TUAE0102 - Oral Abstract
Futures at risk - disability in children affected by HIV in South Africa and Malawi
Presented by Lorraine Sherr (United Kingdom).
S. Skeen1,2, A. Macedo3, L. Sherr4, N. Croome3, M. Tomlinson1
1Stellenbosch University, Psychology, Stellenbosch, South Africa, 2University of Cape Town, Psychiatry and Mental Health, Cape Town, South Africa, 3UCL, London, United Kingdom, 4UCL, Research Department of Infection and Population Health, London, United Kingdom
Background: HIV infection has been
linked with developmental disabilities in children as a result of consequences of infection, exposure
to antiretroviral medication, co-morbid illnesses, and increased lengthy hospital
Other risk factors for developmental delay prevalent in HIV-affected
families include living in poverty,
food insecurity, parental depression and substance use. This study investigated
developmental outcomes in children participating in community-based
organisation (CBO) programmes for children affected by HIV in South Africa and
Malawi over time.
interviewed carers of children attending 28 randomly-selected CBOs in South
Africa and Malawi. Carers
completed the validated
Ten Questions disability screening tool at baseline which
screened for child developmental problems in domains of speech, cognition,
hearing, vision, motor and seizure disorders.
Communication, comprehension and learning appraisal was measured at 1 year
follow up. Household HIV was tracked.
Results: Of 500 consecutive CBO attenders,(aged 4 -9) 74 were HIV+ and 426 HIV-. Overall, 217 (43.4%) showed
delay, significantly higher for HIV+ children (24.4%,n=53 versus
7.4%, n=21 -p< 0.0001). More specifically, HIV+ children were at
increased risk for delay in achieving motor milestones (e.g.sitting, standing, or
walking) (33.8% vs 6.3%-p< 0.0001); hearing difficulties (18.8% versus 8.9%-p=0.02), speech problems
(20.3% versus 10.3%,-p=0.02), and mental
difficulties (e.g., slowness) (28.4% versus 13.1%-p=0.01). Multivariate analysis
revealed that independent predictors of developmental disability included HIV
status (OR: 4.55, 95% CI:
2.29-9.04, p< 0.0001)
as well as living in South Africa (OR: 0.29, 95% CI: 0.12-0.72,
p-0.006) and poor school attendance (OR: 2.94, 95% CI: 1.09-7.97),
p=0.03). At follow up HIV+children continued to have more difficulties in understanding
(8.5% vs. 2.7%-p=.02) and learning new things (25.4% vs. 14.3%-p=.02) compared to HIV-ve children. Difficulty in communicating did not
differ by HIV status. Furthermore HIV- children
living with someone with HIV in the household showed similar scores to HIV- children
living in HIV-free households.
of child developmental disabiliy are high in poor HIV affected
communities. These children face
challenges in accessing schooling in contexts where little specialised
provision is available. We call
for increased awareness of the need for inclusive and specialised educational
support for children affected by HIV in communities affected by HIV.
Back to the Programme-at-a-Glance