title: Predictors of stunting, wasting and underweight among Tanzanian children born to HIV-infected women.
abstract: OBJECTIVE
  Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized. The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months.
  
  
  METHODS
  Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant's birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight.
  
  
  RESULTS
  A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted.
  
  
  CONCLUSIONS
  Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: McDonald
authors.forename: R
authors.initials: R
authors.lastname: Kupka
authors.forename: K P
authors.initials: KP
authors.lastname: Manji
authors.forename: J
authors.initials: J
authors.lastname: Okuma
authors.forename: R J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: S
authors.initials: S
authors.lastname: Aboud
authors.forename: R
authors.initials: R
authors.lastname: Kisenge
authors.forename: D
authors.initials: D
authors.lastname: Spiegelman
authors.forename: W W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: C P
authors.initials: CP
authors.lastname: Duggan
mesh_terms: D000293:Adolescent; D000328:Adult; D001827:Body Height; D001835:Body Weight; D004311:Double-Blind Method; D004522:Educational Status; D005260:Female; D006130:Growth Disorders / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D044342:Malnutrition / Q000209:etiology*; D047928:Premature Birth / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012016:Reference Values; D012737:Sex Factors; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D013851:Thinness / Q000209:etiology*; D019282:Wasting Syndrome / Q000209:etiology*; D055815:Young Adult