HIV This Week

Mishra V, Arnold F, Otieno F, Cross A, Hong R. Education and nutritional status of orphans and children of HIV-infected parents in Kenya. AIDS Educ Prev. 2007;19(5):383-95.

Mishra and colleagues examined whether orphaned and fostered children and children of HIV-infected parents are disadvantaged in schooling, nutrition, and health care. The authors analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14 years included in the 2003 Kenya Demographic and Health Survey, with linked anonymous HIV testing, using multivariate logistic regression. Results indicate that orphans, fostered children, and children of HIV-infected parents are significantly less likely to attend school than non-orphaned/non-fostered children of HIV-negative parents. Children of HIV-infected parents are more likely to be underweight and wasted, and less likely to receive medical care for ARI and diarrhoea. Children of HIV-negative single mothers are also disadvantaged on most indicators. The findings highlight the need to expand child welfare programs to include not only orphans but also fostered children, children of single mothers, and children of HIV-infected parents, who tend to be equally, if not more, disadvantaged.

Editors’ note: Recognition of the vulnerability of children who have not been orphaned by AIDS led to the acronym ‘OVC’ (orphans and vulnerable children) which casts the net more widely. Child welfare programmes that include all disadvantaged children are more likely to mitigate the effects of the epidemic on children while preventing HIV from getting a toehold in the next generation.

Chatterjee and colleagues examine whether maternal HIV disease stage during pregnancy and child malnutrition are associated with child mortality in a prospective cohort study in Tanzania. Indicators of disease stage were assessed for 939 HIV-infected women during pregnancy and at delivery, and children's anthropometric status was obtained at scheduled monthly clinic visits after delivery. Children were followed up for survival status until 24 months after birth. Advanced maternal HIV disease during pregnancy (CD4 count <350 vs. >or=350 cells/mm) was associated with increased risk of child mortality through 24 months of age (hazard ratio [HR] = 1.74, 95% confidence interval [CI]: 1.32 to 2.30). CD4 count <350 cells/mm was also associated with an increased risk of death among children who remained HIV-negative during follow-up (HR = 2.00, 95% CI: 1.36 to 2.94). Low maternal haemoglobin concentration and child undernutrition were related to an increased risk of mortality in this cohort of children. The authors conclude that low maternal CD4 cell count during pregnancy is related to increased risk of mortality in children born to HIV-infected women. Care and treatment for HIV disease, including highly active antiretroviral therapy to pregnant women, could improve child survival. Prevention and treatment of undernutrition in children remain critical interventions in settings with high HIV prevalence.

Editors’ note: The association between mothers’ advanced disease stage and child mortality is complex. Such mothers may transit a more virulent virus strain, may transmit other infections, may not provide as strong passive immunity to their offspring (across the placenta during pregnancy and in breast milk during breastfeeding), and may have reduced parenting capacity due to anaemia, fatigue, and HIV-related disease. To increase child survival in high HIV prevalence areas, integration of maternal and child health programmes with antiretroviral treatment programmes can help prevent and treat childhood malnutrition, while addressing the maternal anaemia and opportunistic infections that can undermine parenting capacity.