5Anthropometric measurements of HIV infected children aged one to five years in a tertiary hospital in Lagos Nigeria

Niger J Paed 2016; 43 (1): 26 – 29

ORIGINAL

Akintan PE

Anthropometric measurements of

Akinsulie AO

HIV-infected children aged one to

Temiye E

Esezobor C

five years in a tertiary hospital in

Lagos Nigeria

DOI:http://dx.doi.org/10.4314/njp.v43i1.5

Accepted: 12th October 2015

Abstract : Objectives: To deter-

taller than the infected children

mine the association between HIV

after 49months (p=0.019). The

Akintan PE

(

)

infection

and

anthropometric

controls had bigger arm than the

Department of Paediatrics,

measures (weight, height, mid-

infected (p=<0.029) while the head

Lagos University Teaching Idi-Araba,

Lagos Nigeria

upper arm circumference and

circumference was also signifi-

Email:akintanpatricia@yahoo.com

head circumference) of children

cantly higher in the controls

aged one to five years.

(p=<0.033) with the difference

Akinsulie AO, Temiye E, Esezobor C

Method:

A cross sectional de-

being more in the children aged

Department of Paediatrics,

scriptive study using structured

less than 3 years.

College of Medicine , University of

questionnaire and measurement of

Conclusion: HIV infection has a

Lagos and Lagos University Teaching

weight, height, head and mid-

profound association with growth

Idi-Araba , Lagos Nigeria

upper arm circumference of 846

being earliest on the head size,

infected children and matched

followed by weight and then

controls.

height.

Results: The mean weights of the

controls were significantly higher

Key words:

HIV, children,

than those of the infected children

weight, height, MUAC, head cir-

at all age groups (p<0.005) while,

cumference

the controls were significantly

Introduction

status.

The most common anthropometric measure-

ments used are weights and height/length. Weight is

In children under five years of age HIV/AIDS accounts

increase in body mass, while height/length signifies in-

for 7.7% of mortality worldwide leading to 19% and

1,2

crease in skeletal size. Hence, wasting and stunting are

36% rise in infant and under five mortality respectively.

deficit in tissue mass and slowing in skeletal growth

-5

respectively . Height gain is a much slower process

Gains in child survival attributed to implementation of

survival strategies had been severely eroded by increas-

than weight gain, but once attained cannot be lost. A

ing mortality for pediatric HIV infections. There is a

stunted child signifies a chronic condition. A child can

high level of malnutrition in children in Africa, with one

lose weight after an acute or chronic illness or might not

in every under five being malnourished . Weng et al

6,7

gain weight appropriately. Other anthropometric meas-

studied the association between maternal HIV infection

urements include: occipito-frontal circumference OFC),

and birth weight and found that HIV infected children

which is an indicator of the size of the head and its con-

weighed less than HIV-negative children born to HIV

tent; the mid upper arm circumference (MUAC), an esti-

seropositive mother. The weight of the uninfected babies

mation of the soft tissue mass of the arm and an objec-

did not defer significantly from that of the reference

tive index of thinness; MUAC in combination with oc-

population . In the European collaboration study , in

cipito-frontal circumference; skin folds thickness, which

children of HIV infected mothers; there was no signifi-

is the measure of tissue fat and; chest circumference

cant difference in length or weight between the infected

which is useful under the age of 3 years usually in com-

and non-infected children at birth. Subsequently there

bination with head circumference. All these measure-

was statistically significant difference in both weight

ments are reported in relation to appropriate standard

reference values for the age of the child . In this study,

and length between the HIV infected children and those

who were not .The difference in growth was observed to

weight, height, mid-upper arm and head circumference

increase after 2 years of age for height and 4 years for

were studied as these measurements are widely applica-

weight. HIV-infected children with serious symptoms

ble for the age groups studied. These measurements are

lagged behind asymptomatic children in both height and

easily measurable, non-invasive and can be compared

weight and the difference was noticed to increase with

with other studies

age.

