Academic journal article Bulletin of the World Health Organization

Trends in Under-5 Mortality Rates and the HIV/AIDS Epidemic

Academic journal article Bulletin of the World Health Organization

Trends in Under-5 Mortality Rates and the HIV/AIDS Epidemic

Article excerpt

Voir page 1205 le resume en francias. En la pagina 1205 figura un resumen en espanol.


Although human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) originally emerged as adult health problems, they have become a major killer of under-5-year-old children, especially in developing countries. Children of HIV-seropositive mothers can acquire the virus directly through vertical transmission; about 25-30% of children born to infected mothers become infected with HIV and almost all of them die before 5 years of age in most developing countries with high HIV prevalence. Thus, under-5 mortality rates among children of HIV-infected mothers are two to five times higher than those among children of HIV-negative mothers (1). The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that by 1996 a cumulative total of about 3 million children had been infected with HIV worldwide and that most of them had died (2). Since then, many more children are believed to have died as a result of HIV infection and other AIDS-related problems. According to UNAIDS estimates, about 14 million women of childbearing age currently live with HIV/AIDS in the world, giving birth to children with an elevated risk of HIV infection and death before the age of 5 years. Even among children who are not infected, many will die because the resources needed to ensure their survival and health are used to care for HIV-seropositive adults.

Adult HIV prevalence and under-5 mortality, rates therefore seem to have increased or stagnated in many countries. A recent World Bank report suggests that life expectancy at birth in countries with a high HIV-prevalence, such as Botswana, Zambia and Zimbabwe, is lower in 2000 than it was in 1975 (3). Although 14 million lives have already been lost to HIV/AIDS, it is estimated that only 10% of the total impact of illness and death from the pandemic has been seen so far. One of the concerns is whether the effects of the epidemic will, as some fear (4), reverse the substantial child survival gains that have resulted from huge international efforts over the past decades in several developing countries. The objective of the present study was to use available data to monitor trends in under-5 mortality in countries with different levels of adult HIV prevalence and estimate how much of the observed under-5 mortality rate is attributable to the prevalence of HIV among adults.

Although HIV/AIDS occurs in both developed and developing countries, the analysis here focuses on developing countries for two main reasons: UNAIDS estimates that more than 90% of all HIV-related deaths occur in the developing world; and medical advances and available treatments in more developed regions make it difficult to observe the precise impact of HIV prevalence. In the USA, for example, although the country has one of the highest adult HIV prevalences in the developed world, infant and child mortality rates have continued to decline. Between 1981 (when the first cases of AIDS were identified in the USA) and 1998, infant mortality rates declined from 11.9 to 7.2 per 1000 live births (5, 6). This is likely to be the experience also in other industrialized countries. Major effects of adult HIV prevalence on under-5 mortality are therefore more likely to be seen in developing countries.

Materials and methods

Data sources

Data from the Demographic and Health Surveys (DHS) were used to derive trends in under-5 mortality rates in countries with different levels of HIV prevalence. The DHS project, which began in 1984, was a 13-year programme of survey data collection in several developing countries with core funding from the US Agency for International Development (USAID). A total of 25 countries that had participated more than once in the DHS programme were selected: 12 in sub-Saharan Africa, 3 in south-east Asia, 6 in Latin America and the Caribbean, and 4 in North Africa and the eastern Mediterranean. …

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