Abstract
A better understanding of the nutritional status of infants who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub-Saharan Africa. A cross-sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV-exposed), aged 6-24 months, attending routine child health clinics, were recruited. Anthropometric, 24-h dietary intake and socio-demographic data was collected. Anthropometric Z-scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression. Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio-economic status. HEU infants aged 6-24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.
Highlights
Under-five mortality declined from 90 to 43 deaths per 1000 live births between 1990 and live births undernutrition, with 45% of these deaths being preventable through optimal nutrition, especially in the first 1000 days [2, 3,4].Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is still a major health challenge in Botswana transmission (PMTCT) of HIV have been highly successful in Botswana, reducing mother-to-child transmission rates to approximately 2.6%mother to child could be as high as 25% [8]
Prevalence of HIV in these districts ranged from 26.3% in Kweneng East to 39.6% in Selebi Phikwe They were selected as having higher HIV prevalence than the national average, in order to ensure an appropriate sample of HIV-exposed but uninfected (HEU) infants
HEU infants had significantly more siblings compared to HUU infants (p
Summary
Mother to child could be as high as 25% [8] This success has resulted in the increase in the population of HIV-exposed but uninfected (HEU) infants. Studies conducted in other African countries comparing the nutritional status of HEU and HUU infants show large variations in the levels of undernutrition [12, 18,19,20]. Majority of these studies were conducted before ART was widely available to mothers and infants. Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is a key to improving population health, in sub-Saharan Africa
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