Child Mortality in Rural Malawi: HIV Closes the Survival Gap between the Socio-Economic Strata
Child Mortality in Rural Malawi: HIV Closes the Survival Gap between the Socio-Economic Strata
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DOI：
10.1371/journal.pone.0011320
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发表时间：
2010-06-28
期刊：
影响因子：
3.7
通讯作者：
Glynn, Judith R.
中科院分区：
文献类型：
--
作者：
Jahn, Andreas;Floyd, Sian;Glynn, Judith R.
背景：随着人口中艾滋病毒相关死亡人数的增加，低社会经济地位与儿童死亡率之间的通常关系可能会改变，特别是当其他原因的死亡率下降时。方法/主要结果：作为2002-2006年马拉维北部人口监测系统的一部分，覆盖3.2万人口，收集了有关家庭社会经济地位的信息。通过口头尸检将死亡归类为与艾滋病毒/艾滋病有关或不与艾滋病毒/艾滋病有关。使用泊松回归模型评估社会经济指标与儿童全因死亡率、艾滋病死亡率和非艾滋病死亡率之间的关系。婴儿死亡195人，1-4岁儿童死亡109人，5-15岁儿童死亡38人。在社会经济地位较高和较低的家庭中，婴儿和1-4岁儿童的全因儿童死亡率相似。在婴儿中，13%的死亡归因于艾滋病，艾滋病或非艾滋病原因的社会经济状况没有明显的趋势。对于1-4岁的儿童来说，27%的死亡归因于艾滋病。房屋建筑质量较好的人群艾滋病死亡率较高，耕种和渔业收入人群的艾滋病死亡率最低，而房屋建筑质量较差的人群非艾滋病死亡率较高，就业收入人群的非艾滋病死亡率最低，且随着家庭资产的增加而下降。结论/意义：在这一人群中，由于成人感染HIV最初在贫困人口中更为常见，儿童死亡模式已经发生了变化。穷人和不那么贫穷的人之间通常存在的生存差距已经消失，但这是因为不那么贫穷的人受到艾滋病毒的影响不成比例，而不是因为最贫穷的人的生存状况相对改善。
Background: As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.Methods/Principal Findings: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.Conclusions/Significance: In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest.