HIV ‘Increasingly Important’ Cause of Child Mortality in Sub-Saharan Africa, Study Says
HIV/AIDS is an "increasingly important cause" of mortality in children under five in sub-Saharan Africa, according to an analysis in the July 27 issue of the Lancet. Beginning in 1960, child mortality rates showed "substantial and consistent declines" across the world, and in 2000 most U.N. member nations agreed to the Millenium Development Goal of reducing child mortality by two-thirds by 2015. However, in recent years, the rates have "stagnated" or reversed in many nations in sub-Saharan Africa, threatening to derail this goal. To determine whether HIV is largely responsible for this reversal and whether HIV/AIDS prevention would help decrease child mortality rates, Neff Walker and Bernhard Schwartlaender of UNAIDS and Jennifer Bryce of WHO's Department of Child and Adolescent Health and Development conducted an analysis of HIV prevalence in 39 sub-Saharan African nations. Using data obtained from antenatal clinics, they estimated for each nation between 1990 and 1999 the number of children born to HIV-positive women, the number of children infected with HIV through vertical transmission, the number of HIV-positive children who died before age five and the number of HIV-positive children who died before age five adjusted for other causes.
An estimated 330,000 HIV-positive children under age five died in 1999. After correcting for competing causes, 7.7% of the deaths were attributable to HIV-related causes, compared to 2% in 1990. Five nations -- Botswana, Namibia, Swaziland, Zambia and Zimbabwe -- had HIV-attributable under-five child mortality rates of above 30 per 1,000 children. Sixteen countries had rates between 10 and 25 per 1,000 children, and the remaining 18 countries had rates below 10 per 1,000.
Reducing HIV-related child mortality can be accomplished by reducing the prevalence of HIV in women of childbearing age, reducing unwanted pregnancies in women with HIV and reducing mother-to-child HIV transmission through Caesarean section, drug interventions and breastfeeding alternatives, the authors note. The estimates also "show that international targets for child survival cannot be met without substantial new efforts above and beyond the prevention of mother-to-child transmission of HIV," the authors state. Interventions to manage pneumonia, treat tuberculosis and diarrhea and prevent malaria are also needed. "[E]fforts must continue to focus on HIV/AIDS, but must also strengthen health systems that can deliver available interventions for the other major killer diseases of children in the developing world," the authors conclude (Walker et al., Lancet, 7/27).