mortality and health outcomes of hiv-exposed and unexposed children in a pmtct cohort in malawi死亡率和健康结果预防母婴传播感染艾滋病毒风险的和未曝光的儿童使用的队列在马拉维.pdfVIP

Mortality and Health Outcomes of HIV-Exposed and Unexposed Children in a PMTCT Cohort in Malawi 1,2 1,3 1,2,3 1 3,4 Megan Landes , Monique van Lettow *, Adrienne K. Chan , Isabell Mayuni , Erik J. Schouten , Richard A. Bedell1 1 Dignitas International, Zomba, Malawi, 2 Department of Family and Community Medicine, University of Toronto, Toronto, Canada, 3 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, 4 Management Sciences for Health, Lilongwe, Malawi Abstract Background: Mortality and morbidity among HIV-exposed children are thought to be high in Malawi. We sought to determine mortality and health outcomes of HIV-exposed and unexposed infants within a PMTCT program. Method: Data were collected as part of a retrospective cohort study in Zomba District, Malawi. HIV-infected mothers were identified via antenatal, delivery and postpartum records with a delivery date 18–20 months prior; the next registered HIV- uninfected mother was identified as a control. By interview and health record review, data on socio-demographic characteristics, service uptake, and health outcomes were collected. HIV-testing was offered to all exposed children. Results: 173 HIV-infected and 214 uninfected mothers were included. 4 stillbirths (1.0%) occurred; among the 383 livebirths, 41 (10.7%) children died by 20 months (32 (18.7%) HIV-exposed and 9 unexposed children (4.3%; p,0.0001)). Risk factors for child death included: HIV-exposure [adjOR2.9(95%CI 1.1–7.2)], low birthweight [adjOR2.5(1.0–6.3)], previous child death (adjOR25.1(6.5–97.5)] and maternal death [adjOR5.3(11.4–20.5)]. At 20 months, HIV-infected children had signific