{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:33:45Z","timestamp":1779204825350,"version":"3.51.4"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["5U2G GH000817-02"],"award-info":[{"award-number":["5U2G GH000817-02"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Uganda reported a significant reduction in the mortality rate of children under 5 years of age, from 146\/1,000 live births in 2000\u201342\/1,000 live births in 2021. With the rollout of Option B+, the vertical transmission rate of HIV decreased from 13.0% (2012) to 6.0% (2019). However, its impact on the mortality rate among children is not well documented. We determined the mortality rate and associated risk factors among infants exposed and not exposed to HIV attending immunization clinics in Uganda.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted an observational prospective cohort study of mother\u2013infant pairs (MIPs) with infants exposed or unexposed to HIV. We enrolled infants aged 4\u201312 weeks. The inclusion criteria were biological mothers attending health facilities that provide routine immunization for children and\/or postnatal care visits who were able to provide signed written informed consent; mothers or infants who were not severely ill; and those who consented to have their infants tested for HIV antibodies at baseline and follow-up visits every 3 months until the children were aged 18 months. Child-HIV infection and death were censored events. Children lost to follow-up or withdrawn from the study were censored from analyses at the last documented study visit. The outcome of interest was child mortality, and the independent variables were mother\u2019s age; infant HIV exposure status; infant sex; family socioeconomic status; marital status; education level; malaria during pregnancy; birth attendee; mother\u2019s ART initiation; mode of transport to health facilities; breastfeeding pattern; 4 or more ANC visits; and mother\u2019s baseline viral load nonsuppression and place of delivery. We used Kaplan\u2013Meier survival curves to estimate cumulative mortality probability and the Wilcoxon log-rank test to compare differences in cumulative survival functions. We used multivariate Weibull proportional hazards and Weibull accelerated failure time (AFT) regression models with 95% confidence intervals (CIs) to identify factors associated with child death.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Among the 16,718 MIPs identified, 11,519 (68.9%) mothers consented to study follow-up. At the 18-month follow-up, 0.7% (79\/11,519) of the infants had died, 40.5% (32\/79) of whom were exposed to HIV. The overall child mortality rate per 1,000 person-years was 5.0 (95% CI: 4.0--6.2) and was significantly greater among the infants exposed to HIV (14.2; 95% CI: 10.0--20.0) than among the infants not exposed to HIV (3.5; 95% CI: 2.6--4.6). In the adjusted model, the mortality risk factors were HIV exposure status (aHR5.6 95% CI: 3.5--9.4), maternal age\u2009&lt;\u200925 years (aHR1.8; 95% CI: 1.1--2.9), living without a partner (aHR1.8; 95% CI: 1.1--2.9), and delivery at home (aHR2.2; 95% CI: 1.3--4.0).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Single young mothers living with HIV delivering at home increased the risk of child mortality. Identifying mothers with risk factors early for support could reduce the risk of child mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324122","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T17:51:17Z","timestamp":1748022677000},"page":"e0324122","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mortality rates in a cohort of infants attending immunization clinics in Uganda (2017\u20132019)"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3981-7953","authenticated-orcid":true,"given":"Samuel","family":"Sendagala","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8211-7012","authenticated-orcid":true,"given":"Rose Bosa","family":"Nakityo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrick","family":"Makumbi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Lutalo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Nabitaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Nalugoda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Lukabwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingo","family":"Kasule","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Namara-Lugolobi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret Achom","family":"Okwero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilda T.","family":"Asiimwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phoebe","family":"Namukanja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernadette","family":"Ng'eno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4631-2643","authenticated-orcid":true,"given":"Emilio","family":"Dirlikov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustina","family":"Delaney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"pone.0324122.ref001","volume-title":"Levels & Trends in Child Mortality: Report 2022, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation","author":"UNICEF","year":"2023"},{"key":"pone.0324122.ref002","author":"UN","year":"2015"},{"issue":"2","key":"pone.0324122.ref003","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the sustainable development goals","volume":"6","author":"J Perin","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"issue":"4","key":"pone.0324122.ref004","doi-asserted-by":"crossref","first-page":"281","DOI":"10.2471\/BLT.15.157149","article-title":"Under-five mortality according to maternal survival: a systematic review and meta-analysis","volume":"95","author":"LC Chikhungu","year":"2017","journal-title":"Bull World Health Organ"},{"issue":"10","key":"pone.0324122.ref005","doi-asserted-by":"crossref","first-page":"2414","DOI":"10.1080\/21645515.2018.1515453","article-title":"Morbidity benefit conferred by childhood immunisation in relation to maternal HIV status: a meta-analysis of demographic and health surveys","volume":"14","author":"OO Adetokunboh","year":"2018","journal-title":"Hum Vaccin Immunother"},{"issue":"5","key":"pone.0324122.ref006","article-title":"Contribution of maternal antiretroviral therapy and breastfeeding to 24-month survival in human immunodeficiency virus-exposed uninfected children: an individual pooled analysis of African and Asian studies","volume":"13","author":"S Arikawa","year":"2018","journal-title":"PLOS ONE"},{"key":"pone.0324122.ref007","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2307\/2807954","article-title":"An analytical framework for the study of child survival in developing countries","volume":"10","author":"WH Mosley","year":"1984","journal-title":"Popul Dev Rev"},{"issue":"6","key":"pone.0324122.ref008","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/01.inf.0000264527.69954.4c","article-title":"Child mortality according to maternal and infant HIV status in Zimbabwe","volume":"26","author":"E Marinda","year":"2007","journal-title":"Pediatr Infect Dis J"},{"issue":"4","key":"pone.0324122.ref009","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1093\/cid\/ciaa076","article-title":"Mortality, human immunodeficiency virus (HIV) transmission, and growth in children exposed to HIV in rural Zimbabwe","volume":"72","author":"C Evans","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0324122.ref010","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3851\/IMP1991","article-title":"Treating HIV-infected mothers reduces under 5 years of age mortality rates to levels seen in children of HIV-uninfected mothers in rural South Africa","volume":"17","author":"J Ndirangu","year":"2012","journal-title":"Antivir Ther"},{"issue":"3","key":"pone.0324122.ref011","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1080\/14034940600979171","article-title":"Socioeconomic determinants of infant mortality: a worldwide study of 152 low-, middle-, and high-income countries","volume":"35","author":"CO Schell","year":"2007","journal-title":"Scand J Public Health"},{"key":"pone.0324122.ref012","author":"MOH","year":"2013"},{"key":"pone.0324122.ref013","author":"UNAIDS","year":"2021"},{"key":"pone.0324122.ref014","author":"WHO","year":"2013"},{"key":"pone.0324122.ref015","author":"WHO","year":"2021"},{"issue":"1","key":"pone.0324122.ref016","first-page":"16","article-title":"An early assessment of Uganda\u2019s roll-out of Option B+: service capacity and infant outcomes","author":"R Baryamutuma","year":"2017","journal-title":"East Afr J Appl Health Monitor Eval"},{"issue":"4","key":"pone.0324122.ref017","doi-asserted-by":"crossref","first-page":"90","DOI":"10.15585\/mmwr.mm7204a2","article-title":"Scale-up of HIV antiretroviral therapy and estimation of averted infections and HIV-related deaths - Uganda, 2004-2022","volume":"72","author":"E Dirlikov","year":"2023","journal-title":"Morb Mortal Wkly Rep"},{"key":"pone.0324122.ref018","unstructured":"Health Mo. Uganda Population Based HIV Impact Assessment 2020-2021, Final Report Kampala: Ministry of Health; 2020 April. 2024."