a1 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
a2 Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
a3 Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
a4 Department of Community Health Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
Objective Predictors and consequences of childhood anaemia in settings with high HIV prevalence are not well known. The aims of the present study were to identify maternal and child predictors of anaemia among children born to HIV-infected women and to study the association between childhood anaemia and mortality.
Design Prospective cohort study. Maternal characteristics during pregnancy and Hb measurements at 3-month intervals from birth were available for children. Information was also collected on malaria and HIV infection in the children, who were followed up for survival status until 24 months after birth.
Setting Dar es Salaam, Tanzania.
Subjects The study sample consisted of 829 children born to HIV-positive women.
Results Advanced maternal clinical HIV disease (relative risk (RR) for stage ≥2 v. stage 1: 1·31, 95 % CI 1·14, 1·51) and low CD4 cell counts during pregnancy (RR for <350 cells/mm3 v. ≥350 cells/mm3: 1·58, 95 % CI 1·05, 2·37) were associated with increased risk of anaemia among children. Birth weight <2500 g, preterm birth (<34 weeks), malaria parasitaemia and HIV infection in the children also increased the risk of anaemia. Fe-deficiency anaemia in children was an independent predictor of mortality in the first two years of life (hazard ratio 1·99, 95 % CI 1·06, 3·72).
Conclusions Comprehensive care including highly active antiretroviral therapy to eligible HIV-infected women during pregnancy could reduce the burden of anaemia in children. Programmes for the prevention of mother-to-child transmission of HIV and antimalarial treatment to children could improve child survival in settings with high HIV prevalence.
(Received October 22 2008)
(Accepted June 01 2009)
(Online publication August 04 2009)
p1 Correspondence address: c/o Wafaie Fawzi, Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA