Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata.


Jahn, A; Floyd, S; McGrath, N; Crampin, AC; Kachiwanda, L; Mwinuka, V; Zaba, B; Fine, PE; Glynn, JR; (2010) Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata. PLoS One, 5 (6). e11320. ISSN 1932-6203 DOI: 10.1371/journal.pone.0011320

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Abstract

BACKGROUND As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline. METHODS/PRINCIPAL FINDINGS As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets. CONCLUSIONS/SIGNIFICANCE In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: ?? XALP ??
Centre for Maternal, Reproductive and Child Health (MARCH)
Population Studies Group
MEIRU
Tropical Epidemiology Group
PubMed ID: 20596521
Web of Science ID: 279259900005
URI: http://researchonline.lshtm.ac.uk/id/eprint/3383

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