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

Crampin, A. C. et al. (2003) The long-term impact of HIV and orphanhood on the mortality and physical well-being of children in rural Malawi. AIDS, 17(3), pp. 389-397. (doi: 10.1097/00002030-200302140-00013) (PMID:12556693)

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.

• Item Type: Articles
• Additional Information: Sponsorship: Until 1996 the Karonga Prevention Study was funded primarily by LEPRA (the British Leprosy Relief Association) and ILEP (the International Federation of Anti-Leprosy Organizations) with contributions from the WHO/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases. Since 1996, the Wellcome Trust has been the principal funder. BN was supported by the British High Commission in Malawi. JRG was partially supported by the British Department for International Development.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Crampin, Professor Mia
• Authors: Crampin, A. C., Floyd, S., Glynn, J. R., Madise, N., Nyondo, A., Khondowe, M. M., Njoka, C. L., Kanyongoloka, H., Ngwira, B., Zaba, B., and Fine, P. E. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: AIDS
• ISSN: 0269-9370
• ISSN (Online): 1473-5571