Child mortality goals are unlikely to be met in societies which fail to pay attention to the survival of HIV-positive mothers, according to findings from the Uganda General Population cohort published this month in AIDS.
The study looked at mother and child survival in 15 villages in the Masaka region of Uganda, using annual censuses and HIV serosurveys between 1989 and 2000. Data on the mother’s serostatus at birth was available for 3004 children out of 3727 births during the period.
The death rate before the age of 1 was 225 per 1000 live births, and by the age of 5, the death rate was 313 per 1000 live births in children of mothers who were HIV-positive at the time of birth, compared to 53 and 114 per 1000 live births in children of HIV-negative mothers.
218 children were born to HIV-positive mothers, and the death or terminal illness of the child’s mother was associated with a 3.8-fold increased risk of child mortality. Having an HIV-positive mother was associated with a 3.2-fold increased risk of death.
These effects were independent of each other, suggesting that even in the absence of HIV infection in the child, early maternal death drastically increases the risk of death for a child, with that risk greatest in the first two years of life. The risk was greatest in the year following the mother’s death (RH=5.5) when compared to maternal survival for at least one year following birth. However, the study was not able to assess directly the relationship between infant HIV infection and mortality because HIV status could not be established for most children.
The concentration of child mortality is likely to be associated in large part with the loss of breastfeeding, which protects against infant diarrhoea and provides a large proportion of nourishment to children where food is limited or of poor nutritional value.
The study is the largest evaluation of the relationship between maternal HIV infection and child mortality to date, with 14,110 child-years of observation. It was carried out by the UK Medical Research Council Programme on AIDS in Uganda.
The authors note that “the very high mortality of mothers who die within a few years of giving birth suggests that simply reducing vertical transmission might not proportionately reduce the mortality risks in children of infected mothers.”
However, maternal mortality only overtook those of children after their children had reached the age of 6.
However, the authors also highlight the high level of mortality among HIV-negative children in this study, and suggest that “programmes directed at improving HIV-related child mortality should be provided in a framework of integrated management of childhood illness, and not merely targeted at HIV-infected families.”
Nakiyangi JS et al. Child survival in relation to mother’s HIV infection and survival: evidence from a Ugandan cohort study. AIDS 17: 1827-1834, 2003.