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Sex differences in nutritional status of HIV-exposed children in Rwanda: a longitudinal study
Jeanine U Condo1, Anastasia Gage, Nancy Mock
1School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Insights
HIV-exposed boys in Rwanda face higher malnutrition risks than girls, despite similar feeding practices. Explanations for this nutritional disparity may extend beyond diet in low-resource settings.
Area of Science:
- Pediatric Nutrition
- Global Health
- HIV/AIDS Research
Background:
- Understanding nutritional status in HIV-exposed children is crucial for early intervention.
- Complementary feeding programs aim to improve infant and child nutrition in vulnerable populations.
- Sex-based disparities in child health outcomes require investigation, particularly in resource-limited settings.
Purpose of the Study:
- To investigate sex differences in nutritional status among HIV-exposed children in Rwanda.
- To examine the relationship between early feeding practices, dietary patterns, and nutritional status over time.
- To identify potential factors contributing to malnutrition disparities in this cohort.
Main Methods:
- Longitudinal study design with three data collection points over 2-3 months.
- Inclusion of infants aged 6-12 months at baseline in a complementary feeding program.
- Multivariate analysis using cross-sectional time series to assess sex differences in nutritional status (stunting, wasting, underweight) and feeding indices (ICFI).
Main Results:
- Statistically significant sex differences observed in stunting, wasting, and underweight (P < 0.001).
- Boys exhibited poorer nutritional status (mean Z-scores: stunting -2.01, wasting -0.15, underweight -1.19) compared to girls (stunting -1.46, wasting 0.22, underweight -0.63).
- Minor differences in early feeding practices and no significant differences in the Infant and Child Feeding Index (ICFI) by sex were found.
Conclusions:
- HIV-exposed male children in this Rwandan cohort are at a higher risk of malnutrition compared to their female counterparts.
- Dietary patterns, as assessed by early feeding practices and ICFI, do not fully explain the observed sex differences in nutritional status.
- Factors beyond dietary patterns may contribute to malnutrition disparities in HIV-exposed children within complementary feeding programs in low-resource settings.
Objective:
To examine sex differences in nutritional status in relation to feeding practices over time in a cohort of HIV-exposed children participating in a complementary feeding programme in Rwanda.
Methods:
We applied a longitudinal design with three measurements 2-3 months apart among infants participating in a complementary feeding programme who were 6-12 months old at baseline. Using early feeding practices and a composite infant and child feeding index (ICFI) as indicators of dietary patterns, we conducted a multivariate analysis using a cross-sectional time series to assess sex differences in nutritional status and to determine whether there was a link to discrepancies in dietary patterns.
Results:
Among 222 boys and 258 girls, the mean (±SD) Z-score of stunting, wasting and underweight was -2.01 (±1.59), -0.15 (±1.46), -1.19 (±1.29) for boys; for girls they were -1.46 (±1.56), 0.22 (±1.29), -0.63 (±1.19); all sex differences in all three indicators were statistically significant (P < 0.001). However, there were only minor differences in early feeding practices and none in the ICFI by sex.
Conclusions:
HIV-exposed male children may be at higher risk of malnutrition in low-resource setting countries than their female counterparts. However, at least in a setting where complementary foods are being provided, explanations may lie outside the sphere of dietary patterns.
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