Maternal HIV infection and infant mortality in Malawi: evidence for increased mortality due to placental malaria infection.

ABSTRACT

PIP: Researchers analyzed data on 2608 women attending one of four prenatal clinics in Mangochi District in Malawi during 1987-1990 to study the relationship between maternal HIV infection, placental malaria infection, and infant mortality. 5.8% (138) of the women were HIV-1 seropositive. HIV-1 seroprevalence increased from 2.3% to 5.8% between 1987 and 1993. Infants born to HIV-1 positive mothers were much more likely to die during the first year of life than those born to HIV-1 negative mothers (235/1000 vs. 144/1000 live births; p 0.001). The excess deaths occurred during the postneonatal period (49 vs. 44, p = 0.3, for neonatal mortality, compared to 186 vs. 100, p 0.001, for postneonatal mortality). In the postneonatal period, diarrhea or gastrointestinal illness was more common as a cause of death among infants of HIV-1 positive mothers than those of HIV-1 negative mothers (8.7% vs. 3.6%; relative risk = 2.4; p = 0.0002). The researchers stratified the effect of maternal HIV infection on postneonatal death according to birth weight and placental malaria infection to control for potential confounding. They found that, when compared with normal birth weight infants born to seronegative mothers with no placental malaria infection, low birth weight infants born to HIV-1 positive mothers with placental malaria had an 11.49 increased odds of dying during the postneonatal period. The multivariate analysis showed that an infant born to an HIV-infected mother with placental malaria was 4.5 times more likely to die during the first year of life than an infant born to a mother with only placental malaria and 2.7-7.7 times (depending on birth weight) more likely to die than an infant born to a mother with only HIV infection. These findings suggest that malaria chemoprophylaxis during pregnancy would reduce the likelihood of HIV transmission from mother to infant in addition to reducing the burden of malaria infection during pregnancy, malaria-associated low birth weight, and their subsequent effect on child survival.