Morbidity and Mortality in HIV exposed under five children in a Rural Malawi setting

Abstract

HIV and AIDS has significantly contributed to the rise of under-five morbidity and mortality in Africa. This threatens recent gains in infant and child survival and health. In Malawi, as in most other southern African countries, the care of HIV exposed children is mostly constrained due to the lack of area specific information on the risk to dying and morbidity of these children. Interventions to reduce childhood morbidity and mortality attributed to HIV exposure are currently available. However, there is no evidence base to support such an intervention in rural Malawian settings. This research therefore aimed at estimating and comparing morbidity and mortality events among HIV exposed and non-exposed under five children in a rural Malawian setting. Methods Data stem from a cohort of 7,929 under-five children born in the Continuous Registration System (CRS) based in the demographic and health site in Karonga district, Malawi from January 2009 to June 2011. Analysis was based on person years of observation, Kaplan–Meier survival analysis and Cox proportional hazard regression, which was used to calculate and compare morbidity and mortality rates among HIV exposed and unexposed children. Results Overall (n=7,929) cohort data of under-five children born in the CRS represented 12380.8 person years of observation (PYO) of which 3.1% were contributed by HIV exposed infants. Half were female and an overall mean age was 18.4 months (SD 13.4) 18.4 months (SD 13.4)18.4 months (SD 13.4) 18.4 months (SD 13.4) 18.4 months (SD 13.4) 18.4 months (SD 13.4) , with older children dominating in the HIV unexposed group. Overall all-cause morbidity rate was 337.6/1000 PYO (95% CI: 327.5/1000 PYO-348.0/1000 PYO) and HIV-exposed children morbidity rate was 1.34 times higher compared to HIV-unexposed children. IMCI pneumonia was the most frequent diagnosis among both exposed and unexposed children but was significantly higher in the HIV exposed group. Overall child mortality rate was 16.6/1000pyo (95% CI 14.5-19.1) from 206 deaths. The HIV exposed children had 4.5 times higher mortality rate as compared to the HIV unexposed children. Generally both mortality and morbidity rates were higher in the first year of life. Conclusion HIV exposure at birth has a greater impact on child mortality and morbidity especially in the first year of life. This burden can be reduced with effective PMTCT interventions which will reduce rates of HIV transmission to infants.