The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case–control study

Figures & data

Figure 1. Map of Tigray Region, Ethiopia, study areas highlighted in light blue.

Figure 2. Sampling frame of study participants.

Table 1. Socio-demographic, economic and reproductive characteristics of respondents by HIV status.

Indicator	Response	N (%)	HIV-positive n (%)	HIV- negative n (%)	P-value
Maternal survival	Surviving	422(98.8)	211(99.0)	211(98.6)	.5
	Dead	5(1.2)	2(1.0)	3(1.4)
Age	15–24 years	115(26.9)	34(15.9)	81(37.8)	<.001*
	25–34 Years	245(57.4)	142(66.7)	103(48.1)
	> 34 years	67(15.7)	37(17.4)	30(14.1)
Marital status	Married	312(73.1)	136(63.8)	176(82.2)	<.001*
	Single	28(6.6)	19(8.9)	9(4.2)
	Divorced	63(14.8)	43(20.1)	20(9.4)
	Widowed	24(5.6)	15(7.0)	9(4.2)
Educational status	Illiterate	284(66.5)	147(69.0)	137(64.0)	.2
	Elementary	100(23.4)	50 (23.5)	50(23.4)
	High school plus	43(10.1)	16(7.5)	27(12.6)
Occupation	Housewife	162(37.9)	71(33.3)	91(42.5)	.001*
	Farmer	170(39.8)	91(42.7)	79(36.9)
	Employed	27(6.3)	7(3.3)	20(9.3)
	Self Employed	68(15.9)	44(20.7)	24(11.2)
Religion	Orthodox Christian	412(96.5)	207(97.2)	205(95.8)	.4
	Muslim	15(3.5)	6(2.8)	9(4.2)
Income status	Lower	114(26.7)	64(29.9)	50(23.3)	.1
	Fair/Good	313(73.3)	149(70.1)	164(76.7)
Number of pregnancies	One	340(82.5)	164(77.7)	176(87.6)	.03*
	Two	65(15.8)	42(19.9)	23(11.4)
	Three	7(1.7)	5(2.4)	2(1.0)
Total children	Less than 4	326(72.1)	152(48.6)	161(51.4)	.4
	4 and above	126(27.9)	61(53.5)	53(46.5)
Household size	Less than 5	338(74.8)	157(48.5)	167(51.5)	.3
	5 and above	114(25.2)	56(54.4)	47(45.6)

Table 2. Characteristics under-5-year-old children by child indicators.

Indicator	Response	N (%)	Exposed (N = 213)  n (%)	Unexposed (N = 214) n (%)	P-value
Survival	Surviving	395(92.5)	189(88.7)	206(96.3)	<.001*
	Dead	32(7.5)	24(11.3)	8(3.7)
Age	Less than 1 month	13(3.0)	10(4.7)	3(1.4)	.1
	1–12 month	137(32.1)	71(33.3)	66(30.8)
	Above 12 months	277(64.9)	132(62.0)	145(67.8)
	Mean age (±SD)		23.2(±17.7)	21.1(±13.6)	.2
Sex	Male	226(52.9)	118(55.4)	108(50.5)	.4
	Female	201(47.1)	95(44.6)	106(49.5)
Breast Feeding	Breast fed	420(98.4)	209(98.1)	213(99.5)	.3
	Not breast fed	7(1.6)	4(1.9)	1(0.5)
Immunization to their age^a	Completed	359(90.9)	174(92.1)	185(89.8)	.4
	No/not adequate	36 (9.1)	15(7.9)	21(10.2)
Antenatal care visits	None	53(12.4)	30(14.1)	23(10.7)	.4
	At least once	359(84.1)	181(85.0)	178(83.2)
	Not known	15(3.5)	2(0.9)	13(6.1)
Place of birth	Home/health post	163(38.2)	60(28.2)	103(48.1)	<.001*
	Hospital/Health centre	264(61.8)	153(71.8)	111(51.9)
HIV status	HIV infected	28(13.2)	28(13.2)	NA	<.001*
	HIV status unknown	51(23.9)	51(23.9)	NA
	HIV uninfected	134(62.9)	134(62.9)	NA
	Unexposed	214(100)	NA	214(100)

Abbreviations: SD = standard deviation, NA = not applicable.

