The Hazard of Dying Before Five Years among Children Born To HIV-Positive and HIV-Negative Mothers in Botswana: A Five-Year Retrospective Study

Abstract

Background: Our previous study suggested that factors affecting the hazard of dying among under-five children (UFC) born to HIV-positive mothers in Botswana depended on many factors such as maternal and child biomedical and sociodemographic characteristics. Identification of such characteristics and those that enhance/reduce the hazard of UFC-death and the strength of their association with the event is critical for an effective response. We aim herein at addressing these issues. Methods: This was a 5-years retrospective cohort study of mortality among UFC in Botswana. Data were extracted from the National Under-Five Mortality Audit Committee (NUFMAC) and analyzed using UFC-death as event and time in months. UFC feeding methods and immunization were treated as time dependent factors, age at death as a continuous-time variable; UFC-HIV status was treated as time fixe variable as all HIV-positive UFC in the study were positive at birth, none of them became positive through breastfeeding. Adjusted hazard ratios (AHRs) and their 95% CIs were computed. The Hazard functions for UFC born to HIV-positive and HIV-negative mothers were plotted and compared. Results: UFC born to HIV-positive mothers were more likely to die than UFC born to HIV-negative mothers. While UFC’s HIV-positive status, prematurity/gestational age <28 weeks, pneumonia, septicaemia, birth asphyxia and malnutrition independently enhanced the hazard of UFC-death, mixed feeding and immunizations reduced UFC’s hazard of dying. Conclusion: Although the country has commendable prevention of mother-to-child transmission programs, the fact that UFC born to HIV-positive mothers still have almost twice the hazard of dying than their counterpart calls for urgent public health action. New strategies focussing on UFC born to HIV-positive mothers are imperative to improve the survival of UFC in general, given the high proportion of UFC born to HIV-positive mothers in this setting.