIV-exposed infants. An individualized approach leads to moderate gains in HFS, but only when mortality risks from replacement feeding are very low or very high, or antiretroviral drug availability is limited. The WHO public health approach is beneficial in most resource-limited settings.
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Masquelier B, Reniers G, Pison G. Divergences in trends in child and adult mortality in sub-Saharan Africa: survey evidence on the survival of children and siblings. Population Studies 2013; 68:161-77. [PMID: 24303913 DOI: 10.1080/00324728.2013.856458] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper provides an overview of trends in mortality in children aged under 5 and adults between the ages of 15 and 60 in sub-Saharan Africa, using data on the survival of the children and siblings collected in Demographic and Health Surveys. If conspicuous stalls in the 1990s are disregarded, child mortality levels have generally declined and converged over the last 30-40 years. In contrast, adult mortality in many East and Southern African countries has increased markedly, echoing earlier increases in the incidence of HIV. In recent years, adult mortality levels have begun to decline once again in East Africa, in some instances before the large-scale expansion of antiretroviral therapy programmes. More surprising is the lack of sustained improvements in adult survival in some countries that have not experienced severe HIV epidemics. Because trends in child and adult mortality do not always evolve in tandem, we argue that model-based estimates, inferred by matching indices of child survival onto standard mortality schedules, can be very misleading.
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Clark S, Hamplová D. Single motherhood and child mortality in sub-Saharan Africa: a life course perspective. Demography 2013; 50:1521-49. [PMID: 23839100 DOI: 10.1007/s13524-013-0220-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Single motherhood in sub-Saharan Africa has received surprisingly little attention, although it is widespread and has critical implications for children's well-being. Using survival analysis techniques, we estimate the probability of becoming a single mother over women's life course and investigate the relationship between single motherhood and child mortality in 11 countries in sub-Saharan Africa. Although a mere 5 % of women in Ethiopia have a premarital birth, one in three women in Liberia will become mothers before first marriage. Compared with children whose parents were married, children born to never-married single mothers were significantly more likely to die before age 5 in six countries (odds ratios range from 1.36 in Nigeria to 2.61 in Zimbabwe). In addition, up to 50 % of women will become single mothers as a consequence of divorce or widowhood. In nine countries, having a formerly married mother was associated with a significantly higher risk of dying (odds ratios range from 1.29 in Zambia to 1.75 in Kenya) relative to having married parents. Children of divorced women typically had the poorest outcomes. These results highlight the vulnerability of children with single mothers and suggest that policies aimed at supporting single mothers could help to further reduce child mortality in sub-Saharan Africa.
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Affiliation(s)
- Shelley Clark
- Department of Sociology, McGill University, Stephen Leacock Building, Room 713, 855 Sherbrooke Street West, Montreal, Quebec, H3A 2T7, Canada,
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Houle B, Stein A, Kahn K, Madhavan S, Collinson M, Tollman SM, Clark SJ. Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status. Int J Epidemiol 2013; 42:1444-54. [PMID: 23912808 PMCID: PMC3807614 DOI: 10.1093/ije/dyt149] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children's risk of dying in rural South Africa. METHODS We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994-2008. Using discrete time event history analysis we estimate children's probability of dying by child characteristics and household composition (other children and adults other than parents) (N=924,818 child-months), and household socio-economic status (N=501,732 child-months). RESULTS Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1-5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2-3.6), 3-5 months (OR 3.0; 95% CI 1.5-5.9), and 2 months (OR 11.8; 95% CI 7.6-18.3) before another household child dies. The odds of dying remain high at the time of another child's death (OR 11.7; 95% CI 6.3-21.7) and for the 2 months following (OR 4.0; 95% CI 1.9-8.6). Having a related but non-parent adult aged 20-59 years in the household reduces the odds (OR 0.6; 95% CI 0.5-0.8). There is an inverse relationship between a child's odds of dying and household socio-economic status. CONCLUSIONS This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.
