The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America.
UCL International Disability Research Centre, University College London, London, United Kingdom.
PLoS One. 2021 May 5;16(5):e0251183. doi: 10.1371/journal.pone.0251183. eCollection 2021.
Previous research on the association between maternal HIV status and child mortality in sub-Saharan Africa was published between 2005-2011. Findings from these studies showed a higher child mortality risk among children born to HIV-positive mothers. While the population of women with disabilities is growing in developing countries, we found no research that examined the association between maternal disability in HIV-positive mothers, and child mortality in sub-Saharan Africa. This study examined the potential compounding effect of maternal disability and HIV status on child mortality in South Africa.
We analyzed data for women age 15-49 years from South Africa, using the nationally representative 2016 South Africa Demographic and Health Survey. We estimated unadjusted and adjusted risk ratios of child mortality indicators by maternal disability and maternal HIV using modified Poisson regressions.
Children born to disabled mothers compared to their peers born to non-disabled mothers were at a higher risk for neonatal mortality (RR = 1.80, 95% CI:1.31-2.49), infant mortality (RR = 1.69, 95% CI:1.19-2.41), and under-five mortality (RR = 1.78, 95% CI:1.05-3.01). The joint risk of maternal disability and HIV-positive status on the selected child mortality indicators is compounded such that it is more than the sum of the risks from maternal disability or maternal HIV-positive status alone (RR = 3.97 vs. joint RR = 3.67 for neonatal mortality; RR = 3.57 vs. joint RR = 3.25 for infant mortality; RR = 6.44 vs. joint RR = 3.75 for under-five mortality).
The findings suggest that children born to HIV-positive women with disabilities are at an exceptionally high risk of premature mortality. Established inequalities faced by women with disabilities may account for this increased risk. Given that maternal HIV and disability amplify each other's impact on child mortality, addressing disabled women's HIV-related needs and understanding the pathways and mechanisms contributing to these disparities is crucial.
此前关于撒哈拉以南非洲地区母婴 HIV 状况与儿童死亡率之间关联的研究发表于 2005 年至 2011 年期间。这些研究的结果表明，HIV 阳性母亲所生儿童的死亡风险更高。尽管发展中国家的残疾女性人数不断增加，但我们并未发现研究调查 HIV 阳性母亲的残疾状况与撒哈拉以南非洲地区儿童死亡率之间的关联。本研究旨在检验南非地区 HIV 阳性母亲的残疾状况与儿童死亡率之间潜在的复合效应。
我们分析了南非全国具有代表性的 2016 年南非人口与健康调查中年龄在 15-49 岁的女性数据。我们使用修正泊松回归估计了由母亲残疾和母亲 HIV 导致的儿童死亡率指标的未经调整和调整后的风险比。
与非残疾母亲所生的儿童相比，残疾母亲所生的儿童的新生儿死亡率（RR=1.80，95%CI：1.31-2.49）、婴儿死亡率（RR=1.69，95%CI：1.19-2.41）和五岁以下儿童死亡率（RR=1.78，95%CI：1.05-3.01）的风险更高。母亲残疾和 HIV 阳性状况对所选儿童死亡率指标的联合风险呈累积效应，超过了母亲残疾或母亲 HIV 阳性状况单一风险的总和（RR=3.97 vs. 联合 RR=3.67 用于新生儿死亡率；RR=3.57 vs. 联合 RR=3.25 用于婴儿死亡率；RR=6.44 vs. 联合 RR=3.75 用于五岁以下儿童死亡率）。
研究结果表明，HIV 阳性残疾妇女所生的儿童过早死亡的风险极高。残疾女性面临的既定不平等可能是导致这种风险增加的原因。鉴于母婴 HIV 和残疾会放大彼此对儿童死亡率的影响，解决残疾妇女与 HIV 相关的需求，并了解导致这些差异的途径和机制至关重要。
