Peer-reviewed article
Risk factors for stunting in children who are HIV‐exposed and uninfected after Option B+ implementation in Malawi
Gabriela Toledo, Megan Landes, Monique van Lettow, Beth A. Tippett Barr, Heather Bailey et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study followed Malawian children who were exposed to HIV but not infected, after the country introduced Option B+ (lifelong antiretroviral treatment for pregnant and breastfeeding women with HIV). It measured their growth at enrolment (1–6 months), about 12 months and about 24 months. At 24 months, 40.4% of the children were stunted and/or underweight. Infectious disease diagnosis and low birthweight were linked to higher odds of stunting, while optimal feeding and maternal employment were linked to lower odds. The authors say efforts to improve growth in these children should address their several health risks, alongside maternal treatment and follow-up of mother-child pairs.
Key points
- Of 1211 children HIV-exposed and uninfected, 562 attended the second visit and 529 aged 24 months (±3 months) were included in the analysis.
- At 24 months, 40.4% of the children were stunted and/or underweight.
- Children with an infectious disease diagnosis had higher odds of stunting than those with none (adjusted odds ratio 3.35, 95% CI 1.82–6.17), and this was modified by co-trimoxazole prophylaxis (p = 0.028).
- Low birthweight was associated with higher odds of stunting.
- Optimal feeding and maternal employment were associated with lower odds of stunting.
Limitations
This is an observational analysis restricted to children who attended the 24-month visit (529 of 1211), so it shows associations rather than causes and may not represent those lost to follow-up. The abstract does not report a comparison with unexposed children.
Abstract
AbstractEvidence suggests children HIV‐exposed and uninfected (CHEU) experience poor growth. We analysed child anthropometrics and explored factors associated with stunting among Malawian CHEU. Mothers with HIV and their infants HIV‐exposed were enroled in a nationally representative prospective cohort within the National Evaluation of Malawi's Prevention of Mother‐to‐Child HIV Transmission Programme after Option B+ implementation (2014–2018). Anthropometry was measured at enrolment (age 1–6 months), visit 1 (approximately 12 months), and visit 2 (approximately 24 months). Weight‐for‐age (WAZ) and length‐for‐age (LAZ) z‐scores were calculated using World Health Organization Growth Standards; underweight and stunting were defined as WAZ and LAZ more than 2 standard deviations below the reference median. Multivariable logistic regression restricted to CHEU aged 24 months (±3 months) was used to identify factors associated with stunting. Among 1211 CHEU, 562/1211 attended visit 2, of which 529 were aged 24 months (±3 months) and were included. At age 24 months, 40.4% of CHEU were stunted and/or underweight, respectively. In multi‐variable analysis, adjusting for child age and sex, the odds of stunting were higher among CHEU with infectious disease diagnosis compared to those with no diagnosis (adjusted odds ratio = 3.35 [95% confidence interval: 1.82–6.17]), which was modified by co‐trimoxazole prophylaxis (p = 0.028). Infant low birthweight was associated with an increased odds of stunting; optimal feeding and maternal employment were correlated with reduced odds. This is one of the first studies examining CHEU growth since Option B+. Interventions to improve linear growth among CHEU should address their multi‐faceted health risks, alongside maternal ART prescription, and follow‐up of mother‐child pairs.