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Affiliation(s)
- Brian Houle
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
| | - Alan Stein
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
| | - Kathleen Kahn
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
| | - Sangeetha Madhavan
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
| | - Mark Collinson
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
| | - Stephen M Tollman
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
| | - Samuel J Clark
- Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK, Centre for Global Health Research, Umeå University, Umeå, Sweden, INDEPTH Network, Accra, Ghana, Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA and Department of Sociology, University of Washington, Seattle, WA, USA
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Ginsburg O. Breast and cervical cancer control in low and middle-income countries: Human rights meet sound health policy. J Cancer Policy 2013. [DOI: 10.1016/j.jcpo.2013.07.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Merdad L, Hill K, Graham W. Improving the measurement of maternal mortality: the sisterhood method revisited. PLoS One 2013; 8:e59834. [PMID: 23565171 PMCID: PMC3614991 DOI: 10.1371/journal.pone.0059834] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/21/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Over the past several decades the efforts to improve maternal survival and the consequent demand for accurate estimates of maternal mortality have increased. However, measuring maternal mortality remains a difficult task especially in developing countries with weak information systems. Sibling histories included in household surveys (most notably the Demographic and Health Surveys (DHS)) have emerged as an important source of maternal mortality data. Data have been mainly collected from women and have not been widely collected from men due to concerns about data quality. We assess data quality of histories obtained from men and the potential to improve the efficiency of surveys measuring maternal mortality by collecting such data. METHODS AND FINDINGS We used data from 10 Demographic and Health Surveys (DHS) that have included a full sibling history in both their women's and men's questionnaires. We estimated adult and maternal mortality indicators from histories obtained from men and women. We assessed the completeness and accuracy of these histories using several indicators of data quality. Our study finds that mortality estimates based on sibling histories obtained from men do not systematically or significantly differ from those obtained from women. Quality indicators were similar when comparing data from men and women. Pooling data obtained from men and women produced narrower confidence intervals. CONCLUSION From experience across nine developing countries, sibling history data obtained from men appear to be a reliable source of information on adult and maternal mortality. Given that there are no significant differences between mortality estimates based on data obtained from men and women, data can be pooled to increase efficiency. This finding improves the feasibility for countries to generate robust empirical estimates of adult and maternal mortality from surveys. Further we recommend that male sibling histories be collected from all sample households rather than from a subsample.
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Affiliation(s)
- Leena Merdad
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
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Ciaranello AL, Perez F, Engelsmann B, Walensky RP, Mushavi A, Rusibamayila A, Keatinge J, Park JE, Maruva M, Cerda R, Wood R, Dabis F, Freedberg KA. Cost-effectiveness of World Health Organization 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe. Clin Infect Dis 2013; 56:430-46. [PMID: 23204035 PMCID: PMC3540037 DOI: 10.1093/cid/cis858] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/17/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe. METHODS We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE. RESULTS Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother-infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother-infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother-infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B. CONCLUSIONS Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions.
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Affiliation(s)
- Andrea L Ciaranello
- Medical Practice Evaluation Center, Divisions of Infectious Disease, Massachusetts General Hospital, Boston, MA 02114, USA.
