HIV This Week

Hong R, Banta JE, Kamau JK. Effect of maternal HIV infection on child survival in Ghana. J Community Health 2007;32:21-36.

Hong and colleagues measured the association between maternal HIV infection and infant mortality in Ghana. The authors used a censored synthetic cohort life table based on the birth history of 3639 childbirths during 1999-2003 obtained from the interviews of a nationally representative sample of 5691 women age 15-49 in 6251 households in the 2003 Ghana Demographic and Health Survey. The survey collected demographic, socioeconomic, and health data of the respondents and, as well, obtained voluntary counselling test for HIV infection from all eligible women. The effects of maternal HIV status and other factors on infant mortality were estimated using multivariate survival regression analysis and the results are presented as Hazard Ratios (HR) with 95% confident interval (95% CI). Children born to HIV infected mothers were three times as likely to die during infancy as those born to uninfected mothers (HR = 3.01; 95% CI: 1.64, 5.50). Controlling for other factors affecting infant mortality further sharpens this relationship (HR = 3.51; 95% CI: 1.87, 6.61). Not receiving antenatal care, low birth weight, and living in households that use high pollution cooking fuels were associated with a higher risk of infant mortality. The authors conclude that maternal HIV status is a strong predictor of infant mortality in Ghana, independent of several other factors. The results suggest that the HIV epidemic has had great impact on child well-being and child survival. This impact tends to increase as the HIV epidemic matures and infection in adults increases.

Editors’ note: The association between maternal HIV infection and infant mortality is likely the result of direct effects of mother-to-child HIV transmission as well as indirect effects. The latter would include maternal illness affecting parenting capacity and immune deficiency leading to reduced levels of protective maternal antibodies to childhood diseases such as measles. The antibodies normally cross the placenta to provide passive protection during the first months of life.