Adolescent parenthood and HIV-infection in South Africa-Associations with child cognitive development.
Adolescent parenthood and HIV-infection in South Africa-Associations with child cognitive development.
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DOI：
10.1371/journal.pgph.0000238
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发表时间：
2022
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艾滋病毒直接和间接地影响儿童发展成果。最严重的影响是感染艾滋病毒的儿童，而那些暴露但未感染的儿童也显示出挑战-尽管不那么严重。然而，对感染艾滋病毒的少女母亲所生子女的发育情况知之甚少。本研究旨在研究青少年母亲所生儿童的认知发展，比较那些感染艾滋病毒的儿童，那些艾滋病毒暴露和未感染（HEU）和那些艾滋病毒未暴露（HU）。分析利用横截面数据920青少年母亲（10-19岁），第一个出生的孩子二人组居住在东开普省，南非。参与者完成了详细的研究问卷，包括验证和研究有关的社会人口特征，艾滋病毒，孕产妇和儿童健康的具体措施。经过培训的评估员对所有儿童进行标准化儿童发育评估（使用马伦早期学习量表）。采用卡方检验和方差分析探讨儿童HIV感染状况（HIV、HEU、HU）对认知发育的影响。线性回归模型被用来探讨儿童艾滋病毒感染状况和儿童认知发展之间的横向关联。1.2%的儿童感染了艾滋病毒，20.5%被归类为高浓缩铀，78.3%被归类为高浓缩铀。总体而言，与高浓缩铀和高浓缩铀组相比，艾滋病毒感染儿童在各发育领域的表现较低（早期学习综合评分：分别为73.0 vs 91.2 vs 94.1：F = 6.45，p = 0.001）。与HU儿童相比，HEU儿童在所有发展领域的平均得分均较低，在大运动领域达到显著性（p<0.05）。探索性分析确定母亲教育中断是儿童认知发育评分较低的潜在风险因素，母亲年龄较高可保护儿童认知发育评分。这些探索性研究结果解决了南非受艾滋病毒影响的青少年母亲所生儿童认知发展的关键证据差距。分析发现，在受艾滋病毒影响的青少年母亲所生的儿童中，根据儿童艾滋病毒状况，儿童认知发展领域的平均得分存在逐步差异;感染艾滋病毒的儿童总体表现较差。年轻母亲及其子女可受益于旨在促进儿童发展成果的经调整的干预措施。有针对性的方案编制，特别是针对年轻的少女母亲和中断教育的少女母亲，可以查明这些家庭，特别是有需要的家庭。注意母亲的教育连续性和受孕年龄可能是需要考虑的干预措施。
HIV, both directly and indirectly, impacts child development outcomes. The most severe impacts are for children infected with HIV, and those exposed but uninfected are also shown to have challenges–though less severe. However, little is known regarding the development of children born to adolescent mothers affected by HIV. This study aims to examine cognitive development for children born to adolescent mothers, comparing those children living with HIV, those HIV exposed and uninfected (HEU) and those HIV unexposed (HU). Analyses utilise cross-sectional data from 920 adolescent mother (10–19 years)-first born child dyads residing in the Eastern Cape Province, South Africa. Participants completed detailed study questionnaires inclusive of validated and study specific measures relating to sociodemographic characteristics, HIV, and maternal and child health. Trained assessors administered standardised child development assessments (using the Mullen Scales of Early Learning) with all children. Chi-square tests and ANOVA tests were used to explore maternal and child characteristics according to child HIV status (HIV, HEU, HU) on cognitive development. Linear regression models were used to explore the cross-sectional associations between child HIV status and child cognitive development. 1.2% of children were living with HIV, 20.5% were classified as being HEU and, 78.3% were classified as HU. Overall, children living with HIV were found to perform lower across developmental domains compared to both HEU and HU groups (composite score of early learning: 73.0 vs 91.2 vs. 94.1, respectively: F = 6.45, p = 0.001). HEU children on average scored lower on all developmental domains compared to HU children, reaching significance on the gross motor domain (p<0.05). Exploratory analyses identified maternal education interruption as a potential risk factor for lower child cognitive development scores and, higher maternal age to be protective of child cognitive development scores. These exploratory findings address a critical evidence gap regarding the cognitive development of children born to adolescent mothers affected by HIV in South Africa. Analyses identify stepwise differences in the average scoring on child cognitive development domains according to child HIV status among children born to adolescent mothers affected by HIV; with children living with HIV performing worse overall. Young mothers and their children may benefit from adapted interventions aimed at bolstering child development outcomes. Targeted programming particularly among younger adolescent mothers and those experiencing education interruption may identify those families, particularly in need. Attention to maternal continuity of education and age of conception may be interventions to consider.