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Clark SJ, Kahn K, Houle B, Arteche A, Collinson MA, Tollman SM, Stein A. Young children's probability of dying before and after their mother's death: a rural South African population-based surveillance study. PLoS Med 2013; 10:e1001409. [PMID: 23555200 PMCID: PMC3608552 DOI: 10.1371/journal.pmed.1001409] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is evidence that a young child's risk of dying increases following the mother's death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother's death, as well as for several months after her death. Therefore we investigated the relationship between young children's likelihood of dying and the timing of their mother's death and, in particular, the existence of a critical period of increased risk. METHODS AND FINDINGS Data from a health and socio-demographic surveillance system in rural South Africa were collected on children 0-5 y of age from 1 January 1994 to 31 December 2008. Discrete time survival analysis was used to estimate children's probability of dying before and after their mother's death, accounting for moderators. 1,244 children (3% of sample) died from 1994 to 2008. The probability of child death began to rise 6-11 mo prior to the mother's death and increased markedly during the 2 mo immediately before the month of her death (odds ratio [OR] 7.1 [95% CI 3.9-12.7]), in the month of her death (OR 12.6 [6.2-25.3]), and during the 2 mo following her death (OR 7.0 [3.2-15.6]). This increase in the probability of dying was more pronounced for children whose mothers died of AIDS or tuberculosis compared to other causes of death, but the pattern remained for causes unrelated to AIDS/tuberculosis. Infants aged 0-6 mo at the time of their mother's death were nine times more likely to die than children aged 2-5 y. The limitations of the study included the lack of knowledge about precisely when a very ill mother will die, a lack of information about child nutrition and care, and the diagnosis of AIDS deaths by verbal autopsy rather than serostatus. CONCLUSIONS Young children in lower income settings are more likely to die not only after their mother's death but also in the months before, when she is seriously ill. Interventions are urgently needed to support families both when the mother becomes very ill and after her death. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Samuel J. Clark
- Department of Sociology, University of Washington, Seattle, Washington, United States of America
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Brian Houle
- Department of Sociology, University of Washington, Seattle, Washington, United States of America
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- * E-mail:
| | - Adriane Arteche
- The Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Mark A. Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Stephen M. Tollman
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Alan Stein
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- The Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Willführ KP, Gagnon A. Are stepparents always evil? Parental death, remarriage, and child survival in demographically saturated Krummhörn (1720-1859) and expanding Québec (1670-1750). BIODEMOGRAPHY AND SOCIAL BIOLOGY 2013; 59:191-211. [PMID: 24215259 DOI: 10.1080/19485565.2013.833803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Parental death precipitates a cascade of events leading to more or less detrimental exposures, from the sudden and dramatic interruption of parental care to cohabitation with stepparents and siblings in a recomposed family. This article compares the effect of early parental loss on child survival in the past in the Krummhörn region of East Frisia (Germany) and among the French Canadian settlers of the Saint Lawrence Valley (Québec, Canada). The Krummhörn region was characterized by a saturated habitat, while the opportunities for establishing a new family were virtually unlimited for the French Canadian settlers. Early parental loss had quite different consequences in these dissimilar environments. Event history analyses with time-varying specification of family structure are used on a sample of 7,077 boys and 6,906 girls born between 1720 and 1859 in the Krummhörn region and 31,490 boys and 33,109 girls whose parents married between 1670 and 1750 in Québec. Results indicate that in both populations, parental loss is associated with increased infant and child mortality. Maternal loss has a universal and consistent effect for both sexes, while the impact of paternal loss is less easy to establish and interpret. On the other hand, the effect of the remarriage of the surviving spouse is population-specific: the mother's remarriage has no effect in Krummhörn, while it is beneficial in Québec. In contrast, the father's remarriage in Krummhörn dramatically reduces the survival chances of the children born from his former marriage, while such an effect is not seen for Québec. These population-specific effects appear to be driven by the availability of resources and call into question the universality of the "Cinderella" effect.
