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Published on: October 31, 2010
Paediatric HIV and neurodevelopment in sub-Saharan Africa: a systematic review
Amina Abubakar1, Anneloes Van Baar, Fons J R Van de Vijver
1Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya. a.abubakarali@uvt.nl
Insights
Human immunodeficiency virus (HIV) infection in sub-Saharan African children causes significant motor, cognitive, and language impairments. Motor development is most severely affected from infancy, with language development also showing delays.
Area of Science:
- Pediatric Neurology
- Developmental Psychology
- Infectious Diseases
Background:
- Sub-Saharan Africa (SSA) faces a high burden of pediatric HIV.
- HIV infection is known to impact neurodevelopmental outcomes in children.
- Understanding the specific domains affected is crucial for early intervention.
Purpose of the Study:
- To quantify the extent of motor, cognitive, language, and social-emotional impairments in children with HIV in SSA.
- To identify which developmental domains are most significantly affected by HIV infection.
Main Methods:
- Systematic literature search of MEDLINE and PsycINFO databases.
- Reference list checking of existing reviews to identify all eligible studies.
- Computation of Cohen's d effect size to measure the degree of impairment.
Main Results:
- Analysis of six eligible reports revealed significant developmental delays.
- Severe motor impairment (Cohen's d = 0.97) observed at 18 months.
- Moderate cognitive delay (d = 0.67) and significant language delay (d = 0.91) noted at 18-24 months.
Conclusions:
- HIV significantly impacts multiple domains of child development in SSA.
- Motor development is the most severely and consistently affected domain.
- Further research is needed to accurately assess language development due to limited evaluation.
Objective:
To determine the degree of motor, cognitive, language and social-emotional impairment related to HIV infection in children living in sub-Saharan Africa (SSA).
Methods:
Literature searches using MEDLINE and PsycINFO. Additionally, the reference lists of previous reviews were checked to ensure that all eligible studies were identified. Cohen's d, a measure of effect size, was computed to estimate the level of impairment.
Results:
Six reports met the inclusion criteria. In infancy a consistent delay in motor development was observed with a median value of Cohen's d = 0.97 at 18 months, indicating a severe degree of impairment. Mental development showed a moderate delay at 18 months, with a median value d = 0.67. Language delay did not appear until 24 months of age, d = 0.91. Less clear findings occurred in older subjects.
Conclusion:
Although HIV has been shown to affect all domains of child functioning, motor development is the most apparent in terms of severity, early onset, and persistence across age groups. However, motor development has been the most widely assessed domain while language development has been less vigorously evaluated in SSA, hence an accurate quantitative estimate of the effect cannot yet be made.
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