},{"issue":"5","key":"pone.0324122.ref019","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1467-842X.2001.tb00294.x","article-title":"How can I deal with missing data in my study?","volume":"25","author":"DA Bennett","year":"2001","journal-title":"Aust N Z J Public Health"},{"key":"pone.0324122.ref020","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/1471-2458-14-314","article-title":"Two year mortality and associated factors in a cohort of children from rural Uganda","volume":"14","author":"P Nabongo","year":"2014","journal-title":"BMC Public Health"},{"key":"pone.0324122.ref021","volume-title":"Uganda Demographic and Health Survey 2011","author":"Uganda Bureau of Statistics - UBOS, ICF International","year":"2012"},{"key":"pone.0324122.ref022","volume-title":"Uganda AIDS Indicator Survey (UAIS) 2011","author":"Ministry of Health\/Uganda, ICF International","year":"2012"},{"issue":"1","key":"pone.0324122.ref023","doi-asserted-by":"crossref","first-page":"16263","DOI":"10.1038\/s41598-021-95886-8","article-title":"Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis","volume":"11","author":"RA Simmons","year":"2021","journal-title":"Sci Rep"},{"issue":"12","key":"pone.0324122.ref024","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(14)70329-8","article-title":"Protective efficacy of prolonged co-trimoxazole prophylaxis in HIV-exposed children up to age 4 years for the prevention of malaria in Uganda: a randomised controlled open-label trial","volume":"2","author":"J Homsy","year":"2014","journal-title":"Lancet Glob Health"},{"issue":"9448","key":"pone.0324122.ref025","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1016\/S0140-6736(04)17442-4","article-title":"Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial","volume":"364","author":"C Chintu","year":"2004","journal-title":"Lancet"},{"issue":"12","key":"pone.0324122.ref026","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1097\/00002030-200308150-00012","article-title":"Child survival in relation to mother\u2019s HIV infection and survival: evidence from a Ugandan cohort study","volume":"17","author":"JS Nakiyingi","year":"2003","journal-title":"AIDS"},{"issue":"15","key":"pone.0324122.ref027","doi-asserted-by":"crossref","DOI":"10.1097\/00002030-200010200-00021","article-title":"Mortality associated with HIV infection in rural Rakai district, Uganda","volume":"14","author":"N Sewankambo","year":"2000","journal-title":"AIDS"},{"issue":"9","key":"pone.0324122.ref028","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.2217\/fvl.15.70","article-title":"Morbidity and mortality in HIV-exposed uninfected children","volume":"10","author":"C Thorne","year":"2015","journal-title":"Future Virol"},{"issue":"3","key":"pone.0324122.ref029","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1086\/649886","article-title":"Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers","volume":"50","author":"L Kuhn","year":"2010","journal-title":"Clin Infect Dis"},{"issue":"7","key":"pone.0324122.ref030","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1001\/jama.296.7.794","article-title":"Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study","volume":"296","author":"I Thior","year":"2006","journal-title":"JAMA"},{"issue":"4","key":"pone.0324122.ref031","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1097\/01.qai.0000188122.15493.0a","article-title":"Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda","volume":"41","author":"H Brahmbhatt","year":"2006","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"4","key":"pone.0324122.ref032","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1086\/519847","article-title":"Infant morbidity, mortality, and breast milk immunologic profiles among breast-feeding HIV-infected and HIV-uninfected women in Botswana","volume":"196","author":"RL Shapiro","year":"2007","journal-title":"J Infect Dis"},{"issue":"2","key":"pone.0324122.ref033","doi-asserted-by":"crossref","first-page":"279","DOI":"10.3390\/v15020279","article-title":"Immune and metabolic alterations in children with perinatal HIV exposure","volume":"15","author":"LDV du Toit","year":"2023","journal-title":"Viruses"},{"issue":"7","key":"pone.0324122.ref034","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1093\/infdis\/jiac133","article-title":"Defective monocyte enzymatic function and an inhibitory immune phenotype in human immunodeficiency virus-exposed uninfected African Infants in the era of antiretroviral therapy","volume":"226","author":"L Afran","year":"2022","journal-title":"J Infect Dis"},{"key":"pone.0324122.ref035","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1186\/1471-2393-14-240","article-title":"The effect of mother\u2019s age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania","volume":"14","author":"M Selemani","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pone.0324122.