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Affiliation(s)
- Kai P Willführ
- a Max Planck Institute for Demographic Research , Rostock , Germany
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Landes M, van Lettow M, Chan AK, Mayuni I, Schouten EJ, Bedell RA. Mortality and health outcomes of HIV-exposed and unexposed children in a PMTCT cohort in Malawi. PLoS One 2012; 7:e47337. [PMID: 23082157 PMCID: PMC3474798 DOI: 10.1371/journal.pone.0047337] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/10/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mortality and morbidity among HIV-exposed children are thought to be high in Malawi. We sought to determine mortality and health outcomes of HIV-exposed and unexposed infants within a PMTCT program. METHOD Data were collected as part of a retrospective cohort study in Zomba District, Malawi. HIV-infected mothers were identified via antenatal, delivery and postpartum records with a delivery date 18-20 months prior; the next registered HIV-uninfected mother was identified as a control. By interview and health record review, data on socio-demographic characteristics, service uptake, and health outcomes were collected. HIV-testing was offered to all exposed children. RESULTS 173 HIV-infected and 214 uninfected mothers were included. 4 stillbirths (1.0%) occurred; among the 383 livebirths, 41 (10.7%) children died by 20 months (32 (18.7%) HIV-exposed and 9 unexposed children (4.3%; p<0.0001)). Risk factors for child death included: HIV-exposure [adjOR2.9(95%CI 1.1-7.2)], low birthweight [adjOR2.5(1.0-6.3)], previous child death (adjOR25.1(6.5-97.5)] and maternal death [adjOR5.3(11.4-20.5)]. At 20 months, HIV-infected children had significantly poorer health outcomes than HIV-unexposed children and HIV-exposed but uninfected children (HIV-EU), including: hospital admissions, delayed development, undernutrition and restrictions in function (Lansky scale); no significant differences were seen between HIV-EU and HIV-unexposed children. Overall, no difference was seen at 20 months among HIV-infected, HIV-EU and HIV-unexposed groups in Z-scores (%<-2.0) for weight, height and BMI. Risk factors for poor functional health status at 20 months included: HIV-infection [adjOR8.9(2.4-32.6)], maternal illness [adjOR2.8(1.5-5.0)] and low birthweight [adjOR2.0(1.0-4.1)]. CONCLUSION Child mortality remains high within this context and could be reduced through more effective PMTCT including prioritizing the treatment of maternal HIV infection to address the effect of maternal health and survival on infant health and survival. HIV-infected children demonstrated developmental delays, functional health and nutritional deficits that underscore the need for increased uptake of early infant diagnosis and institution of ART for all infected infants.
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Affiliation(s)
- Megan Landes
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Adrienne K. Chan
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Erik J. Schouten
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Management Sciences for Health, Lilongwe, Malawi
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Taha TE, Dadabhai SS, Sun J, Rahman MH, Kumwenda J, Kumwenda N. Child mortality levels and trends by HIV status in Blantyre, Malawi: 1989-2009. J Acquir Immune Defic Syndr 2012; 61:226-34. [PMID: 22692091 PMCID: PMC3458133 DOI: 10.1097/qai.0b013e3182618eea] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Continuous evaluation of child survival is needed in sub-Saharan Africa where HIV prevalence among women of reproductive age continues to be high. We examined mortality levels and trends over a period of ∼20 years among HIV-unexposed and -exposed children in Blantyre, Malawi. METHODS Data from 5 prospective cohort studies conducted at a single research site from 1989 to 2009 were analyzed. In these studies, children born to HIV-infected and -uninfected mothers were enrolled at birth and followed longitudinally for at least 2 years. Information on sociodemographic, HIV infection status, survival, and associated risk factors was collected in all studies. Mortality rates were estimated using birth-cohort analyses stratified by maternal and infant HIV status. Multivariate Cox regression models were used to determine risk factors associated with mortality. RESULTS The analysis included 8286 children. From 1989 to 1995, overall mortality rates (per 100 person-years) in these clinic-based cohorts remained comparable among HIV-uninfected children born to HIV-uninfected mothers (range 3.3-6.9) or to HIV-infected mothers (range 2.5-7.5). From 1989 to 2009, overall mortality remained high among all children born to HIV-infected mothers (range 6.3-19.3) and among children who themselves became infected (range 15.6-57.4, 1994-2009). Only lower birth weight was consistently and significantly (P < 0.05) associated with higher child mortality. CONCLUSIONS HIV infection among mothers and children contributed to high levels of child mortality in the African setting in the pretreatment era. In addition to services that prevent mother-to-child transmission of HIV, other programs are needed to improve child survival by lowering HIV-unrelated mortality through innovative interventions that strengthen health infrastructure.
