Few studies have documented the contribution of HIV/AIDS to mortality among children under 15 years. From June 30 to October 19, 2001, all child deaths ( ) registered to the morgue and/or hospitals of the city of Pointe-Noire, Congo, were investigated using a combined approach including an interview of relatives and postmortem clinical and biological HIV diagnosis. Twenty-one percent of children were HIV positive, while 10.5% of deaths were attributed to AIDS. The most common causes of death in HIV-infected children were pneumonia (30%), pyrexia (22%), diarrhoea (16%) and wasting syndrome (16%). Infant mortality rate was estimated 6.3 times higher in children born to HIV-infected mothers compared to HIV-uninfected mothers. This study provides a direct measure of HIV/AIDS as impact on child mortality using a rapid and reliable method. A significant number of deaths could be prevented if HIV infection was diagnosed earlier and infants were provided with antiretroviral treatments. 1. Introduction In 2007, UNAIDS estimated that 2.0 million children under 15 years were living with HIV/AIDS, among whom 90% were in sub-Saharan Africa and that during the same year 270,000 children had died of AIDS [1]. In developing countries, the relative importance of AIDS among all causes of death in children is difficult to evaluate because death registers are often incomplete, and causes of death are often imprecise or inaccurate [2]. In addition, the diagnosis of AIDS is particularly difficult in children since the signs and symptoms are not specific [3]. Also, physicians and families may be reluctant to declare HIV/AIDS as the cause of death, a disease which remains highly stigmatized. Finally, when an HIV serology is available, it may only reflect the HIV status of the mothers in children less than 15 months due to the transfer of anti-HIV antibodies through the placenta [4]. Although the Republic of the Congo was one of the first countries in Africa to be affected by the HIV epidemic, HIV prevalence in the adult population has remained relatively stable over the past 25 years. In 2001, it was estimated as 4.4% in adults [1]. A small cohort study carried out during the first decade of the epidemic showed that infant mortality in children born to HIV-infected mothers exceeded 260 per thousand, while it was only 44 per thousand in children born to HIV-negative mothers [5]. As the definitive diagnosis of HIV in infants was not possible at the time, it is possible that this excess of mortality reflected both children’s HIV infection as well as the impact of AIDS in their
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