Abstract
Introductionto determine the predictors of mortality in infants in Siaya, western Kenya, ahead of novel tuberculosis (TB) vaccine trials in the same population.Methodsin a study to determine tuberculosis incidence, 2900 infants aged 0-45 days, weighing ≥ 1700g were enrolled. Four monthly follow up visits were conducted for at least 12 months. HIV testing was done at six weeks of age. Free ancillary care was provided. Deaths were reported by parents, study staff and community workers. Cox proportional Hazard analysis was used to identify risk factors. The period of analysis commenced at six weeks old and was censored at 12 months of age.Resultsincluded in the analysis were 2528 infants with 2020 person years of follow up (pyo). There were 117 deaths (4.6 %). The post-neonatal mortality rate was 58 (95% CI: 48, 69) per 1000 pyo. In multivariate analysis, health facility births were protective against mortality (Hazard Ratio (HR) 0.54; 95% CI: 0.34, 0.84) and infant HIV infection at baseline was associated with increased mortality (HR 10.3; 95% CI: 6.40, 16.7). HIV uninfected infants born to HIV infected mothers had increased hazards of mortality (HR 1.73; 95% CI: 1.03, 2.90). Gender, weight at six weeks, maternal education and occupation were not significant predictors of mortality.Conclusioninfant mortality was high and was associated with being born outside a health facility, maternal HIV infection and HIV infection of the infant. Measures to decrease mother to child transmission and other HIV control measures need to be strengthened further to see incremental reductions in infant mortality.
Highlights
Strategies to reduce child deaths have been extensively studied [13]
The post- neonatal mortality rate was 58 per 1000 person years of follow up (95% C.I 48, 69)
The post-neonatal mortality rate (58 (95%CI: 48, 69) per 1000 pyo is higher than a similar study in Eastern Uganda, which found 40 per 1000 pyo [21], Eastern Uganda has a less intense malarial transmission [19,20,21,22] and antenatal HIV prevalence rates are less than half of those in Western Kenya [23]
Summary
Strategies to reduce child deaths have been extensively studied [13]. Over the last two decades considerable progress has been made in averting thousands of child deaths [4]. Birth order, maternal illiteracy, income disparities, rural versus urban residence, relative distance from health facilities have all been known to account for high child mortality [911]. These have been identified from cross-sectional studies such as national health and demographic surveys [1, 2]. We conducted a cohort study between June 2009 and September 2011 to determine what factors predicted infant mortality in Western Kenya. This was a preparatory study to obtain tuberculosis (TB) incidence estimates amongst infants in preparation for trialing novel TB vaccine candidates in the same population, with infant mortality as a secondary objective. Excess mortality implies missed end-points when they occur prematurely
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