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Affiliation(s)
- Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Young S, Murray K, Mwesigwa J, Natureeba P, Osterbauer B, Achan J, Arinaitwe E, Clark T, Ades V, Plenty A, Charlebois E, Ruel T, Kamya M, Havlir D, Cohan D. Maternal nutritional status predicts adverse birth outcomes among HIV-infected rural Ugandan women receiving combination antiretroviral therapy. PLoS One 2012; 7:e41934. [PMID: 22879899 PMCID: PMC3413694 DOI: 10.1371/journal.pone.0041934] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 06/29/2012] [Indexed: 11/25/2022] Open
Abstract
Objective Maternal nutritional status is an important predictor of birth outcomes, yet little is known about the nutritional status of HIV-infected pregnant women treated with combination antiretroviral therapy (cART). We therefore examined the relationship between maternal BMI at study enrollment, gestational weight gain (GWG), and hemoglobin concentration (Hb) among 166 women initiating cART in rural Uganda. Design Prospective cohort. Methods HIV-infected, ART-naïve pregnant women were enrolled between 12 and 28 weeks gestation and treated with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination regimen. Nutritional status was assessed monthly. Neonatal anthropometry was examined at birth. Outcomes were evaluated using multivariate analysis. Results Mean GWG was 0.17 kg/week, 14.6% of women experienced weight loss during pregnancy, and 44.9% were anemic. Adverse fetal outcomes included low birth weight (LBW) (19.6%), preterm delivery (17.7%), fetal death (3.9%), stunting (21.1%), small-for-gestational age (15.1%), and head-sparing growth restriction (26%). No infants were HIV-infected. Gaining <0.1 kg/week was associated with LBW, preterm delivery, and a composite adverse obstetric/fetal outcome. Maternal weight at 7 months gestation predicted LBW. For each g/dL higher mean Hb, the odds of small-for-gestational age decreased by 52%. Conclusions In our cohort of HIV-infected women initiating cART during pregnancy, grossly inadequate GWG was common. Infants whose mothers gained <0.1 kg/week were at increased risk for LBW, preterm delivery, and composite adverse birth outcomes. cART by itself may not be sufficient for decreasing the burden of adverse birth outcomes among HIV-infected women. Trial Registration Clinicaltrials.gov NCT00993031
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Affiliation(s)
- Sera Young
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Katherine Murray
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Julia Mwesigwa
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
| | - Paul Natureeba
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
| | - Beth Osterbauer
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jane Achan
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Arinaitwe
- Makerere University-University of California San Francisco Research Collaboration, Kampala, Uganda
| | - Tamara Clark
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Veronica Ades
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Albert Plenty
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Edwin Charlebois
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Theodore Ruel
- Department of Pediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Moses Kamya
- Department of Medicine, Makerere University Medical School, Kampala, Uganda
| | - Diane Havlir
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Deborah Cohan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health. PLoS One 2012; 7:e38109. [PMID: 22719867 PMCID: PMC3374817 DOI: 10.1371/journal.pone.0038109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/02/2012] [Indexed: 11/19/2022] Open
Abstract
Background More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries. Methodology Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic regression models describe associations between the characteristics of children, caregivers, and households and child health outcomes: fair or poor child health; fever, cough, or diarrhea within the past two weeks; illness in the past 6 months; and fair or poor health on at least two assessments. Principal Findings Across the six study areas, 23% of OAC were reported to be in fair or poor health; 19%, 18%, and 2% had fever, cough, or diarrhea, respectively, within the past two weeks; 55% had illnesses within the past 6 months; and 23% were in fair or poor health on at least two assessments. Female gender, suspected HIV infection, experiences of potentially traumatic events, including the loss of both parents, urban residence, eating fewer than 3 meals per day, and low caregiver involvement were associated with poorer child health outcomes. Particularly strong associations were observed between child health measures and the health of their primary caregivers. Conclusions Poor caregiver health is a strong signal for poor health of OAC. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.