Anthropometry is widely used in assessing nutritional

Method

The controls were screened using the immunochroma-

tographic test, which detects HIV antibody, which if

The study, a cross sectional one, was conducted in the

present would react with HIV antigen coated on the

strip. The test strips used were the Determine

Paediatrics Department of Lagos University Teaching

HIV –

Hospital over a one year period from June 2009 to July

1/29 manufacture by Abbott Laboratories Illinois U.S.A

2010.A total of 846 children HIV infected and non-

for HIV antibody detection. The parents or guardians

infected aged 1-5 years were studied. Approval for the

received pre- and post-test counseling and the results of

study was obtained from the Research and Ethics Com-

the HIV tests were adequately communicated to them.

mittee of Lagos University Teaching Hospital. Written

All data obtained from the study were stored in an ac-

informed consent was obtained from the parents or

cess file and were analyzed using the Epiinfo version

guardians of the children. Children showing evidence of

3.5.1 in conjunction with the nutritional software NUT-

malnutrition were referred to the dietician for interven-

STAT. Measures of central tendency were computed for

tion and to the Child Survival Unit of Paediatrics De-

all quantitative variables like weight, height, occipito-

partment for food demonstration. HIV-infected children

frontal circumference and MUAC. Categorical variable

below the age of five years irrespective of HAART use

were compared using the chi-square, while continuous

were recruited consecutively as they presented to the

variable were analyzed using the student t test. Statisti-

Paediatrics Special Clinic, which provide comprehen-

cal significant value was taken at p <0.05

sive antiretroviral therapy services. Some HIV-infected

children were not on HAART as at the time of enrol-

ment either as a result of not being eligible or being

worked up for commencement. The controls were re-

Results

cruited from the well-baby clinic (for growth monitor-

ing); paediatrics surgical clinic (children with hydro-

Table 1: General characteristics of the children studied

coele, or followed up after appendicectomy or herniot-

Variables

Subjects n (%)

Control n (%)

Total n (%)

omy); immunization clinic and the respiratory clinic

N (%)

n (%)

(those followed up after treatment for bronchopneu-

Gender

Male

215(25.4)

208 (24.6)

423(50)

monia) of the hospital. Children with chronic medical

Female

204(24.1)

219(25.9)

423(50)

condition affecting growth were exempted from the

Age(months)

study. For each HIV-infected subjected, one healthy

12 -24

104(12.2)

107(12.6)

211 (24.9)

HIV-uninfected control of the same age group, gender

25 -36

105(12.4)

108(12.7)

213(25.2)

37 -48

105(12.4)

107(12.6)

212(25.1)

and socioeconomic status as the subject was recruited,

49 -60

105(12.4)

210(24.8)

For the HIV-infected children already attending the Pae-

diatric Specialist Clinic confirmatory evidence of HIV

There were equal numbers of male and female 423

infection (HIV DNA PCR for those less than 18 months

males and 423 females giving a ratio 1:1. The children

and HIV antibodies for those older than 18 months) was

were evenly distributed among the various age groups.

obtained from their case notes. A questionnaire to col-

lect various information about the subjects, controls and

Mean Weight and height -for -age

parents was used. It was administered by the inter-

viewer, and was designed to answer questions such as

The mean weights and heights with respect to age

HIV status of parents, health of the mother or caregiver,

groups is shown in table 2. The mean weight was con-

use and duration of antiretroviral drugs.

sistently higher for all age intervals in the HIV-negative

children compared to the HIV-positive children. The

A focused physical examination of both subjects and

controls were taller than the HIV-infected children but

control was done. The parameters measured included

this only reached statistical significant level in the age

weight, height/length, occipito- frontal and mid upper

group 46-60 months.

arm circumference. Subjects were weighed in kilogram

to the nearest 0.1kg using an electronic Seca

scale.

Table 2: M ean weights and Heights of Subjects and Controls

Study participants were weighed barefooted with under-

Age-group Variable

HIV-positive

HIV-negative

T-test

p-value

wear only. The scale was adjusted and checked for accu-

(Months)

Mean ± SD

racy after every 10 readings by calibration. Height was

12-24

Weight (kg) 9.6±1.7

10.1± 1.8

2.52

0.000*

measured to the nearest centimeter using a graduated

Height (cm) 76.7±6.7

77.1±6.1

0.27

0.560

25-36

Weight (kg) 12.2± 2.1

13.7± 1.2

3.43

0.007*

panel fixed to the wall. The children were asked to stand

Height (cm) 87.9±6.6

89.2±7.6

0.53

0.262

erect with body against the wall looking straight ahead,

37-48

Weight (kg) 14.3± 2.6

16. 7 ±1.4

4.65

0.000*

the lower border of the eye socket being in the same

Height (cm) 94.8±5.9

98.9±6.7

0.93

0.349

horizontal plane as the external auditory meatus

12,13

. The

49-60

Weight (kg) 16.1± 2.8

18.5 ±2.3

3.38

0.001*

Height (cm) 104.5±6.6

108.4±7.5

2.36

0.019*

MUAC was measured using a non-stretch tape at a mid-

point of the distance between the acromion of the shoul-

*significant

der joint and the olecranium process of the elbow, while

occipito-frontal circumference was measured placing the

Mean MUAC and OFC of subjects and controls

tape at the frontal area just above the eyebrow through

to the occiput. All laboratory analyses were done by the

Table 3: shows the MUAC and occipito-frontal circum-

laboratory scientists at the PEPFAR/APIN laboratory.

