HIV, malaria, and infant anemia as risk factors for postneonatal infant mortality among HIV-seropositive women in Kisumu, Kenya

Background. HIV and malaria in sub-Saharan Africa are associated with poor pregnancy outcome and infant survival. We studied the association of placental malaria, infant malaria and anemia, and infant HIV status with postneonatal infant mortality ( PNIM) among infants of HIV-seropositive women. Methods. During 1996-2001, infants born to 570 HIV-seropositive mothers in Kisumu, Kenya were monitored monthly for malaria ( parasitemia or clinical malaria) and anemia ( hemoglobin level < 8 g/dL) and vital status. Results. Thirty-nine deaths occurred among 112 HIV-positive infants ( 420/1000 live births [ LBs] [ 95% confidence interval {CI}, 318-522 LBs]), and 36 occurred among 458 HIV-negative infants ( 99/1000 LBs [ 95% CI, 68-130 LBs]) (p < .001). In multivariate Cox regression analysis among HIV-negative infants, PNIM was associated with infant anemia ( adjusted hazard ratio [ AHR], 5.03 [ 95% CI, 1.97-12.81]) but not with placental malaria ( AHR, 1.22 [ 95% CI, 0.50-2.95]) or infant malaria ( AHR, 0.35 [ 95% CI, 0.10-1.21]). Among HIV-positive infants, neither placental malaria ( AHR, 0.34 [ 95% CI, 0.10-1.10]) nor infant malaria ( AHR, 0.31 [ 95% CI, 0.07-1.33]) or anemia ( AHR, 1.07 [ 95% CI, 0.32-3.61]) was significantly associated with PNIM. Conclusion. In this study population, placental malaria and infant parasitemia were not risk factors for PNIM among infants of HIV-seropositive women. The prevention of infant anemia may decrease PNIM among HIV-negative infants of HIV-seropositive women.