Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program

Pan Afr Med J. 2011;9:37. doi: 10.4314/pamj.v9i1.71215. Epub 2011 Aug 3.


Introduction: We sought to compare risk of death among children aged under-2 years born to HIV positive mother (HIV-exposed) and to HIV negative mother (HIV non-exposed), and identify determinants of under-2 mortality among the two groups in Rwanda.

Methods: In a stratified, two-stage cluster sampling design, we selected mother-child pairs using national Antenatal Care (ANC) registers. Household interview with each mother was conducted to capture socio-demographic data and information related to pregnancy, delivery and post-partum. Data were censored at the date of child death. Using Cox proportional hazard model, we compared the hazard of death among HIV-exposed children and HIV non-exposed children.

Results: Of 1,455 HIV-exposed children, 29 (2.0%; 95% CI: 1.3%-2.7%) died by 6 months compared to 18 children of the 1,565 HIV non-exposed children (1.2%; 95% CI: 0.6%-1.7%). By 9 months, cumulative risks of death were 3.0% (95%; CI: 2.2%-3.9%) and 1.3% (96%; CI: 0.7%-1.8%) among HIV-exposed and HIV non-exposed children, respectively. By 2 years, the hazard of death among HIV-exposed children was more than 3 times higher (aHR:3.5; 95% CI: 1.8-6.9) among HIV-exposed versus non-exposed children. Risk of death by 9-24 months of age was 50% lower among mothers who attended 4 or more antenatal care (ANC) visits (aHR: 0.5, 95% CI: 0.3-0.9), and 26% lower among families who had more assets (aHR: 0.7, 95% CI: 0.5-1.0).

Conclusion: Infant mortality was independent of perinatal HIV exposure among children by 6 months of age. However, HIV-exposed children were 3.5 times more likely to die by 2 years. Fewer antenatal visits, lower household assets and maternal HIV seropositive status were associated with increased mortality by 9-24 months.

Keywords: HIV; PMTCT; Rwanda; child mortality; infant mortality; maternal HIV infection; under-five mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cause of Death
  • Child Mortality
  • Child, Preschool
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • HIV Seropositivity*
  • Humans
  • Infant
  • Infant Mortality*
  • Male
  • Pregnancy
  • Pregnancy Complications, Infectious
  • Retrospective Studies
  • Risk Factors
  • Rwanda / epidemiology
  • Surveys and Questionnaires