Decline in early life mortality in a high HIV prevalence rural area of South Africa: Evidence of HIV prevention or treatment impact?
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba, KwaZulu-Natal 3935, South Africa; Centre for Paediatric Epidemiology and Biostatistics, University College London, Institute of Child Health, United States; Division of Developmental Medicine, University of Glasgow Medical Faculty, United Kingdom
OBJECTIVE: We present early life mortality rates in a largely rural population with high antenatal HIV prevalence, and investigate temporal and spatial associations with a prevention of mother-to-child transmission (PMTCT) programme, an HIV treatment programme, and maternal HIV. DESIGN: A retrospective cohort analysis. METHODS: All births from January 2000 to January 2007 to women in the Africa Centre demographic surveillance were included. Under-two child mortality rates (U2MR) computed as deaths per 1000 live-births per year; factors associated with mortality risk assessed with Weibull regression. Availability of PMTCT (single-dose nevirapine; sdNVP) and antiretroviral therapy (ART) in a programme included in multivariable analysis. Results: Eight hundred and forty-eight (6.2%) of 13 583 children under 2 years died. Deaths in under twos declined by 49% between 2001 and 2006, from 86.3 to 44.1 deaths per thousand live-births. Mortality was independently associated with birth season (adjusted hazard ratio 1.16, 95% confidence interval 1.02-1.33), maternal education (1.21, 1.02-1.43), maternal HIV (4.34, 3.11-6.04) and ART availability (0.46, 0.33-0.65). Children born at home (unlikely to have received sdNVP) had a 35% higher risk of dying than children born in a facility where sdNVP was available (1.35, 1.04-1.74). For 2005 births the availability of PMTCT and ART in public health programmes would have explained 8 and 31% of the decline in U2MR since 2000. Conclusion: These findings confirm the importance of maternal survival, and highlight the importance of the PMTCT and especially maternal HIV treatment with direct benefits of improved survival of their young children. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
anti human immunodeficiency virus agent; nevirapine; adult; article; child; childhood mortality; controlled study; female; health program; human; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; infant feeding; major clinical study; male; newborn period; priority journal; risk assessment; risk factor; rural area; single drug dose; South Africa; vertical transmission; Adult; Anti-HIV Agents; Child, Preschool; Cohort Studies; Female; HIV Infections; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Nevirapine; Post-Exposure Prophylaxis; Pregnancy; Prenatal Care; Prevalence; Retrospective Studies; Risk Factors; Rural Health; South Africa