RECENT UPTURN IN MORTALITY IN RURAL ZIMBABWE - EVIDENCE FOR AN EARLY DEMOGRAPHIC-IMPACT OF HIV-1 INFECTION

Objectives: To describe recent mortality trends in rural Zimbabwe and to assess the impact of HIV-1 infection. Method: Comparative, cross-se ctional, retrospective, demographic survey with 1-year follow-up. Para llel HIV-1 surveillance. Comparison of results with 1992 national cens us and vital registration data and results from mathematical model-bas ed population projections. Setting and participants: Residents of 929 (745 revisited in 1995) households in two rural areas of Manicaland Pr ovince, Zimbabwe, with contrasting HIV-1 prevalence: Honde and Rusitu valleys. Subjects gave information on parental survival for 2320 resid ent children. Female residents aged 13-49 years (n = 1237) provided in formation on birth histories and child survival. Consenting women atte nding local antenatal clinics (n = 487) provided blood samples for HIV -1 screening and demographic information. Main outcome measures: HIV-1 prevalence in pregnant women; per capita death registration rates; in cidence of parental death for children aged under 8 years; infant mort ality and age-specific death probabilities. Results: HIV-1 prevalence was high in each study area. Death registration and age-specific morta lity have begun to rise. The largest increases were seen in the area o f higher HIV-1 prevalence (Honde) and among younger adults, particular ly men. Incidence of parental death was observed to be rising. Increas es in registered deaths were concentrated among HIV-1-associated cause s. Conclusions: The observed increases in mortality by age, sex and ca use of death were consistent with those expected early in a severe HIV -1 epidemic, on the basis of mathematical model projections and observ ations elsewhere in Africa. Further rises in mortality, particularly a mong women and young children, and consequent increases in orphanhood, are to be expected in rural areas of Zimbabwe.