| Summary: | M.Sc.(Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009 === Background: Sub Saharan Africa hosts 90% of the world s Human Immunodeficiency Virus
infected children, and in 2007 an estimated 150,000 of these were Kenyan (UNAIDS, 2007).
Baseline neuropsychological performance is a strong predictor of their disease s progression (Van
Rie et al, 2006). There is no data on the baseline neurodevelopment (ND) status of Human
Immunodeficiency Virus infected children in Kenya. Interventions to minimise morbidity and
improve quality of life are routinely not instituted in Kenya.
Aim: The aim was to determine the prevalence, spectrum and severity of ND delay among a
cohort of HIV infected Kenyan eligible for HAART initiation but had not received HAART
previously children at Kenyatta National Hospital Comprehensive Care Center.
Methods: This was a prospective observational cohort study carried out at the Kenyatta
National Hospital, comprehensive care center, in Nairobi, Kenya. Bayley Scales of Infant
Development third edition (BSID III) was carried out on 36 highly active anti-retroviral therapy
(HAART) naïve HIV infected children aged between two weeks and 36 months, about to start
HAART. These had met all eligibility criteria for HAART according to the KNH CCC protocols
and were due to start the therapy. Study subjects were scheduled to have monthly bailey scales
assessments to a maximum of at least six months post HAART. This was to enhance follow up
as only the initial and sixth month assessment was crucial for data analysis. The children
vi
underwent laboratory tests and other clinical services in accordance to the hospital s standard of
care for HIV children.
Results: Thirty two - out of thirty - six children with HIV had neurodevelopment delay in at
least one of the five constructs assessed by the BSID III at baseline. In descending order of
frequency ND was most common in motor, language, cognitive and adaptive BSID III constructs
respectively. The child aged 18 months and older demonstrated more frequent ND delay in all
constructs measured except motor while secondary and above maternal education level was
associated with worse cognitive performance of this cohort.
Cognitive, language and social emotional scores improved in the 12 children who completed
follow up for at least six months of HAART. The clinical significance of this data is the fact that
even after 6 months of HAART patients still fell in the ND delayed category. This shows HAART
alone is not sufficient to address ND problems. This data is of clinical significance but further
research needs to be done to validate its statistical significance. HAART had no effect in
improving motor delay in these twelve children.
Conclusion: Neurodevelopment delay in this cohort of Kenyan children with HIV is prevalent;
83.3% motor delay, 66.6% language delay, 61.2% cognitive delay, 60.6% adaptive delay and
36.4% socio-emotional delay. All facets of ND delay as measured by the BSID III are affected.
The magnitude of delay falls in the range that would benefit from early interventional
rehabilitation. Data of the effect of highly active antiretroviral provision in this cohort is minimal
but it shows that these drugs alone are not enough to manage the delay. Further research needs to
be done to validate this point.
|
|---|
