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A decline in early life mortality in a high HIV prevalence rural area of South Africa: associated with implementation of PMTCT and/or ART programmes?
Presented by James Ndirangu (South Africa).
J. Ndirangu, R. Bland, M.-L. Newell
Africa Center for Health and Population Studies, UKZN, Durban, South Africa
Background: Maternal HIV infection contributes substantially to child mortality in HIV prevalence areas. All children born to HIV-infected mothers are at increased mortality risk, particularly early in life and before and after maternal death. We present early life mortality rates in a largely rural population with high HIV prevalence in women, and investigate temporal associations with a PMTCT programme, an HIV treatment programme, and maternal HIV status.
Methods: Data from the Africa Centre demographic surveillance, including deaths and births, collected twice yearly, in approximately 90,000 people; all births between 1 January 2000 and 31 December 2006 included. Under two child mortality rates (U2CMR) computed based on deaths per 1000 live-births per year; Cox proportional hazards model to investigate factors associated with risk of mortality. Additionally, taking 2005 as example, we modelled the contribution of PMTCT and maternal ART to the decline in U2CMR.
Results: There were 13,583 live-births and 848 deaths in children under 2 years. U2CMR have been declining from 2001, with the overall number of deaths in the under 2s declining by 57% between 2001 and 2006, from a peak of 86.3 to 36.7 deaths per thousand live-births; a decline of 36% before ART implementation (from 2001 to 2004), and 34% thereafter (2004 to 2006). Multivariably, maternal HIV-infection was significantly associated with increased child mortality risk (aHR=4.63, p< 0.001), while maternal death effect did not reach statistical significance (aHR=2.02, p=0.076). Modeling implied PMTCT would explain 8% and maternal ART programme 31% of the decline in U2CMR between 2001 and 2005 respectively.
Conclusions: The decline in U2CMR is substantially explained by maternal ART and consequent survival, with PMTCT (single dose NVP only) having a limited effect. Until very recently few infants were started on ART and paediatric treatment could not yet have impacted on early life mortality.
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