Incidence of Mortality among Under-Five-Year-Old Children Born to Women Living with HIV and Those Born to Women Not Living with HIV in Botswana: A 5-Year Retrospective Study.
Onalethata Lesetedi, Jose Gaby Tshikuka, Shimeles G Hamda, Mgaywa Gilbert Mjungu Damas Magafu, Roy Tapera, Tiny Masupe, Julius Chacha Mwita
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引用次数: 0
Abstract
Background: Child mortality is a core indicator for child health and wellness. Botswana reported an under-five-year-old children (UFC) mortality rate of 48 deaths per 1000 live births in 2017 against 152 deaths per 1000 live births in 1971. This was a commendable accomplishment. However, given the current country situation whereby 23% of children are born to women living with HIV, the incidence of mortality among UFC born to women living with and not living with HIV and their survival are better health metrics to inform decision making. Nevertheless, such data are still very scarce in Botswana. The study's objective was to estimate the incidence of UFC mortality among children born to women living with and not living with HIV and to compare UFC survival between the two groups.
Methods: A retrospective cohort study of mortality among UFC was conducted in Botswana, including all UFC born between January 2014 and June 2018. Data were extracted from the National Under-Five Mortality Audit Committee (NUFMAC) database using a standardized data collection tool. The incidence rate of UFC death was estimated as a function of the duration from birth to death. Survival functions of UFC born to women living with and not living with HIV were plotted and compared using Kaplan-Meier survival analysis.
Results: The overall incidence of UFC death was 4.63/1000 child months (CM) (95% CI 4.36-4.90). The incidence of UFC death among children born to women living with HIV was 6.96/1000 CM (95% CI 6.47-7.45) and that of UFC born to women not living with HIV was 4.34/1000 CM (95% CI 4.03-4.65). The overall average and standard error (SE) time to event/death for UFC born to women living with and not living with HIV was 54.80 (0.18) months. The mean (SE) time to death for UFC born to women living with HIV was 52.79 (0.41) months and that of UFC born to women not living with HIV was 55.44 (0.19) months (log-rank X2 = 37.59, p < 0.001). Prematurity or low birth weight was the leading cause of UFC death in both groups; but, it was higher in UFC born to women not living with HIV subgroup than their counterparts. Four cases only or 0.5% of the 806 death cases reported by reporting physicians were attributable to HIV-related complications.
Conclusion: Despite the commendable efforts made in reducing UFC death, the incidence of UFC death among UFC born to women living with HIV in Botswana is still higher, and their survival is shorter compared to UFC born to women not living with HIV. Child survival interventions should prioritize UFC born to women living with HIV to improve their survival.
背景:儿童死亡率是儿童健康和保健的核心指标。博茨瓦纳报告称,2017年5岁以下儿童死亡率为每1000例活产死亡48例,而1971年为每1000例活产死亡152例。这是一项值得称赞的成就。然而,鉴于该国目前23%的儿童是由感染艾滋病毒的妇女所生的情况,感染艾滋病毒和未感染艾滋病毒的妇女所生的UFC的死亡率及其存活率是更好的健康指标,可为决策提供信息。然而,这类数据在博茨瓦纳仍然非常稀少。该研究的目的是估计艾滋病毒感染者和非艾滋病毒感染者所生儿童的UFC死亡率,并比较两组之间的UFC存活率。方法:在博茨瓦纳进行了一项UFC死亡率的回顾性队列研究,包括2014年1月至2018年6月出生的所有UFC。数据采用标准化数据收集工具从全国五岁以下儿童死亡率审计委员会(NUFMAC)数据库中提取。UFC死亡的发生率被估计为从出生到死亡持续时间的函数。使用Kaplan-Meier生存分析对感染和未感染艾滋病毒的妇女所生UFC的生存功能进行了绘制和比较。结果:UFC总死亡率为4.63/1000个月(CM) (95% CI 4.36-4.90)。感染艾滋病毒的妇女所生儿童的UFC死亡率为6.96/1000 CM (95% CI 6.47-7.45),未感染艾滋病毒的妇女所生儿童的UFC死亡率为4.34/1000 CM (95% CI 4.03-4.65)。感染和未感染艾滋病毒的妇女所生的UFC事件/死亡的总体平均和标准误差(SE)时间为54.80(0.18)个月。感染艾滋病毒妇女所生UFC的平均(SE)死亡时间为52.79(0.41)个月,未感染艾滋病毒妇女所生UFC的平均(SE)死亡时间为55.44(0.19)个月(log-rank x2 = 37.59, p < 0.001)。早产或低出生体重是两组中UFC死亡的主要原因;但是,没有感染艾滋病毒的妇女所生的UFC比她们的同龄人要高。在报告医生报告的806例死亡病例中,只有4例或0.5%可归因于艾滋病毒相关并发症。结论:尽管在减少UFC死亡率方面作出了值得赞扬的努力,但博茨瓦纳感染艾滋病毒的妇女所生的UFC死亡率仍然较高,与未感染艾滋病毒的妇女所生的UFC相比,她们的生存时间更短。儿童生存干预措施应优先考虑感染艾滋病毒的妇女所生的UFC,以改善她们的生存。
期刊介绍:
AIDS Research and Treatment is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies focused on all aspects of HIV and AIDS, from the molecular basis of disease to translational and clinical research. In addition, articles relating to prevention, education, and behavior change will be considered