Elaine J. Abrams
SEATTLE — Researchers found that combining nutrition and sanitation interventions led to improved motor and cognitive development in children aged 2 years in rural Zimbabwe, according to study results presented at CROI.
“There is an emerging concern about the health outcomes of babies who were born to moms living with HIV but who escape infection,” Elaine J. Abrams, MD, professor of epidemiology and pediatrics at Columbia University and clinical vice chair for the CROI program committee, said during a news conference.
Abrams, who was uninvolved in the study, noted “there is growing literature on the health outcomes of these HIV-exposed, uninfected infants.”
Robert Ntozini, MPH, associate director of the Zvitambo Institute for Maternal and Child Health Research in Harare, Zimbabwe, and colleagues studied the effects of infant and young children feeding (IYCF) and improved water, sanitation and hygiene (WASH) on neurodevelopment in rural Zimbabwe.
Specifically, the researchers evaluated four interventions:
- standard of care (SOC) — a combination of promoting breast-feeding for up to 6 months, advice on neonatal care, and promoting uptake of antenatal care, immunizations and family planning;
- IYCF, which included the SOC messages, plus 20 g of a small-quantity, lipid-based nutrient supplement given once a day to infants aged 6 to 18 months, along with complementary feeding counseling;
- WASH, which included the SOC messages, plus a ventilated latrine, two hand-washing stations, liquid soap, chlorine, a play space and hygiene counseling; and
- a combined approach of IYCF and WASH.
Ntozini and colleagues first conducted cluster-randomized trial that included 5,280 pregnant women, of whom 726 were HIV positive. There were 738 HIV-exposed live births, including 12 from twin pregnancies. Of these children, 668 were included in the growth analysis at age 18 months.
In a set of published studies, the researchers reported that the IYCF interventions reduced stunting in both HIV-exposed and HIV-nonexposed children.
The researchers then conducted a substudy looking at the early childhood development (ECD) outcomes of HIV-exposed children aged 2 years. They conducted ECD assessments on 323 children, including 300 HIV-exposed, uninfected children; six HIV-positive children; and 17 children with unknown status.
“When we implemented each intervention on its own [IYCF only and WASH only], when compared to the control arm, they had similar outcomes,” Ntozini told Infectious Diseases in Children.
However, children who received IYCF plus WASH had higher Malawi Development Assessment Tool (MDAT) scores than those who received SOC.
The increase in MDAT scores in the combined intervention group was accompanied by higher gross motor and fine motor skills, language and social components, the researchers said. Children in the combined intervention also had higher vocabulary skills. However, these events were not evident in children who received either the IYCF or WASH interventions alone. – by Bruce Thiel
Humphrey JH, et al. Lancet Glob Health. 2019;doi:10.1093/cid/civ844.
Ntozini et al. Abstract 42. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.
Prendergast AJ, et al. Lancet Child Adolesc Health. 2019;doi:10.1016/S2352-4642(18)30340-7.
Disclosures: Abrams and Ntozini report no relevant financial disclosures.