Gregson Simon, Mushati Phyllis, Nyamukapa Constance
Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, London, United Kingdom.
J Acquir Immune Defic Syndr. 2007 Feb 1;44(2):188-95. doi: 10.1097/01.qai.0000247230.68246.13.
Households form the basic social and economic building blocks of sub-Saharan African societies. Household viability is threatened by sustained crisis-level mortality in widely disseminated HIV epidemics. This article describes the impact of adult deaths on households in small towns, estates, and villages in eastern Zimbabwe.
A stratified baseline household census was conducted, and 9842 adults were interviewed, tested for HIV infection, and followed up after 3 years. For 374 (93%) of 404 respondents who died, verbal autopsies were conducted with caregivers and data were collected on income foregone, health care and funeral expenditure, and household dissolution and relocation. The household impact of AIDS and non-AIDS deaths was compared.
Deaths occurred disproportionately in more urban and low-income households, with AIDS deaths more often resulting in the loss of the household head (57% vs. 46%, adjusted odds ratio [AOR] = 2.47; P = 0.003). The median gross expenditure on health care and funerals was 25 US dollars (interquartile ratio [IQR]: 5-88) and 73 US dollars (IQR: 43-128), respectively, with external contributions being substantial for funerals (25 US dollars, IQR: 10-54). Households with AIDS deaths spent more on health care (incidence rate ratio = 1.83; 95% confidence interval: 1.06 to 3.15) and had more frequently dissolved or relocated (39% vs. 27%, AOR = 1.87; P = 0.038) than those with non-AIDS deaths. Households migrated disproportionately to rural villages.
Despite the extended family system, adult deaths undermine the viability of sub-Saharan African households. HIV epidemics have greatly increased adult mortality, and AIDS deaths can be particularly destabilizing.
家庭是撒哈拉以南非洲社会基本的社会和经济组成单元。广泛传播的艾滋病疫情致使危机级别的死亡率持续存在，威胁着家庭的生存能力。本文描述了津巴布韦东部小镇、庄园和村庄中成年人死亡对家庭的影响。
开展了分层基线家庭普查，对9842名成年人进行了访谈、艾滋病毒感染检测，并在3年后进行随访。对于404名死亡受访者中的374名（93%），对其照料者进行了死因推断，并收集了收入损失、医疗保健和丧葬支出以及家庭解体和搬迁的数据。比较了艾滋病死亡和非艾滋病死亡对家庭的影响。
死亡在城市地区较多和低收入家庭中不成比例地发生，艾滋病死亡更常导致户主死亡（57%对46%，调整优势比[AOR]=2.47；P=0.003）。医疗保健和丧葬的总支出中位数分别为25美元（四分位间距[IQR]：5 - 88）和73美元（IQR：43 - 128），丧葬的外部捐款数额可观（25美元，IQR：10 - 54）。与非艾滋病死亡家庭相比，艾滋病死亡家庭在医疗保健方面支出更多（发病率比=1.83；95%置信区间：1.06至3.15），家庭解体或搬迁的频率更高（39%对27%，AOR = 1.87；P = 0.038）。家庭不成比例地向农村村庄迁移。
尽管存在大家庭制度，但成年人死亡仍会破坏撒哈拉以南非洲家庭的生存能力。艾滋病疫情大幅增加了成年人死亡率，艾滋病死亡可能尤其具有破坏性。
