Infant mortality in Haiti: the role of HIV-1 infection measles and diarrhea.

Researchers analyzed cohort data on 1499 live births between October 1981 and April 1982 on 4588 pregnant women from July 1986 to August 1988 and 9103 pregnancy histories from 1977 onward in Cite Soleil a periurban slum of Port au Prince Haiti to evaluate the Centers for Development and Health (CDS) community health program established in 1974. Infant mortality had steadily declined from 235 to 89.4 between 1976 and 1981 probably due to the decline in neonatal tetanus. It fluctuated from 92.3 to 108.2 to 82 between 1982 and 1984 but since 1985 it increased to 120.6 even though CDS continued its preventive services. This may have occurred due to the considerable political and economic instability in Haiti since 1985. The expected infant mortality rate was 108. Infant mortality was 23.4% for those children born to HIV-1 positive mothers (1987-89). Thus maternal HIV-1 infections caused an 11.7% rise in the infant mortality rate. Measles vaccinations were not even available to the community until 1982 and were not a priority until 1984. Vaccination against measles had the leading role in child survival among 9-39 month old economically disadvantaged children (odds ratio 6.5; (p = .0013). 79.5% of mothers knew about oral rehydration therapy as the means to treat dehydration caused by diarrhea. 93.4% of mothers whose children had diarrhea within the last week used ORT. Yet diarrhea was responsible for 55.9% of all deaths between 1979 and 1984. Diarrheal deaths were especially problematic in severely malnourished children (41%). 71% of the mothers in Cite Soleil also began to bottle feed their =or< 1 month old infants however. These results stressed the need for preventive programs to have multifaceted interventions to improve child survival. These programs should not sacrifice these interventions while pursuing efforts to control AIDS however.