The impact of HIV/AIDS on mortality and household mobility in rural Tanzania

Objective: To assess the impact of the AIDS epidemic on mortality and house hold mobility before and after death. Design: Open community cohort study with a demographic surveillance system and two sero-epidemiological surveys. Methods: Ten rounds of demographic surveillance were completed during 1994- 1998 in the study area, which has a population of about 20 000 people in a rural ward in north-west Tanzania. Households with deaths were visited for a detailed interview, including a verbal autopsy. Data on HIV status were c ollected in two surveys of all residents aged 15-44 years. Results: Mortality rates among HIV-infected adults were 15 times higher tha n those among HIV-negative adults and HIV/AIDS was associated with nearly h alf of deaths at ages 15-44 years. Verbal autopsies without HIV test result s considerably underestimated the proportion of deaths associated with HIV/ AIDS. The mortality probability between 15 and 60 years was 49% for men and 46% for women and life expectancy was 43 years for men and 44 years for wo men. By their second birthday nearly one-quarter of the new-borns of HIV-in fected mothers had died, which was 2.5 times higher than among children of HIV-negative mothers. Mobility of household members before and after death was high. In 44% of households in which the head died all members moved out of the household. Conclusions: In this rural population with HIV prevalence close to 7% among adults aged 15-44 years during the mid-1990s, HIV/AIDS is having substanti al impact on adult mortality. A common response to death of a head of house hold in this community is household dissolution, which has implications for measurement of the demographic and socio-economic impact of AIDS. (C) 2001 Lippincott Williams & Wilkins.