ference (OFC) of both groups of children studied. At all

at age groups the controls had larger MUAC than the

HIV-infected children. The controls also have higher

than those of control before the age of 3 years. Rapid

OFC than the HIV-infected children up to the age of 36

brain growth occurs in the first 2years of life and any

months but afterwards the difference was not statisti-

chronic illness that affects children during these would

have a profound effect. This differs from another study

cally significant.

where there was no significant difference between HIV

Table 3: Mean MUAC and OFC of the children studied

infected and controls; this may have been as a result of

Age

Variable

HIV-

HIV-negative T test

p-value

the difference in care and early commencement of ARV

group

positive

Mean ±SD

in that study.

(months)

Mean ±SD

12-24

MUAC (cm) 14.2± 3.5

14.5± 1.1

1.53

0.016*

This study supports the multi-faceted adverse effects of

OFC (cm)

45.2 ± 2.4

47.0 ± 1.9

3.37

0.000*

HIV infection on the growth of the child. Repeated and

25-36

MUAC (cm) 14.8± 1.4

15.4± 1.0

5.82

0.000*

chronic infections in the presence of immune-

OFC (cm)

48.0± 1.9

48.6 ± 1.6

2.13

0.033*

suppression in HIV-infected children further worsen

37-48

MUAC (cm) 15.2± 1.3

16.3± 0.8

7.45

0.000*

postnatal growth

18, 20

, as a result about 50% of HIV-

OFC (cm)

48.9± 4.7

49.6 ± 1.6

1.29

0.085

49-60

MUAC (cm) 15.7± 1.1

16.4± 1.0

2.19

0.029*

infected children die before their second birth day in the

OFC (cm)

50.3± 2.1

50.7 ±0.9

3.22

0.398

era prior to widespread use of antiretroviral drugs in

younger children . HIV-infected children were shorter,

*significant

and weighed less with smaller heads and mid upper

arms, being statistically significant levels at different

age groups and these were consistent with findings from

other studies

,9, 16-19, 22-23,

Discussion

.The conduct of the study in the

Paediatric Special Clinic implies early detection of HIV

The weights for age of the HIV infected were signifi-

infection in these children and interventions including

cantly lower than that of the control at all age groups.

use of HAART that may have alleviated the adverse

This was similar to other studies

9, 14, 15

which reported

effect of HIV infection on malnutrition.

that HIV infected children weighed less than the nega-

tive control with the difference in weight increasing as

the children grew older. This is most likely due to the

persistent effect of HIV on the weight of children. The

Conclusion

difference in weight was observed to increase with age

between the HIV infected children and the controls.

HIV-infected children aged 1-5 years have poorer an-

There is increase demand and metabolism as children

thropometric measures of nutrition such as weight,

grow, and if intake is inadequate, growth can be im-

height, MUAC and head circumference when compared

paired. HIV infection cause immune suppression leading

to age and sex-matched HIV-negative children. This

to recurrent infection placing an extra demand on the

indicates that malnutrition is more common in HIV-

body’s requirement.

infected children compared to HIV-negative children

Limitation to the study. A prospective study design

The mean height of the HIV-infected children was lower

would have better demonstrated the growth rate of the

than those of the controls at all ages but was only sig-

children with HIV infection.

nificant after the age of 4years.A similar trend was ob-

served in a study but the difference in height occurred

earlier at 2years. This may be due to the prevalence of a

Authors’ contributions

high level of stunting in the general population in a

AP Conceived the study and with the others all partici-

country such as Nigeria. This high level of stunting in

pated in the study design sample collection analysis of

the general population means that differences in height

the result and its interpretation. All authors contributed

between HIV-infected children and the general popula-

to the discussions. The final draft of this work was

tion may not be evident until a much longer period.

jointly approved by all the authors.

Height is a much slower process than weight and takes a

Conflict of interest: None

longer time to become evident; hence, a deficit may not

Funding: None

be obvious in a short time. Other studies.

14, 17, 18

also

showed that HIV infected children were shorter than

their controls.

The mid upper aim circumference of the HIV infected

Acknowledgement:

children were significantly lower than those of the con-

trol at all age groups. Though there is limited date com-

We wish to express our gratitude to all the children, par-

paring mid upper arm circumference of HIV infected

ent and care giver who participated in the study. We also

children with non-infected control, however the finding

acknowledge al laboratory staff for their commitment

is similar to a study where infected children had lower

and dedication

mid arm circumference compared to controls implying

loss of subcutaneous fat and muscle bulk. The head size

of the HIV infected children, was significantly smaller

References

UNAIDS Global summary of

Newell ML, Borja M C, Peckham

18.

