Sociodemographic characteristics, care, feeding practices, and growth of cohorts of children born to HIV-1 seropositive and seronegative mothers in Nairobi, Kenya

OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and ser onegative mothers. METHODS A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mother s in Pumwani Maternity Hospital which serves a low-income population in Nai robi, Kenya from December 1991 and January 1994. RESULTS With few exceptions, at the time of their birth children in all thr ee cohorts had parents with similar characteristics, lived in similar housi ng in similar geographical areas, had their mothers as their primary care g ivers, had similar feeding practices and similar growth status and patterns . However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their hu sband's first wife (79% vs. 91%, P = 0.02) and more likely to have a one-ro om house (75% vs. 63%, P = 0.04). All three cohorts had mean Z-scores in le ngth-for-age and in weight-for-height within the normal range (greater than or equal to 2.0 Z-scores) from birth to 21 months with the exception of th e length-for-age of the seropositive children at the 18-month visit. In all cohorts length-for-age became more compromised than weight-for-length, dro pping to about -1.45 Z-score by 21 months; in contrast, weight-for-length d ropped to about -0.5 Z-score by this age. The only statistically significan t differences in growth indices among the three cohorts were between the tw o cohorts of seronegative children: those with seronegative mothers were le ss compromised in length-for-age at 1.5 months (mean Z-score = -0.19 vs. -0 .48, P < 0.05) and more compromised in weight-for-length at 6 months (mean Z-score = 0.10 vs. 0.45, P < 0.05) and at 18 months (mean Z-score = -0.73 v s. -0.16, P < 0.05). 27-34% were exclusively breastfed at 1.5 months; 52-61 % consumed solid foods in addition to breast milk by 2.5 months. CONCLUSIONS Low-income HIV-1 seropositive- and seronegative-born children w ere from families with similar characteristics and similar housing environm ents. Similar growth patterns in the cohorts suggest that the challenging e nvironment and the choice of weaning foods had an impact on all three cohor ts. The aggressive care given the children with HIV-1 seropositive mothers and their children may have reduced the progression and impact of HIV-1 dis ease on the growth of the seropositive children. Further research is needed to corroborate our findings to be certain that our results are not affecte d by loss to follow-up bias: we lost the same proportion in all three cohor ts but cannot verify that the children we lost had the same growth patterns as those who remained in the study.