Nakiyingi Jessica S, Bracher Michael, Whitworth James A, Ruberantwari Anthony, Busingye June, Mbulaiteye Sam M, Zaba Basia
Medical Research Council Programme on AIDS in Uganda, Uganda Virus Research Institute PO Box 49, Entebbe, Uganda.
AIDS. 2003 Aug 15;17(12):1827-34. doi: 10.1097/00002030-200308150-00012.
To analyse the contribution of maternal survival and HIV status to child (under-5 years) mortality in a rural population cohort in South-west Uganda.
Approximately 10 000 people residing in 15 neighbouring villages were followed between 1989 and 2000 using annual censuses and serological surveys to collect data on births, deaths, and adult HIV serostatus. Mother-child records were linked, child mortality risks (per 1000 births) and hazard ratios (HRs) for child mortality according to maternal HIV serostatus were computed, allowing for time-varying covariates.
A total of 3727 children were born, of whom 415 died during 14 110 child years of follow-up. Mother's HIV status at birth was ascertained unambiguously for 3004 children, of whom 218 were born to HIV-positive mothers. Infant mortality risk was higher for HIV seropositive than seronegative mothers (225 versus 53) as was child mortality risk (313 versus 114). Child mortality risk was also higher for mothers who died (571) than for surviving mothers (128). After controlling for child's age and sex, independent predictors of mortality in children were: mother's terminal illness or death (HR = 3.8); mother being HIV positive (HR = 3.2); child being a twin (HR = 2.0); teenage motherhood (HR = 1.7) and maternal absence (HR = 1.7).
Maternal survival and HIV status are strong predictors of child survival. The higher mortality in HIV-infected women compounds mortality risks for their children, regardless of children's HIV status. Programmes aimed at the welfare of children should take into account the independent effect of mothers' HIV and vital status.
分析乌干达西南部农村人口队列中孕产妇生存情况和艾滋病毒感染状况对5岁以下儿童死亡率的影响。
1989年至2000年期间，通过年度人口普查和血清学调查，对居住在15个相邻村庄的约10000人进行随访，收集出生、死亡及成人艾滋病毒血清学状态的数据。将母婴记录进行关联，计算儿童死亡风险（每1000例出生）以及根据孕产妇艾滋病毒血清学状态得出的儿童死亡风险比（HRs），同时考虑随时间变化的协变量。
共出生3727名儿童，在14110个儿童年的随访期间，其中415名儿童死亡。明确确定了3004名儿童出生时母亲的艾滋病毒感染状况，其中218名儿童的母亲为艾滋病毒阳性。艾滋病毒血清阳性母亲的婴儿死亡风险高于血清阴性母亲（分别为225和53），儿童死亡风险也是如此（分别为313和114）。死亡母亲的儿童死亡风险（571）也高于存活母亲的儿童（128）。在控制儿童年龄和性别后，儿童死亡的独立预测因素为：母亲的晚期疾病或死亡（HR = 3.8）；母亲艾滋病毒呈阳性（HR = 3.2）；儿童为双胞胎（HR = 2.0）；少女母亲（HR = 1.7）以及母亲不在身边（HR = 1.7）。
孕产妇生存情况和艾滋病毒感染状况是儿童生存的有力预测因素。无论儿童的艾滋病毒感染状况如何，艾滋病毒感染妇女中较高的死亡率都会增加其子女的死亡风险。旨在保障儿童福利的项目应考虑母亲的艾滋病毒感染状况和生命状态的独立影响。