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Karpelowsky J, Millar AJW. Surgical implications of human immunodeficiency virus infections. Semin Pediatr Surg 2012; 21:125-35. [PMID: 22475118 DOI: 10.1053/j.sempedsurg.2012.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric HIV (human immunodeficiency virus) is a pandemic predominantly in sub-Saharan Africa. Approximately 2.2 million children aged less than 15 years are infected with HIV, representing almost 95% of the total number of children globally infected with HIV. Therefore, increasing numbers of HIVi or -exposed but uninfected children can be expected to require a surgical procedure to assist in the diagnosis of an HIV/acquired immune deficiency syndrome-related complication, to address a life-threatening complication of the disease, or for routine surgery encountered in HIV-unexposed children. HIVi children may present with both conditions unique to HIV infection and surgical conditions routine in pediatric surgical practice. HIV exposure confers an increased risk of complications and mortality for all children after surgery, whether they are HIV infected or not. This risk of complications is higher in the HIVi group of patients. These findings seem to be independent of whether patients undergo an elective or emergency procedure, but the risk of an adverse outcome is higher for a major procedure. Surgical implications of HIV infection are comprehensively reviewed in this article.
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Railton J, Mash R. How children access antiretroviral treatment at Kgapane District Hospital, Limpopo, South Africa. S Afr Fam Pract (2004) 2012. [DOI: 10.1080/20786204.2012.10874220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- J Railton
- Division of Family Medicine and Primary Care, Stellenbosch University
| | - R Mash
- Division of Family Medicine and Primary Care, Stellenbosch University
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Ndirangu J, Newell ML, Thorne C, Bland R. Treating HIV-infected mothers reduces under 5 years of age mortality rates to levels seen in children of HIV-uninfected mothers in rural South Africa. Antivir Ther 2012; 17:81-90. [PMID: 22267472 PMCID: PMC3428894 DOI: 10.3851/imp1991] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Maternal and child survival are highly correlated, but the contribution of HIV infection on this relationship, and in particular the effect of HIV treatment, has not been quantified. We estimate the association between maternal HIV and treatment, and under 5 years of age (under-5) child mortality in a rural population in South Africa. METHODS All children born between January 2000 and January 2007 in the Africa Centre Demographic Surveillance Area were included. Maternal HIV status information was available from HIV surveillance; maternal antiretroviral treatment (ART) information from the HIV Treatment Programme database was linked to surveillance data. Mortality rates were computed as deaths per 1,000 person-years observed. Time-varying maternal HIV effect (positive, negative, ART) on under-5 mortality was assessed in Cox regression, adjusting for other factors associated with under-5 mortality. RESULTS In total, 9,068 mothers delivered 12,052 children, of whom 947 (7.9%) died before age 5. Infant mortality rate declined by 49% from 69.0 in 2000 to 35.5 in 2006 deaths per 1,000 person-years observed; a significant decline was observed post-ART (2004-2006). The estimated proportion of deaths across all age groups were higher among the children born to the HIV-positive and HIV-not-reported status women than among children of HIV-negative women. Multivariably, mortality in children of mothers on ART was not significantly different from children of HIV-negative mothers (adjusted hazard ratio 1.29, 0.53-3.17; P=0.572). CONCLUSIONS These findings highlight the importance of maternal HIV treatment with direct benefits of improved survival among all children under-5. Timely HIV treatment for eligible women is required to benefit both mothers and children.
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Affiliation(s)
- James Ndirangu
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.
