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Morbidity and mortality in HIV-exposed under-five children in a rural Malawi setting: a cohort study
Oscar Divala1, Charles Michelo1, Bagrey Ngwira2
1Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
Insights
HIV exposure in children significantly increases their risk of illness and death, particularly within the first year of life. Targeted interventions, including focused prevention of mother-to-child transmission (PMTCT), are crucial for reducing pediatric HIV impact.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Global child health
Background:
- Paediatric HIV infection is a major cause of child morbidity and mortality in southern Africa.
- Limited area-specific data on HIV-exposed children's health risks hinders effective care in Malawi.
- This study addresses the critical need for local data on child health outcomes in Malawi.
Purpose of the Study:
- To estimate and compare morbidity and mortality rates in HIV-exposed versus HIV-unexposed children under five years old.
- To provide crucial area-specific data for improving child healthcare in rural Malawi.
- To inform targeted public health interventions for vulnerable children.
Main Methods:
- Analysis of data from under-five children (n=7,929) at a demographic and health site in Karonga, Malawi (Jan 2009 - June 2011).
- Calculation and comparison of morbidity and mortality rates using Kaplan-Meier survival analysis and Cox proportional hazard regression.
- Assessment of outcomes stratified by HIV exposure status.
Main Results:
- HIV-exposed children experienced 1.34 times higher morbidity rates (p<0.001) and 4.5 times higher mortality rates (p<0.001) compared to HIV-unexposed children.
- All-cause morbidity rate was 337.6/1000 person years of observation (PYO), and child mortality rate was 16.6/1000 PYO.
- Higher mortality rates were observed in children under one year (129.2/1000 PYO).
Conclusions:
- HIV exposure at birth significantly elevates child morbidity and mortality, especially in the first year of life.
- The findings highlight the urgent need for targeted interventions, including enhanced prevention of mother-to-child transmission (PMTCT) programs.
- Strengthening PMTCT services is essential to reduce HIV transmission and improve infant survival in this region.
Introduction:
Paediatric HIV infection significantly contributes to child morbidity and mortality in southern Africa. In Malawi as in most countries in the region, care of HIV-exposed children is constrained by the lack of area-specific information on their risk to dying and morbidity. This research estimates and compares morbidity and mortality events between HIV-exposed and -unexposed under-five children in a rural Malawian setting.
Methods:
Data for children under the age of five collected from January 2009 to June 2011 at a demographic and health site in Karonga district of northern Malawi were analyzed. Morbidity and mortality rates among HIV-exposed and -unexposed children were calculated and compared using Kaplan-Meier survival analysis and Cox proportional hazard regression.
Results:
Overall (n=7,929) cohort data of under-five children born in a demographic and health site represented 12380.8 person years of observation (PYO) of which 3.1% were contributed by HIV-exposed infants. Females accounted for half of the sample, and the overall mean age was 18.4 months (SD 13.4) with older children in the HIV-unexposed group. All-cause morbidity rate was 337.6/1000 PYO (95% CI 327.5/1000-348.0/1000) and HIV-exposed children morbidity rate was 1.34 times higher (p<0.001) compared to HIV-unexposed children. integrated management of childhood illness (IMCI) pneumonia was the most common diagnosis (39.3%) in this cohort. Child mortality rate was 16.6/1000 PYO (95% CI 14.5-19.1) from 206 deaths. HIV-exposed children had 4.5 times higher (p<0.001) mortality rate compared to the HIV-unexposed children. Higher mortality rates were observed in children under one year (129.2/1000 PYO) compared to older age groups.
Conclusion:
HIV exposure at birth has a greater impact on child morbidity and mortality especially in the first year of life. This underscores the need for targeted and synergetic interventions that included focused prevention of mother-to-child transmission (PMTCT) which could reduce HIV transmission to children in their infancy in this setting.
