Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata

Jahn, A., Floyd, S., McGrath, N., Crampin, A. C. , Kachiwanda, L., Mwinuka, V., Zaba, B., Fine, P. E.M. and Glynn, J. R. (2010) Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata. PLoS ONE, 5(6), e11320. (doi: 10.1371/journal.pone.0011320) (PMID:20596521) (PMCID:PMC2893132)

Abstract

Background: As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline. Methods/Principal Findings: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1–4 years, and 38 in children aged 5–15. All-cause child mortality in infants and 1–4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1–4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets. Conclusions/Significance: In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest.

• Item Type: Articles
• Additional Information: The Karonga Prevention Study is funded primarily by the Wellcome Trust (www.wellcome.ac.uk), with contributions from LEPRA (The British Leprosy Relief Association, www.lepra.org.uk).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Jahn, A., Floyd, S., McGrath, N., Crampin, A. C., Kachiwanda, L., Mwinuka, V., Zaba, B., Fine, P. E.M., and Glynn, J. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• ISSN (Online): 1932-6203
• Copyright Holders: Copyright © 2010 Jahn et al.
• First Published: First published in PLoS ONE 5(6):e11320
• Publisher Policy: Reproduced under a Creative Commons license