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James Ndirangu Marie-Louise Newell Claire Thorne Ruth Bland

Treating HIV infected mothers benefits children under-5 years of age: evidence from rural, high HIV prevalence South Africa. James Ndirangu Marie-Louise Newell Claire Thorne Ruth Bland. Background. Globally, reducing child mortality remains a major public health priority – MDG 4

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James Ndirangu Marie-Louise Newell Claire Thorne Ruth Bland

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  1. Treating HIV infected mothers benefits children under-5 years of age: evidence from rural, high HIV prevalence South Africa James Ndirangu Marie-Louise Newell Claire Thorne Ruth Bland

  2. Background • Globally, reducing child mortality remains a major public health priority – MDG 4 • Maternal HIV affects child mortality through vertical transmission or maternal ill-health • Recent evidence shows that ART contributes to a decline in adult and child mortality at a population level

  3. Yearly percentage decline in U5MR 1990-2010 SA: 5.7 million people living with HIV in 2009; 1 out of 3 women aged 25-29 Source: Rajaratnam J.K. et al. Lancet 2010

  4. Objectives • We investigated under-5 mortality and quantified the association between maternal survival and child mortality, by linking mother and child records from demographic surveillance and an HIV treatment programme

  5. Methods – Data Source HIV treatment (ART) programme (~40% of patients on ART live in the surveillance area) 774 women on ART were matched, of whom ~300 had initiated within 5 years post-delivery 2002-2004 PMTCT (sdNVP) & IF 2000-2001 2005-2007 HIV treatment (ART) programme Late 2004 N=2,172 women on ART 2006

  6. Variables • Outcome variable was child mortality • Maternal HIV status from surveillance data was classified as: HIV-negative: negative at birth and throughout 5 years post-delivery HIV-positive or unknown status: - Not-initiated – mothers never initiated on ART - Initiated – mothers initiated on ART < 5 years post-delivery

  7. Crude U5MR/1000 live-births

  8. Estimated unadjusted U5MR by maternal ART status; for women of HIV positive/unknown status

  9. Multivariable analysis Adjusting for: multipregnancy, birth order, delivery location, birth area, household assets, birth season, maternal age, mat education, previous fetal death, previous child death, and residency status

  10. Adjusting for all other factors including maternal ART

  11. Conclusion • The U5MR decline occurred despite continuing high HIV incidence and prevalence • This highlights the importance of maternal HIV treatment with benefits of improved survival in all children under-5 years of age • Urgency in scaling up HIV treatment programmes is necessary to realise MDG4 by 2015

  12. Thank you!

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