Analysis of comprehensive intervention measures on reducing the mortality rate of infants born to human immunodeficiency virus-infected pregnant women / 中华传染病杂志

ABSTRACT

Objective:To evaluate the effect of comprehensive intervention measures on reducing the mortality rate of infants born to human immunodeficiency virus (HIV)-infected pregnant women.Methods:A total of 9 773 infants born to pregnant women with positive HIV antibody and confirmed HIV infection in Sichuan Province from 2005 to 2019 were included. The changes of infant mortality, death composition, time of death, and main causes of death in the whole province and different regions at baseline (2005 to 2016) and after comprehensive intervention measures (from 2017 to 2019) were analyzed. Statistical analysis was conducted by chi-square test and trend chi-square test.Results:After the intervention, the infant mortality rate born to HIV-infected mothers was 49.6‰ (221/4 455), which dropped 40.6% compared to the baseline (83.5‰ (444/5 318)), and that in Liangshan Yi Autonomous Prefecture was 53.3‰ (186/3 491), which dropped 48.3% compared to the baseline (103.1‰ (379/3 676)). Furthermore, the infant mortality rate in Sichuan Province and Liangshan Yi Autonomous Prefecture decreased with time (trend χ2=42.058 and 60.041, respectively, both P<0.01). The proportions of infant death of HIV-infected mothers among the total infant death in Sichuan Province and Liangshan Yi Autonomous Prefecture decreased from 29.3% (130/444) and 25.9% (98/379) to 13.6%(30/221) and 9.7%(18/186), respectively, and the differences were statistically significant ( χ2=19.918 and 20.020, respectively, both P<0.01). The infant death time was mainly delayed from less than one month (31.5%(140/444) and 28.5%(108/379), respectively) to 2-3 months (27.6%(61/221) and 28.5%(53/186), respectively) in Sichuan Province and Liangshan Yi Autonomous Prefecture, and the differences were statistically significant ( χ2=24.642 and 26.009, respectively, both P<0.01). The infant mortality rates due to pneumonia, diarrhea, suspected HIV infection, premature delivery or low birth weight decreased from 44.4‰ (236/5 318), 12.0‰ (64/5 318), 4.9‰ (26/5 318) and 4.3‰ (23/5 318) at baseline to 26.9‰ (120/4 455), 7.6‰ (34/4 455), 1.8‰ (8/4 455) and 0.7‰ (3/4 455), respectively, and the differences were statistically significant ( χ2=21.010, 4.734, 6.691 and 12.182, respectively, all P<0.05). Conclusions:Through the implementation of comprehensive intervention measures, the infant mortality rates of HIV-infected mothers in Sichuan Province and the high endemic areas decrease significantly. However, it is necessary to pay more attention to the high death risk and the infant death in the middle or low endemic areas. The infant health care of HIV-infected mothers within six months should be strengthened. The quality of follow-up and health care services targeted to the main cause of death should be improved.