^aDeceased children excluded.

Table 3. Comparison of 24 exposed and 8 un-exposed deceased under-5-year-old children by maternal and child indicators.

Indicators	Response	N (%)	Exposed n (%)	Unexposed n (%)	P-value
Age of respondent	15–24 years	115(26.9)	4(16.7)	1(12.5)	.16
	25–34 years	245(57.4)	14(58.3)	5(62.5)
	35–49 years	67(15.7)	6(25.0)	2(25.0)
Marital status	Married	312(73.1)	13(54.2)	6(75.0)	.09
	Single	28(6.6)	1(4.2)	0(0.0)
	Divorced	63(14.8)	8(33.3)	1(12.5)
	Widowed	24(5.6)	2(8.3)	1(12.5)
Religion	Orthodox Christian	412(96.5)	22(91.7)	8(100.0)	.38
	Muslim	15(3.5)	2(8.3)	0(0.0)
Educational status	Illiterate	284(66.5)	18(75.0)	8(100.0)	.16
	Elementary	100(23.4)	6(25.0)	0(0.0)
	High school plus	43(10.1)	0(0.0%)	0(0.0)
Occupation	House wife	162(37.9)	7(29.2)	2(25.0)	.19
	Farmer	170(39.8)	10(41.7)	6(75.0)
	Employed	27(6.3)	0(0.0%)	0(0.0)
	Self employed	68(15.9)	7(29.2)	0(0.0)
Number of pregnancies	One	340(82.5)	15(62.5)	4(50.0)	<.001
	Two	65(15.8)	6(25.0)	4(50.0)
	Three	7(1.7)	3(12.5)	0 (0.0)
Total children	Less than 4	313(73.3)	19(79.2)	4(50.0)	.2
	4 and above	114(26.7)	5(20.8)	4(50.0)
Household size	Less than 5	324(75.9)	19(79.2)	4(50.0)	.6
	5 and above	103(24.1)	5(20.8)	4(50.0)
Antenatal care visits	None	53(12.4)	9(37.5)	1(12.5)	.004*
	At least once	359(84.1)	15(62.5)	7(87.5)
Income status	Lower	114(26.7)	13(54.2)	1(12.5)	.04*
	Fair/Good	313(73.3)	11(45.8)	7(87.5)
Place of birth	Hospital/Health centre	264(61.8)	6(25.0)	1(12.5)	<.001*
	Home/Health Post	163(38.2)	18(75.0)	7(87.5)
Child HIV status	Infected	28(13.2)	8(25.0)	NA	<.001*
	Uninfected	51(23.9)	12(37.5)	NA
	Unknown status	134(62.9)	4(12.5)	NA
	Unexposed	214(100)	NA	8 (25.0)

Abbreviation: NA = not applicable.

*Significant association.

Table 4. Bivariate and multivariate analyses of risk factors for under-5-year-old child mortality.

Indicator	n (%)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	P-value
Maternal HIV status^a
Positive	24(75.0)	3.8(1.4–7.5)	2.6(0.8–7.7)	.1
Negative	8(25.0)	1	1
Antenatal care visit
None	10(31.3)	3.6(1.6–8.0)	1.5(0.6–3.7)	.4
At least once	22(68.8)	1	1
Place of delivery
Home/ Health Post	25(78.1)	6.7(2.8–15.8)	6.2(2.2–17.3)	<.001*
Hospital/Health centre	7(21.9)	1	1
Income status
Lower	14(43.8)	2.6(1.2–5.4)	1.8(0.8–4.0)	.2
Fair/Good	18(56.3)	1	1
Child HIV status^b,c
Infected	8(25.0)	10.3 (3.5–30.4)	5.2(1.5–18.0)	.009*
Uninfected	12(37.5)	2.5(1.0–6.4)	2.6(0.9–7.2)	.07
Unexposed	8(25.0)	1	1

Abbreviations: OR = odds ratio, CI = confidence interval.