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Ciaranello AL, Perez F, Keatinge J, Park JE, Engelsmann B, Maruva M, Walensky RP, Dabis F, Chu J, Rusibamayila A, Mushavi A, Freedberg KA. What will it take to eliminate pediatric HIV? Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: a model-based analysis. PLoS Med 2012; 9:e1001156. [PMID: 22253579 PMCID: PMC3254654 DOI: 10.1371/journal.pmed.1001156] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 11/29/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has called for the "virtual elimination" of pediatric HIV: a mother-to-child HIV transmission (MTCT) risk of less than 5%. We investigated uptake of prevention of MTCT (PMTCT) services, infant feeding recommendations, and specific drug regimens necessary to achieve this goal in Zimbabwe. METHODS AND FINDINGS We used a computer model to simulate a cohort of HIV-infected, pregnant/breastfeeding women (mean age, 24 y; mean CD4, 451/µl; breastfeeding duration, 12 mo). Three PMTCT regimens were evaluated: (1) single-dose nevirapine (sdNVP), (2) WHO 2010 guidelines' "Option A" (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral therapy for women with advanced disease), and (3) WHO "Option B" (pregnancy/breastfeeding-limited combination antiretroviral drug regimens without advanced disease; lifelong antiretroviral therapy with advanced disease). We examined four levels of PMTCT uptake (proportion of pregnant women accessing and adhering to PMTCT services): reported rates in 2008 and 2009 (36% and 56%, respectively) and target goals in 2008 and 2009 (80% and 95%, respectively). The primary model outcome was MTCT risk at weaning. The 2008 sdNVP-based National PMTCT Program led to a projected 12-mo MTCT risk of 20.3%. Improved uptake in 2009 reduced projected risk to 18.0%. If sdNVP were replaced by more effective regimens, with 2009 (56%) uptake, estimated MTCT risk would be 14.4% (Option A) or 13.4% (Option B). Even with 95% uptake of Option A or B, projected transmission risks (6.1%-7.7%) would exceed the WHO goal of less than 5%. Only if the lowest published transmission risks were used for each drug regimen, or breastfeeding duration were shortened, would MTCT risks at 95% uptake fall below 5%. CONCLUSIONS Implementation of the WHO PMTCT guidelines must be accompanied by efforts to improve access to PMTCT services, retain women in care, and support medication adherence throughout pregnancy and breastfeeding, to approach the "virtual elimination" of pediatric HIV in Zimbabwe. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Andrea L Ciaranello
- Division of Infectious Disease, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Mugwaneza P, Umutoni NWS, Ruton H, Rukundo A, Lyambabaje A, Bizimana JDD, Tsague L, Wagner CM, Nyankesha E, Muita J, Mutabazi V, Nyemazi JP, Nsanzimana S, Karema C, Binagwaho A. Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program. Pan Afr Med J 2011; 9:37. [PMID: 22145068 PMCID: PMC3215559 DOI: 10.4314/pamj.v9i1.71215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/26/2011] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Placidie Mugwaneza
- Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda
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Karpelowsky JS, Millar AJW, van der Graaf N, van Bogerijen G, Zar HJ. Outcome of HIV-exposed uninfected children undergoing surgery. BMC Pediatr 2011; 11:69. [PMID: 21801358 PMCID: PMC3161858 DOI: 10.1186/1471-2431-11-69] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 07/29/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure. METHODS A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality. RESULTS Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06). CONCLUSION HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.
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Affiliation(s)
- Jonathan S Karpelowsky
- Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, South Africa.
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WHO 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe: modeling clinical outcomes in infants and mothers. PLoS One 2011; 6:e20224. [PMID: 21655097 PMCID: PMC3107213 DOI: 10.1371/journal.pone.0020224] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 04/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Zimbabwean national prevention of mother-to-child HIV transmission (PMTCT) program provided primarily single-dose nevirapine (sdNVP) from 2002-2009 and is currently replacing sdNVP with more effective antiretroviral (ARV) regimens. METHODS Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe (mean age 24.0 years, mean CD4 451 cells/µL). We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1) no antenatal ARVs (comparator); 2) sdNVP; 3) WHO 2010 guidelines using "Option A" (zidovudine during pregnancy/infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy (ART) for women with advanced disease); 4) WHO "Option B" (ART during pregnancy/breastfeeding without advanced disease; lifelong ART with advanced disease); and 5) "Option B+:" lifelong ART for all pregnant/breastfeeding, HIV-infected women. Pediatric (4-6 week and 18-month infection risk, 2-year survival) and maternal (2- and 5-year survival, life expectancy from delivery) outcomes were projected. RESULTS Eighteen-month pediatric infection risks ranged from 25.8% (no antenatal ARVs) to 10.9% (Options B/B+). Although maternal short-term outcomes (2- and 5-year survival) varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP (13.8 years) or Option B (13.9 years) compared to no antenatal ARVs (14.0 years), Option A (14.0 years), or Option B+ (14.5 years). CONCLUSIONS Replacement of sdNVP with currently recommended regimens for PMTCT (WHO Options A, B, or B+) is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.
