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Placidie Mugwaneza, Nadine Umutoni Wa Shema, Hinda Ruton, Alphonse Rukundo, Alexandre Lyambabaje, Jean de Dieu Bizimana, Landry Tsague, Claire Wagner, Elévanie Nyankesha, Jane Muita, Vincent Mutabazi, Jean Pierre Nyemazi, Sabin Nsanzimana, Corine Karema, Agnes Binagwaho. Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program. The Pan African Medical Journal. 2011;9:37 Key words: HIV, PMTCT, maternal HIV infection, infant mortality, child mortality, under-five mortality, Rwanda Permanent link: http://www.panafrican-med-journal.com/content/article/9/37/full Received: 18/05/2011 - Accepted: 26/07/2011 - Published: 03/08/2011 © Placidie Mugwaneza et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program
Placidie Mugwaneza1,&, Nadine Umutoni Wa Shema1, Hinda Ruton1, Alphonse Rukundo1, Alexandre Lyambabaje2, Jean de Dieu Bizimana3, Landry Tsague4, Claire M Wagner5, Elévanie Nyankesha4, Jane Muita4, Vincent Mutabazi1, Jean Pierre Nyemazi1, Sabin Nsanzimana1, Corine Karema1, Agnes Binagwaho5,6
1Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda, 2Department of Applied Mathematics, National University of Rwanda, Butare, Rwanda, 3Development Research Group, World Bank, Washington DC, USA, 4UNICEF Rwanda, Kigali, Rwanda, 5Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA, 6Ministry of Health of Rwanda, Kigali, Rwanda
&Auteur correspondant
Placidie Mugwaneza, TRAC Plus, Boulevard de la Revolution, BP 2717, Kigali, Rwanda
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.
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 non-exposed children.
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 HIV-exposed 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).
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.
