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The long-term impact of HIV and orphanhood on the mortality and physical well-being of children in rural Malawi.

By Amelia C Crampin, Sian Floyd, Judith R Glynn, Nyovani Madise, Andrew Nyondo, Masiya M Khondowe, Chance L Njoka, Huxley Kanyongoloka, Bagrey Ngwira, Basia Zaba and Paul E Fine

Abstract

OBJECTIVE: To assess the influence of maternal HIV status and orphanhood on child mortality and physical well-being. DESIGN: Retrospective cohort study with > 10 years of follow-up. METHODS: From population-based surveys in Karonga District, Malawi in the 1980s, 197 individuals were identified as HIV-positive. These individuals and 396 HIV-negative individuals matched for age and sex, and their spouses and offspring, were sought in 1998-2000. RESULTS: All but 11 of the index individuals were traced, identifying 2520 offspring; of these, 1106 offspring were included in analyses. Among those with HIV-positive mothers, mortality was 27% [95% confidence interval (CI), 17-38] in infants (1-30 days), 46% (95% CI, 34-58) in those under 5 years and 49% (95% CI, 38-61) in those under 10 years. The corresponding figures for those with HIV-negative mothers were 11% (95% CI, 8-13), 16% (95% CI, 13-19) and 17% (95% CI, 14-20). Death of HIV-positive mothers, but not of HIV-negative mothers or of fathers, was associated with increased child mortality. Among survivors who were still resident in the district, neither maternal HIV status nor orphanhood was associated with stunting, being wasted, or reported ill-health. CONCLUSIONS: Mortality in children under 5 years is much higher in children born to HIV-positive mothers than in those born to HIV-negative mothers. With 10% of pregnant women HIV-positive, we estimate that approximately 18% of under-5 deaths in this population are attributable to HIV. Most of the excess is attributable to vertical transmission of HIV. Our findings suggest that, in terms of physical well-being, the extended family in this society has not discriminated against surviving children whose parents have been ill or have died as a result of HIV/AIDS

Publisher: 'Ovid Technologies (Wolters Kluwer Health)'
Year: 2003
DOI identifier: 10.1097/00002030-200302140-00013
OAI identifier: oai:researchonline.lshtm.ac.uk:16293
Provided by: LSHTM Research Online
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Citations

  1. (2008). A public health approach to rapid scale-up of antiretroviral treatment in Malawi during 2004-2006.
  2. (2010). Making a difference: Funding.
  3. (2009). Organization. Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector:
  4. (2009). Patient retention and attrition on antiretroviral treatment at district level in rural Malawi. Trans R Soc Trop Med Hyg
  5. (2007). Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review.
  6. (2010). Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-2009: systematic review. Trop Med Int Health 15(Suppl 1):
  7. (2010). Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa.
  8. (2010). Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa,
  9. The Global Fund. The Global Fund 2010: Innovation and impact:
  10. World Health Organization. AIDS epidemic update:

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