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Venkatesh KK, de Bruyn G, Marinda E, Otwombe K, van Niekerk R, Urban M, Triche EW, McGarvey ST, Lurie MN, Gray GE. Morbidity and mortality among infants born to HIV-infected women in South Africa: implications for child health in resource-limited settings. J Trop Pediatr 2011; 57:109-19. [PMID: 20601692 PMCID: PMC3107462 DOI: 10.1093/tropej/fmq061] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa. METHODS We conducted a prospective cohort study of 848 mother-child dyads. Multivariable Cox proportional hazards models were used. RESULTS The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40-4.85; p = 0.002) and maternal plasma viral load (PVL) >100,000 copies ml⁻¹ (HR: 1.87; 95% CI: 1.01-3.48; p = 0.048), and lower with maternal age < 20 years (HR: 0.25; 95% CI: 0.07-0.88; p = 0.031). Mortality was higher with infant HIV infection (HR: 4.10; 95% CI: 1.18-14.31; p = 0.027) and maternal PVL >100,000 copies ml⁻¹ (HR: 6.93; 95% CI: 1.64-29.26; p = 0.008). Infant feeding status did not influence the risk of morbidity nor mortality. CONCLUSIONS Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.
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Affiliation(s)
- Kartik K. Venkatesh
- Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA
| | - Guy de Bruyn
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Edmore Marinda
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Ronelle van Niekerk
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Michael Urban
- Coronation Hospital, Department of Pediatrics, Johannesburg, South Africa
| | - Elizabeth W. Triche
- Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA
| | - Stephen T. McGarvey
- Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA
| | - Mark N. Lurie
- Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA
| | - Glenda E. Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa
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Zagheni E. The impact of the HIV/AIDS epidemic on kinship resources for orphans in Zimbabwe. POPULATION AND DEVELOPMENT REVIEW 2011; 37:761-783. [PMID: 22319773 DOI: 10.1111/j.1728-4457.2011.00456.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The extended family has been recognized as a major safety net for orphans in sub-Saharan Africa. However, the mortality crisis associated with HIV/AIDS may drastically reduce the availability of relatives and thus undermine traditional forms of mutual support. In this article, the microsimulator SOCSIM is used to estimate and project quantities such as the number of living uncles, aunts, siblings, and grandparents available to orphans. The model is calibrated to the setting of Zimbabwe, using data from demographic and Health Surveys and estimates and projections of demographic rates from the United Nations. The article shows that there is a lag of more than ten years between the peak in orphanhood prevalence and the peak in scarcity of grandparents for orphans. The results indicate that a generalized HIV/AIDS epidemic has a prolonged impact on children and orphans that extends well beyond the peak in mortality. A rapid increase in the number of orphans is followed by a steady reduction in the number of living grandparents for orphans. Consequently, the burden of double orphans (both of whose parents have died) is likely to shift to uncles and aunts. In Zimbabwe, the number of living uncles and aunts per double orphan decreased between 1980 and 2010, but it is expected to increase progressively during the next few decades. Changes in kinship structure have important social consequences that should be taken into account when seeking to address the lack of care for orphans.
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Affiliation(s)
- Emilio Zagheni
- Max Planck Institute for Demographic Research, Rostock, Germany
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Sear R, Coall D. How much does family matter? Cooperative breeding and the demographic transition. POPULATION AND DEVELOPMENT REVIEW 2011; 37:81-112. [PMID: 21280366 DOI: 10.1111/j.1728-4457.2011.00379.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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