HIV and Child Mortality: Evidence from Surveillance Studies in Uganda, Tanzania and Malawi

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Author(s): Zaba B, Marston M, Nakiyingi J, Whitworth J, Ruberantwari A, Urassa M, Issingo R, Mwaluko G, Crampin A, Floyd S, Nyondo A, Bracher M

Year: 2003

The steady decline in child mortality that has been seen in most African countries in the 1960s, 70s and 80s has stalled in many countries in the 1990s, because of the AIDS epidemic. However, the census and household survey data that are generally used to produce estimates of child mortality do not enable the adverse effect of HIV on child mortality to be precisely quantified. This paper uses pooled data from three longitudinal community based studies that classified births by the mother's HIV status to calculate the excess risks of child mortality due to maternal HIV status. The excess risks of child death due to increased mortality among mothers are also estimated, and the joint effects of maternal HIV status and maternal survival are quantified using multivariate techniques in a survival analysis. The analysis shows that the excess risk of death associated with having an HIV positive mother is 3.2, and this effect lasts throughout childhood ages. The excess risk associated with a maternal death is 3.6 in the two year period centered on the mother's death, with children of both infected and uninfected mothers experiencing elevated mortality risks at this time.