Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jun 28;5(6):e11320.
doi: 10.1371/journal.pone.0011320.

Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata

Andreas Jahn  1 , Sian Floyd, Nuala McGrath, Amelia C Crampin, Lackson Kachiwanda, Venance Mwinuka, Basia Zaba, Paul E M Fine, Judith R Glynn
Affiliations

Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata

Andreas Jahn et al. PLoS One. .

Abstract

Background: As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.

Methods/principal findings: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.

Conclusions/significance: In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Mortality rates by socio-economic status and cause in infants and children age 1–4 years, Karonga District Malawi, 2002-6.
See this image and copyright information in PMC

References

    1. van Rossum CT, Shipley MJ, van de Mheen H, Grobbee DE, Marmot MG. Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study. J Epidemiol Community Health. 2000;54:178–184. - PMC - PubMed
    1. Gwatkin D, Rutstein S, Johnson K, Suliman E, Wagstaff A, et al. An overview: World Bank; 2007. Socio-economic differences in health, nutrition, and population within developing countries. - PubMed
    1. Razzell P, Spence C. Social capital and the history of mortality in Britain. Int J Epidemiol. 2005;34:477–478; author reply 479-480. - PubMed
    1. Over M, Piot P. HIV infection and sexually transmitted diseases. In: Jamison DT, Mosley WH, Mensham AR, Bobadilla JL, editors. Disease control priorities in developing countries. Oxford: Oxford University Press; 1993. pp. 455–527.
    1. Wojcicki JM. Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review. J Biosoc Sci. 2005;37:1–36. - PubMed

Publication types