Malnutrition decreases the odds of attaining motor milestones in HIV exposed children: results from a paediatric DREAM cohort

Objective. HIV and malnutrition are the two major causes of infant mortality in Sub-Saharan Africa. The study describes the impact of malnutrition on motor milestone development in HIV-exposed children. Design. Randomized community intervention trial (SMAC, Safe Milk for African Children). Setting and participants. Growth, motor development, and malnutrition were assessed in a sample of 76 HIV-exposed children, aged 0-24 months, at the Blantyre Dream Centre in Malawi. Main outcome measures. We assessed growth and selected motor milestone achievement in agreement with WHO/UNICEF criteria. Odds ratios and 95% confidence intervals were calculated according to motor milestones and malnutrition indices. Multivariable logistic regression was performed with 18 months data. Results. High rates of malnutrition were observed. Underweight increased by 6.7/9.2 and 3.2/5.5 the odds of not standing alone and not walking alone at 15 and 18 months. Stunting increased by 9.7 the odds of not standing alone at 11 months and by 6.1 the odds of not walking alone at 18 months. Wasting increased by 5.5/10.3 the odds for not walking with assistance at 12 and 18 months. Low weight for age was associated with delay in walking at 18 months (HR=2.9). Conclusion. Malnutrition in HIV-exposed children decreases the likelihood of adequate development.