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Iron Deficiency and Neurobehavioral Outcomes in Ugandan Children Exposed to HIV
Victor Musiime1, Paul Bangirana2, John Ssenkusu3
1Research Department, Joint Clinical Research Centre, Kampala, Uganda; Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
Insights
Iron deficiency (ID) is common in Ugandan children, including those exposed to HIV. Iron deficiency anemia (IDA) is linked to poorer socioemotional development, suggesting a need for early iron interventions.
Area of Science:
- Pediatric Health
- Nutritional Science
- Neurodevelopmental Research
Background:
- Iron deficiency (ID) prevalence and neurobehavioral impact in children exposed to HIV in utero remain understudied.
- Understanding iron status is crucial for optimizing health outcomes in vulnerable pediatric populations.
Purpose of the Study:
- To assess iron status in Ugandan children aged 6-59 months across three groups: HIV-infected (HI), HIV-exposed but uninfected (HEU), and HIV-unexposed (HUU).
- To investigate the relationship between iron status and neurobehavioral outcomes, including cognition, attention, executive function, and socioemotional behavior.
Main Methods:
- Enrollment of 210 children (70 per group: HI, HEU, HUU) aged 6-59 months in Uganda.
- Assessment of neurobehavioral domains and iron status (plasma ferritin, C-reactive protein).
- Logistic regression and age-adjusted Z-score calculations to compare ID prevalence and analyze associations with neurobehavioral outcomes.
Main Results:
- Over 40% of children in all groups exhibited ID; HEU children had a higher ID prevalence than HI children (59.4% vs. 42%).
- HEU children showed a higher prevalence of iron deficiency anemia (IDA) compared to HUU children (32.4% vs. 18.8%).
- ID was associated with lower fine motor scores. IDA, particularly in HI children, correlated with poorer socioemotional behaviors like reduced exploration, increased fear, less positive affect, and decreased adaptability.
Conclusions:
- A significant burden of ID exists among Ugandan children, affecting HI and HEU groups.
- IDA is linked to adverse socioemotional development in children.
- Further research into the safety and efficacy of early-life iron interventions is warranted to support neurobehavioral development in this population.
Background:
The prevalence of iron deficiency (ID) among children exposed to HIV in utero is unclear, and an association with ID and neurobehavioral deficits has not been investigated.
Objectives:
We assessed iron status in Ugandan children aged 6 to 59 mo who were HIV-infected (HI), exposed to HIV but uninfected (HEU), or not exposed to HIV (HUU) and examined the relationship with neurobehavioral outcomes.
Methods:
We enrolled children who were HI (n = 70), HEU (n = 70), or HUU (n = 70) and conducted assessments of cognition, attention, executive function, and socioemotional behavior. We used logistic regression to compare ID prevalence among the groups and tested for associations between iron status and neurobehavioral outcomes, using the HUU group to calculate age-adjusted Z-scores.
Results:
More than 40% of children in each group had ID (plasma ferritin <12 or <30 μg/L if C-reactive protein >10 mg/L). Children who were HEU had a higher prevalence of ID than children who were HI (59.4% compared with 42%, P = 0.04) and a higher prevalence of ID with anemia (IDA) than children who were HUU (32.4% compared with 18.8%, P = 0.04). Overall, children with ID scored lower in fine motor {adjusted Z-score [95% confidence interval (CI)] for ID compared with not ID: -0.20 [-0.4, -0.03] compared with 0.07 [-0.09, 0.24]}, but there were no other differences by ID. Children with IDA, particularly those who were HI, had poorer socioemotional behavior, exhibiting poorer exploration quantity [adjusted odds ratio IDA compared with not IDA (95% CI): 0.39 (0.17, 0.92)], greater fear [4.5 (1.6, 12.1)], less positive affect [0.44 (0.23, 0.87)], and less adaptability [0.38 (0.17, 0.82)].
Conclusions:
There is a significant burden of ID among Ugandan children, including those who are HI and HEU. IDA was associated with poorer socioemotional behavior, highlighting the need to study the safety and efficacy of early-life iron interventions to optimize neurobehavioral development in this population.
