A Retrospective Study of Childhood Mortality and Spontaneous Abortion in HIV-1 Infected Women in Urban Malawi

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Abstract
Miotti P G (Infectious Diseases Program, Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA), Dallabetta G A, Chiphangwi J D, Liomba G and Saah A J. A retrospective study of childhood mortality and spontaneous abortion in HIV-1 infected women in urban Malawi. International Journal of Epidemiology 1992; 21: 792–799. HIV infection in pregnant women has been shown to have an adverse effect on the fetus and newborn. We undertook this study to examine the adverse effect of maternal HIV-1 infection on two outcomes of the previous pregnancy, as reported by the women: childhood mortality under the we of 3 years and spontaneous abortion. Some 6605 consecutive women who presented to a large urban hospital in Malawi for antenatal care were interviewed and tested for HIV-1 antibody. Of these 4229 (64%) were multiparous and 833 (19.7%) were seropositive for HIV-1. A history of under-3 mortality of the previous pregnancy was more common in HIV-1 seropositive than HIV-1 seronegative women (35% versus 15%, P < 0.001). In the previous pregnancy, death of infants and children under 3 yeers was 77 and 119 per 1000 respectivety for HIV-1 seronegative mothers, but increased to 171 and 292 per 1000 in infanta and children under 3 years for HIV-1 seropositive mothers. History of child mortality was independently associated with positive HIV-1 serology, positive syphilis serology, low socioeconomic status, young age and not having married. There was no correlation between history of child mortality and reported symptoms of HIV/AIDS by infected mothers, except for history of tuberculosis which was reported more often by mothers whose child had died (4% versus 1%. P < 0.036). History of spontaneous abortion was reported more often by HIV-1 seropositive than seronegative women (15% versus 7%, P < 0.001) and was independently associated with history of previous abortion, positive HIV-1 and syphilis serology, history of sexually transmitted disease and young age. In HIV-1 infected mothers, cough and fever for more than 1 month were the only HIV-related symptoms associated with spontaneous abortion. Thsse data show that maternal HIV-1 infection is a risk factor for both childhood mortality and adversa obstetric outcomes. This study also confirms that progress toward reducing infant and chilhood mortality in less developed countries is likely to be largely nullified by the HIV-1 epidemic.

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