Comparison of Growth in Infants according to Maternal HIV-status in Harare, Zimbabwe

Abstract

Background: Sub-Saharan Africa is representing 69 % of the global HIV burden, with an estimated number of 34 million HIV positive people worldwide, 1.2 million HIV positives are living in Zimbabwe. With around one in seven adults living with HIV today, Zimbabwe is experiencing one of the most severe HIV/AIDS epidemics in the world. In 2010, more than 13 % of the population in Zimbabwe was younger than 5 years, and according to UNICEF, as many as one in four children in Zimbabwe are orphaned as a result of parents dying from HIV/AIDS.

We wanted to study the growth among a group of infants related to maternal HIV-status in the Harare region during 2002-2003 related to the WHO growth charts.

Method: Our study is based on a broader prospective cohort study about mother to child transmission (MTCT) of HIV in Harare, lasting from April 2002 to November 2003. A total of 1050 pregnant women were enrolled at gestational age 36 from three clinics outside Harare. 774 (408 HIV negative mothers and 366 HIV positive mothers) met our criteria of inclusion. They were followed up with their index child, and measurements of weight, length and head circumference were taken at birth, 6 weeks, 4 months and 9 months of age. Data on boys and girls were analysed separately. The sample size for the boys and girls who had their measurements registered at all time points were 122 and 122 for weight, 116 and 122 for length, and 120 and 124 for head circumference respectively.

Results: The differences we found in growth according to maternal HIV-status at the different time points, were of no statistical significance (p>0.05). Neither did we find any significant differences in low birth weight (< 2500 g) in the two groups We also compared the growth curves to WHO´s growth standards, to see how many of the children who fell beneath the 3rd percentile and above the 97th percentile. We found that the mean for length lies lower and the mean for head circumference lies higher for the infants in the study, in comparison to the WHO growth standards. According to maternal HIV-status, we found that there were almost fifteen times more deceased mothers and more than three times more deceased infants in the HIV-positive group. Amittedly, all the children who died before 9 months of age are not included in our growth analysis, and may have influenced the results in the HIV positive group in a negative favour.

Conclusion: In our study results we found no differences in growth of statistical significance according to maternal HIV-status the first 9 months of life. What we did find, was that HIV positive mothers had a higher mortality and so did their children. The findings in our study might be unreliable due to several possible sources of bias, with measurement errors being one of these. Since it is likely to believe that these errors were equally divided in both groups, we still believe that our results are to be considered as valuable. Similar studies in other African countries show variable results, and further research is needed to conclude that there is no difference in growth according to maternal HIV-status.