title: The role of weight for age and disease stage in poor psychomotor outcome of HIV-infected children in Kilifi, Kenya.
abstract: OBJECTIVE
  We aimed to investigate the contribution of disease stage and weight for age to the variability in psychomotor outcome observed among children with human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  This cross-sectional study involved 48 Kenyan children (20 females, 28 males) aged 6 to 35 months (mean 19.9mo SD 8.9) exposed prenatally to HIV. Two subgroups of HIV-exposed children were seen: those who were HIV-infected and those who were uninfected. The reference population was composed of 319 children (159 females, 160 males) aged 6-35 months, (mean age = 19 months, SD=8.43) randomly selected from the community. Disease stage varied from stage 1 to stage 3, reflecting progression from primary HIV infection to advanced HIV infection and acquired immune deficiency syndrome. A locally developed and validated measure, the Kilifi Developmental Inventory, was used to assess psychomotor development.
  
  
  RESULTS
  Using age-corrected psychomotor scores, a significant main effect of HIV status was observed (F((2,38.01))=7.89, p<0.001). Children in the HIV-infected group had lower mean psychomotor scores than the HIV-exposed children and the reference group. In the HIV-infected group, disease stage was a negative predictor and weight for age a positive predictor of psychomotor outcome.
  
  
  CONCLUSIONS
  Weight for age and disease stage provide viable, easily measurable benchmarks to specify when frequent developmental monitoring and psychomotor rehabilitation are required. Nutritional intervention and other measures aimed at slowing disease progression may delay the onset and severity of psychomotor impairment in the paediatric HIV population in Africa.
authors.affiliation: Department of Psychology and Developmental Medicine, Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya. AAbubakar@kilifi.kemri-wellcome.org
authors.forename: Amina
authors.initials: A
authors.lastname: Abubakar
authors.forename: Penny
authors.initials: P
authors.lastname: Holding
authors.forename: Charles R J C
authors.initials: CR
authors.lastname: Newton
authors.forename: Anneloes
authors.initials: A
authors.lastname: van Baar
authors.forename: Fons J R
authors.initials: FJ
authors.lastname: van de Vijver
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D001835:Body Weight; D016022:Case-Control Studies; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007630:Kenya; D008297:Male; D009752:Nutritional Status / Q000502:physiology; D011203:Poverty; D011596:Psychomotor Disorders / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D011597:Psychomotor Performance / Q000502:physiology*; D012016:Reference Values; D012720:Severity of Illness Index