Risk factors for mortality among Tanzanian infants and children

Rodrick R Kisenge,Karim P Manji,Christopher P Duggan,Chris A Rees,Wafaie W Fawzi,Enju Liu,Jacqueline M Lauer

doi:10.1186/s41182-020-00233-8

Abstract

BackgroundDuring the era of the Millennium Development Goals, under 5 mortality rates decreased significantly worldwide; however, reductions were not equally distributed. Children in sub-Saharan Africa still account for more than 50% of the world’s annual childhood deaths among children under 5 years of age. Understanding upstream risk factors for mortality among children may reduce the large burden of childhood mortality in sub-Saharan Africa. Our objective was to identify risk factors for mortality among infants and children in Tanzania.MethodsWe conducted a secondary analysis of data pooled from two randomized-controlled micronutrient supplementation trials. A total of 4787 infants were enrolled in the two trials (n = 2387 HIV-exposed and n = 2400 HIV-unexposed). Predictors of mortality were assessed using unadjusted and adjusted hazard ratios (aHRs).ResultsThere were 307 total deaths, 262 (11%) among children who were HIV-exposed and 45 (2%) among children who were HIV-unexposed (P < 0.001). The most common cause of death was respiratory diseases (n = 109, 35.5%). Causes of death did not significantly differ between HIV-exposed and HIV-unexposed children. In adjusted regression analyses, children with birth weight <2500 g (aHR 1.75, 95% CI 1.21–2.54), Apgar score of ≤7 at 5 min (aHR 2.16, 95% CI 1.29–3.62), or who were HIV-exposed but not infected (aHR 3.35, 95% CI 2.12–5.28) or HIV-infected (aHR 27.56, 95% CI 17.43–43.58) had greater risk of mortality.ConclusionsInfection with HIV, low birthweight, or low Apgar scores were associated with higher mortality risk. Early identification and modification of determinants of mortality among infants and children may be the first step to reducing such deaths.

Highlights

During the era of the Millennium Development Goals, under 5 mortality rates decreased significantly worldwide; reductions were not distributed
The mortality rate among children born to human immunodeficiency virus (HIV)-infected mothers (11%) was substantially higher compared to children born to HIV-negative mothers (2%) (P < 0.001)
The greatest risk of mortality was conferred by HIV status as infants and children who were HIV-exposed but not infected and those HIV-infected had greater risk of mortality when compared to children who were not exposed to HIV

Summary

Introduction

During the era of the Millennium Development Goals, under 5 mortality rates decreased significantly worldwide; reductions were not distributed. Understanding upstream risk factors for mortality among children may reduce the large burden of childhood mortality in sub-Saharan Africa. Our objective was to identify risk factors for mortality among infants and children in Tanzania. During the era of the Millennium Development Goals, the under 5 mortality rate decreased by 53% worldwide [1]; reductions were not distributed. Many factors contribute to high rates of childhood mortality in sub-Saharan Africa, including high prevalence of human immunodeficiency virus (HIV), limited access to skilled healthcare. The implementation of triage systems has been shown to decrease inpatient mortality among children in subSaharan Africa [7, 8] and early recognition scores are being developed to identify patients at risk of inpatient mortality [9,10,11]. The under 5 mortality rate is 53/1000 live births, a threefold decline over the past 30 years [13]

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