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

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 nonexposed 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 HIVexposed 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.Key words: HIV, PMTCT, maternal HIV infection, infant mortality, child mortality, under-five mortality, Rwand

Understandings and Responses to Domestic Violence in the African Great Lakes Communities of Western Sydney

The project is a partnership between the Sexualities and Genders Research initiative of Western Sydney University (WSU) and the Great Lakes Agency for Peace and Development (GLAPD). The project is guided by three research questions: what are the views and attitudes of Great Lakes community members in Australia on domestic violence within their communities?; what are the views and experiences of health professionals on domestic violence in the Great Lakes community?; and how can health and welfare responses to domestic violence in the Great Lakes community be improved? We found five overlapping themes to be core to understandings and responses to domestic violence. These were cultural dissonance resulting from migration and displacement; responsibility within and outside of communities; trust; cultural codes of shame and respect; and broader social and structural factors such as racism and socio-economic disadvantage arising from unemployment. Our recommendations were for education within the Great Lakes communities, and of service providers; building trust within Great Lakes communities and between service providers and these communities; and legal sanctions as a last resort