*Significant difference.

^aAdjusted for all variables in the table except for child HIV status including maternal age, mariatal statu, number of pregnancy in the five years prior to study and occupation.

^bAdjusted for all variables in the table except for maternal HIV status, including maternal age, mariatal status, number of pregnancy in the five years prior to study and occupation.

^cExposed children with unknown HIV status removed.

Table 5. Health status, episodes of morbidity and health service utilization surviving under-5-year-old children two months prior to the study.

Indicators	Yes n (%)	Unadjusted		Adjusted
		OR (CI 95%)	P-value	OR (CI 95%)	P-value
Reported poor health
Child HIV status^a,b
Infected	9(19.1)	4.6(1.8–12.0)	.002	3.3(1.1–10.0)	.03*
Uninfected	7(14.9)	0.3 (0.1–0.8)	.01	0.4(0.1–0.9)	.04*
Unexposed	31(66.0)	1		1
Occupation
House wife	16(30.8)	2.8(0.6–12.8)	.2	2.6(0.5–12.4)	.2
Farmer	29(55.8)	5.1(1.2–22.8)	.03	4.5(1.0–20.6)	.05
Employee	4(7.7)	5.9(1.0–35.2)	.05	6.1(1.0–38.2)	.05
Self employed	3(5.8)	1		1
Antenatal care
None	13(26.5)	2.3(1.0–5.3)	.04	2.4(1.0–5.6)	.05
At least once	36(73.5)	1		1
Place of birth
Home/Health post	31(59.6)	2.2(1.1–4.4)	.02	2.9(1.4–6.0)	.005*
Hospital/Health centre	21(40.4)	1		1
Episodes of Diarrhoea
Maternal HIV status^a
Positive	32(16.9)	0.6(0.4–1.0)	.04	0.6(0.4–1.2)	.2
Negative	52 (25.2)	1		1
Child HIV status^a,b
Infected	6(30.0)	1.3(0.5–3.5)	.6	1.3(0.5–3.7)	.6
Uninfected	20(16.4)	0.6(0.3–1.0)	.07	0.6(0.3–1.1)	.1
Unexposed	52 (25.2)	1		1
Episode of Fever
Child HIV status^a,b
Infected	7(35.0)	2.4(0.9–6.4)	.08	2.0(0.7–5.8)	.2
Uninfected	16(13.1)	0.7(0.4–1.3)	.2	0.7(0.3–1.3)	.3
Unexposed	38(18.4)	1		1
Cough with fast breath
Child HIV status^a,b
Infected	2(10.0)	1.0(0.2–4.5)	.9	1.3(0.3–6.9)	.7
Uninfected	8(6.6)	0.7(0.3–1.5)	.3	0.9(0.3–2.2)	.8
Unexposed	20(9.7)	1		1
Income status
Lower	14(40.0)	2.1(1.0–4.4)	.04	2.2(1.0–5.0)	.05
Fair/Good	21(60.0)	1		1
Visit to health facility
Child HIV status^a,b
Infected	11(5.1)	0.7(0.3–1.9)	.5	1.0(0.4–2.7)	.9
Uninfected	78(35.9)	1.0(0.7–1.7)	.7	1.1(0.7–1.9)	.7
Unexposed	128(59.0)	1		1
Place of birth
Home/Health post	77(30.6)	1.7(1.1–2.6)	.02	0.6(0.4–1.0)	.07
Hospital/Health centre	175(69.4)	1		1
Child age
≤ 1 year	96(38.1)	1.7(1.1–2.7)	.02	0.6(0.4–1.0)	.07
>1 year	156(61.9)	1		1

Abbreviations: OR = odds ratio, CI = confidence interval.

*Significant difference.

^aAdjusted for variables in each table and for maternal age, mariatal status, number of pregnancy in the five years prior to study and occupation.

^bExposed children with unknown HIV status removed.