Mast T C, Kigozi G, Wabwire-Mangen F, Sewankambo N, Serwadda D, Gray R, Wawer M, Black R
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
AIDS Care. 2006 Oct;18(7):755-63. doi: 10.1080/09540120500521053.
To evaluate the impact of maternal HIV-infection on routine childhood Immunisation coverage, we compared the Immunisation status of children born to HIV-infected and HIV-uninfected women in rural Uganda. The study population was 214 HIV(+) and 578 HIV(-) women with children aged 6 to 35 months previously enrolled in a community study to evaluate maternal and child health in Rakai District, Uganda. Sampling of subjects for interview was stratified by the use of voluntary counselling and testing (VCT) service so that the final sample was four groups: HIV + /VCT+ (n = 98); HIV + /VCT- (n = 116); HIV - /VCT+ (n= 348); HIV - /VCT- (n = 230). The main outcome measure was the percent of complete routine childhood Immunisations recommended by the WHO as assessed from Immunisation cards or maternal recall during household interviews. We found that Immunisation coverage in the overall sample was 26.1%. For all vaccines, children born to HIV-infected mothers had lower Immunisation coverage than children born to HIV-negative mothers (21.3 vs. 27.7%). There was a statistically significant interaction between maternal HIV-infection and maternal knowledge of HIV-infection (p = 0.034). The children of mothers who were HIV-infected and knew their serostatus (HIV + /VCT + ) had a more than two-fold odds of underImmunisation (OR = 2.21, 95% CI: 1.14, 4.29) compared to children of mothers who were HIV - /VCT-. We conclude that maternal HIV-infection was associated with childhood underImmunisation and this was mediated by a mother's knowledge of her HIV status. HIV VCT programmes should encourage HIV-infected mothers to complete childhood Immunisation. Improving access to Immunisation services could benefit vulnerable populations such as children born to HIV-infected mothers.
为评估孕产妇感染艾滋病毒对儿童常规免疫接种覆盖率的影响，我们比较了乌干达农村地区感染艾滋病毒和未感染艾滋病毒的妇女所生孩子的免疫接种状况。研究人群为214名感染艾滋病毒（HIV(+)）和578名未感染艾滋病毒（HIV(-)）的妇女，她们的孩子年龄在6至35个月，此前已纳入一项社区研究，以评估乌干达拉凯区的母婴健康状况。采用自愿咨询和检测（VCT）服务对访谈对象进行分层抽样，最终样本分为四组：HIV+/VCT+（n = 98）；HIV+/VCT-（n = 116）；HIV-/VCT+（n = 348）；HIV-/VCT-（n = 230）。主要结局指标是根据免疫接种卡或家庭访谈中母亲的回忆，评估世界卫生组织推荐的儿童常规免疫接种完成率。我们发现，总体样本中的免疫接种覆盖率为26.1%。对于所有疫苗，感染艾滋病毒母亲所生孩子的免疫接种覆盖率低于未感染艾滋病毒母亲所生孩子（21.3%对27.7%）。孕产妇感染艾滋病毒与孕产妇对艾滋病毒感染的知晓情况之间存在统计学上的显著交互作用（p = 0.034）。与HIV-/VCT-母亲的孩子相比，感染艾滋病毒且知晓自身血清学状态（HIV+/VCT+）的母亲的孩子未充分免疫接种的几率高出两倍多（OR = 2.21，95%CI：1.14，4.29）。我们得出结论，孕产妇感染艾滋病毒与儿童未充分免疫接种有关，而这是由母亲对自身艾滋病毒状态的知晓情况介导的。艾滋病毒自愿咨询和检测项目应鼓励感染艾滋病毒的母亲完成儿童免疫接种。改善免疫接种服务的可及性可能会使诸如感染艾滋病毒母亲所生孩子等弱势群体受益。