Arpadi .S. M Growth failure in

HIV/AIDS epidemic Updates

C. Height, weight, in children

children with HIV infection,

[Internet] 2008 DEC. [cited Mar

Born to mother with HIV infec-

http://www.jaids.com JAIDS

2006] Available from.

tion in Europe collaboration

2000; 25:537-42.

www.unaids.org/en/HIV_data/

study. J Amer Acad Paed. 2003;

19.

Matee MI, Lyamuya EF, Simon

epi2008/default. asp.

111:52-60

EE, et.al, Clinical predictors of

UNAIDS Fact sheet 2007 sub-

10.

Iroha EO, Ezeaka VC, Akinsulie

HIV-1 infection among pre-

Sahara Africa UNAID [Internet]

AO et al. Maternal HIV infection

school children in Dar es Salaam,

2008Jan [cited Feb 2008] Avail-

and intra uterine growth: a pro-

Tanzania. East Afr Med J.

able from http://www.unaids.org/

spective study in Lagos, Nigeria.

1995;72(11):694-8.

en/HIV_data/epi2007/default.

West Afr J Med. 2007 26(2):121-

20. Chantry CJ, Byrd RS, Englund

asp.

JA, et .al Growth, survival and

Tindyebywa et al.The Handbook

Use and interpretation of anthro-

viral load in symptomatic child-

on Paediatric AIDS in Africa by

pometric indicator of nutritional

hood human immunodeficiency

USAID's Regional Economic

status Review Analysis Bull

virus infection. Pediatr Infect Dis

Development Services http://

WHO.1986;64: 941.

J. 2003;22(12):1033-9.

www.fhi.org/en/HIVAIDS/pub/

12.

Saxena N, Nayor Deepika, Kapil

21.

Fergusson P, Chinkhumba J.

guide/ mans1.htm.

U Prevalence of underweight

Grijalva-Eternod C. et.al Nutri-

UNAIDS DEC. 2006 Sub-Sahara

Stunting and wasting. 2003 April

tional recovery in HIV-infected

Africa, summary of HIV/AIDS

http://www.indianpaediatrics.

and HIV-uninfected children with

epidemic Updates 0-23.

com.

severe acute malnutrition. Arch

www.unaids.org/en/HIV_data/

13.

Jane MD Physical growth of

Dis Child 2009 ; 94: 512-16

epi2006/default.asp.

Nigerian Yoruba children Trop

22.

Kurawige Jean-Baptiste, Gatsinzi

AIDS Epidemic update. Joint

Med Jr 1974 ;26:389-98.

T, Vera Kleinfeldt V etal .HIV -1

United Nations Programme 0n

Berhane R, Bagenda D Marum L

Infection among malnourished

HIV/AIDS (UNAIDS) and

et al Growth failure as a prognos-

children in Butare, Rwanda. J

World Health Organization

tic indicator of mortality in HIV

Trop Paediat 1993; 39(2):92-6

(WHO). 2006 Dec.http://www:

infection. J Amer Acad Paed.

Seitaboth S, Brady MF, Lurie M,

WHO. Int./ HIVAIDS.

1997; 100:7-12.

et al. Malnutrition in HIV in-

UNICEF. Statistical tables

15.

Bobat R: Growth in early child

fected Cambodian children Int.

(nutrition). The state of the

hood in cohort of children of HIV

Conf AIDS. 2004 Jul; 15:

world’s children. New York:

infected women from Durban

www.research.brown.edu/

Oxford University Press,

South Africa. Ann Trop Paed.

pdf/1100925759.pdf

2006:104.

2001; 21:203-10

UNICEF. Statistical tables (basic

16.

Agostoni, CZuccotti G V,M Gio-

indicators, nutrition, health, HIV/

vannini, et al Growth in the first

AIDS, demographic indicators,

two years of uninfected children

economic indicators). The state of

born to HIV-1 seropositive moth-

the world’s children. New York:

ers Arch Dis Child 1998;79:175-

Oxford University Press, 2005.

Weng S, Butery M. Chao A et al

17. Dunger DB, Kahn K.Nutritional

Perinatal human immunodefi-

status and HIV in rural South Afri-

ciency virus-1 transmission and

can children. BMC Pediatr. 2011

intrauterine growth: a cohort study

Mar 25; 11:23.

in Butare, Rwanda. Paediatrics.

1998; 102(2):24.