Association of Exposure to Intimate Partner Violence With Maternal Depressive Symptoms and Early Childhood Socioemotional Development Among Mothers and Children in Rural Tanzania

Oliveira, Clariana Vitória Ramos de; Sudfeld, Christopher R.; Muhihi, Alfa; McCoy, Dana Charles; Fawzi, Wafaie W.; Masanja, Honorati; Yousafzai, Aisha K.

doi:10.1001/jamanetworkopen.2022.48836

Cited by 6 publications

(2 citation statements)

References 44 publications

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“…Maternal marital status, absence of a biologic father, IPV and food insecurity were significantly associated with lower child neurodevelopment scores. Parental relationship conflict and household violence can threaten a child's neurodevelopment [ 22 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Over a quarter of women of reproductive age in eastern Africa were estimated to have experienced IPV in the past year [ 26 , 52 , 53 ]; the prevalence of IPV among Kenyan pregnant women is estimated to be approximately 10%, with almost all perpetrators being a current or former husband or partner [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopment of children who are HIV‐exposed and uninfected in Kenya

Bulterys,

Njuguna,

King'e

et al. 2023

J Int AIDS Soc.

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IntroductionPredictors of neurodevelopment among children who are HIV‐exposed uninfected (CHEU) are poorly understood.MethodsMothers with and without HIV and their children were enrolled during 6‐week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1‐year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site.ResultsAt 1‐year evaluation, CHEU (n = 709) and children who are HIV‐unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate‐to‐severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: −1.38, 95% CI: −2.05, −0.71), food insecurity was associated with lower social scores (adjusted coeff: −0.37, 95% CI: −0.73, −0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: −0.76, 95% CI: −1.40, −0.13) and gross motor scores (adjusted coeff: −1.07, 95% CI: −1.81, −0.33). Among CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: −0.51, 95% CI: −1.01, −0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: −0.45, 95% CI: −0.87, −0.03) or a deceased or absent father (adjusted coeff: −0.81, 95% CI: −1.58, −0.05), respectively.ConclusionsBiologic and social factors were associated with child neurodevelopment. Despite socio‐demographic differences between CHEU and CHUU, 1‐year neurodevelopment was similar. Addressing IPV and food insecurity may provide benefits regardless of maternal HIV status. DTG use was associated with higher neurodevelopmental scores in CHEU, compared to EFV regimens, potentially contributing to a lack of neurodevelopmental difference between CHEU and CHUU.

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Section: Discussionmentioning

confidence: 99%

Neurodevelopment of children who are HIV‐exposed and uninfected in Kenya

Bulterys,

Njuguna,

King'e

et al. 2023

J Int AIDS Soc.

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“…Beyond the biologic pathways described above, universal risk factors for child neurodevelopment, such as poor caregiver mental health, violence and food insecurity in the household, are amplified among CHEU [90][91][92]. Women living with HIV experience disproportionately high rates of intimate partner violence and food insecurity which considerably threaten a child's neurodevelopment and academic performance [28,29,[91][92][93][94][95][96][97][98][99][100][101][102][103][104].…”

Section: Home Environment and Caregivingmentioning

confidence: 99%

Neurodevelopment among children exposed to HIV and uninfected in sub‐Saharan Africa

Bulterys,

Njuguna,

Mahy

et al. 2023

J Int AIDS Soc.

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IntroductionThe population of 16 million children exposed to HIV and uninfected (CHEU) under 15 years of age continues to expand rapidly, and the estimated prevalence of CHEU exceeds 20% in several countries in sub‐Saharan Africa with high HIV prevalence. Some evidence suggests that CHEU experience suboptimal neurodevelopmental outcomes compared to children born to women without HIV. In this commentary, we discuss the latest research on biologic and socio‐behavioural factors associated with neurodevelopmental outcomes among CHEU.DiscussionSome but not all studies have noted that CHEU are at risk of poorer neurodevelopment across multiple cognitive domains, most notably in language and motor skills, in diverse settings, ages and using varied assessment tools. Foetal HIV exposure can adversely influence infant immune function, structural brain integrity and growth trajectories. Foetal exposure to antiretrovirals may also influence outcomes. Moreover, general, non‐CHEU‐specific risk factors for poor neurodevelopment, such as preterm birth, food insecurity, growth faltering and household violence, are amplified among CHEU; addressing these factors will require multi‐factorial solutions. There is a need for rigorous harmonised approaches to identify children at the highest risk of delay. In high‐burden HIV settings, existing maternal child health programmes serving the general population could adopt structured early child development programmes that educate healthcare workers on CHEU‐specific risk factors and train them to conduct rapid neurodevelopmental screening tests. Community‐based interventions targeting parent knowledge of optimal caregiving practices have shown to be successful in improving neurodevelopmental outcomes in children and should be adapted for CHEU.ConclusionsCHEU in sub‐Saharan Africa have biologic and socio‐behavioural factors that may influence their neurodevelopment, brain maturation, immune system and overall health and wellbeing. Multidisciplinary research is needed to disentangle complex interactions between contributing factors. Common environmental and social risk factors for suboptimal neurodevelopment in the general population are disproportionately magnified within the CHEU population, and it is, therefore, important to draw on existing knowledge when considering the socio‐behavioural pathways through which HIV exposure could impact CHEU neurodevelopment. Approaches to identify children at greatest risk for poor outcomes and multisectoral interventions are needed to ensure optimal outcomes for CHEU in sub‐Saharan Africa.

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