Influence of mothers’ health and survival on children’s survival

Mother to child HIV transmission interventions that ignore maternal health are unlikely to confer longer term benefit to child health and survival, irrespective of a child’s serostatus.

A study published in the August issue AIDS evaluated the impact of maternal HIV on child health including both the direct effects to a child of HIV infection and the indirect effects due to parental mortality, and reports a 3.2-fold increase in mortality risk to children born to HIV-positive mothers.

Mother and child survival data from a Ugandan cohort from 15 villages in the Masaka district followed by the Medical Research Council (MRC) between 1989 and 2000 was analysed. This included records from approximately 10,000 people using annual censuses and serological surveys to collect data on births, deaths, and adult HIV serostatus. Mother and child records were linked and child mortality risks (per 1,000 births) and hazard ratios (HRs) for child mortality according to maternal HIV serostatus were assessed.

Of the 3,727 children born during the study period 415 (11%) died during and 716 (19%) left the study district and 2,596 were still alive. The mother’s HIV status at birth was ascertained for 3,004 (81%) children, of whom 218 (6%) were born to HIV-positive mothers.

Maternal and infant mortality were highly correlated and the investigators reported that “in the year leading up to and following a mother’s death children experienced mortality rates that were five times higher than those with living mothers”.

Infant mortality risk was higher for HIV-positive than HIV-negative mothers – 225 per thousand live births [95% CI, 174-385] versus 53, as was child mortality risk – 313 [95% CI, 174-289] versus 114.

After controlling for child’s age and sex, the investigators found independent predictors of mortality in children were: mother’s terminal illness or death (HR = 3.8); mother being HIV positive (HR = 3.2); child being a twin (HR = 2.0); teenage motherhood (HR = 1.7) and maternal absence (HR = 1.7).

“The very high mortality of mothers who die within a few years of giving birth suggests that simply reducing vertical transmission might not proportionately reduce the mortality risks in children of infected mothers,” the authors write. They add: “Programmes aimed at the welfare of children should take into account the independent effect of mothers’ HIV and vital status.”

Nakiyingi JS; Bracher M; Whitworth JAG et al. Child survival in relation to mother’s HIV infection and survival: evidence from a Ugandan cohort study. AIDS 2003, 17: 1827-1834.