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0195731","article-title":"The impact of young maternal age at birth on neonatal mortality: evidence from 45 low and middle income countries","volume":"13","author":"S Neal","year":"2018","journal-title":"PLoS One"},{"issue":"2","key":"pone.0324122.ref037","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/ije\/dyl284","article-title":"Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study","volume":"36","author":"X-K Chen","year":"2007","journal-title":"Int J Epidemiol"},{"issue":"2","key":"pone.0324122.ref038","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2011-000226","article-title":"The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries","volume":"1","author":"JE Finlay","year":"2011","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0324122.ref039","doi-asserted-by":"crossref","first-page":"16","DOI":"10.6000\/1929-4247.2017.06.01.2","article-title":"Adolescent fertility and child health: the interaction of maternal age, parity and birth intervals in determining child health outcomes","volume":"6","author":"JE Finlay","year":"2017","journal-title":"Int J Child Health Nutr"},{"key":"pone.0324122.ref040","volume-title":"Uganda Demographic and Health Survey 2016: Key Indicators Report","author":"ICF UBoSUa","year":"2017"},{"issue":"2","key":"pone.0324122.ref041","doi-asserted-by":"crossref","first-page":"451","DOI":"10.4314\/ahs.v22i2.52","article-title":"Prevalence and factors associated with teenage pregnancy among parturients in Mbale Regional Referral Hospital: a cross sectional study","volume":"22","author":"V Chemutai","year":"2022","journal-title":"Afr Health Sci"},{"issue":"5","key":"pone.0324122.ref042","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-007681","article-title":"Effect of adolescent pregnancy on child mortality in 46 countries","volume":"7","author":"N Noori","year":"2022","journal-title":"BMJ Glob Health"},{"issue":"4","key":"pone.0324122.ref043","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.jpag.2021.03.003","article-title":"Prevalence of low birth weight, premature birth, and stillbirth among pregnant adolescents in Canada: a systematic review and meta-analysis","volume":"34","author":"N DeMarco","year":"2021","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"2","key":"pone.0324122.ref044","first-page":"192","article-title":"Young maternal age and infant mortality: the role of low birth weight","volume":"102","author":"A Friede","year":"1987","journal-title":"Public Health Rep"},{"issue":"1","key":"pone.0324122.ref045","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12963-019-0195-7","article-title":"The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil","volume":"17","author":"CS Vilanova","year":"2019","journal-title":"Popul Health Metr"},{"issue":"1","key":"pone.0324122.ref046","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1186\/s12884-019-2347-y","article-title":"Predictors of teenage pregnancy among girls aged 13-19\u2009years in Uganda: a community based case-control study","volume":"19","author":"AM Ochen","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0324122.ref047","doi-asserted-by":"crossref","DOI":"10.1363\/2020.31593","volume-title":"Adding it up: investing in sexual and reproductive health 2019","author":"E Sully","year":"2020"},{"issue":"7","key":"pone.0324122.ref048","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1080\/17441692.2021.1922732","article-title":"Her, his, and their fertility desires and contraceptive behaviours: a focus on young couples in six countries","volume":"17","author":"IS Speizer","year":"2022","journal-title":"Glob Public Health"},{"issue":"1","key":"pone.0324122.ref049","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1186\/s12889-023-16531-9","article-title":"Development and validation of the socioeconomic status composite scale (SES-C)","volume":"23","author":"H Sacre","year":"2023","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0324122.ref050","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12884-019-2190-1","article-title":"Poverty, urban-rural classification and term infant mortality: a population-based multilevel analysis","volume":"19","author":"YA Mohamoud","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"4","key":"pone.0324122.ref051","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s11113-005-0088-2","article-title":"Infant mortality and socioeconomic status: new bottle, same old wine","volume":"24","author":"EG Stockwell","year":"2005","journal-title":"Popul Res Policy Rev"},{"key":"pone.0324122.ref052","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.socscimed.2015.08.003","article-title":"Impact of hospital delivery on child mortality: an analysis of adolescent mothers in Bangladesh","volume":"143","author":"S Pal","year":"2015","journal-title":"Soc Sci Med"},{"issue":"9","key":"pone.0324122.ref053","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1093\/aje\/kwv125","article-title":"Vaccination and all-cause child mortality from 1985 to 2011: global evidence from the demographic and health surveys","volume":"182","author":"ME McGovern","year":"2015","journal-title":"Am J Epidemiol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T17:51:34Z","timestamp":1748022694000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324122"}},"subtitle":[],"editor":[{"given":"Emma K.","family":"Kalk","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324122","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]}}}