Sherry B, Embree J E, Mei Z, Ndinya-Achola J O, Njenga S, Muchunga E R, Bett J, Plummer F A
Department of Epidemiology, University of Washington, Seattle, USA.
Trop Med Int Health. 2000 Oct;5(10):678-86. doi: 10.1046/j.1365-3156.2000.00631.x.
OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers.
A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994.
With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, 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 husband's first wife (79% vs. 91%, P = 0.02) and more likely to have a one-room house (75% vs. 63%, P = 0.04). All three cohorts had mean Z-scores in length-for-age and in weight-for-height within the normal range (>/= 2.0 Z-scores) from birth to 21 months with the exception of the 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, dropping to about -1.45 Z-score by 21 months; in contrast, weight-for-length dropped to about -0.5 Z-score by this age. The only statistically significant differences in growth indices among the three cohorts were between the two cohorts of seronegative children: those with seronegative mothers were less 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 vs. -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.
Low-income HIV-1 seropositive- and seronegative-born children were from families with similar characteristics and similar housing environments. Similar growth patterns in the cohorts suggest that the challenging environment and the choice of weaning foods had an impact on all three cohorts. The aggressive care given the children with HIV-1 seropositive mothers and their children may have reduced the progression and impact of HIV-1 disease on the growth of the seropositive children. Further research is needed to corroborate our findings to be certain that our results are not affected by loss to follow-up bias: we lost the same proportion in all three cohorts but cannot verify that the children we lost had the same growth patterns as those who remained in the study.
目的 比较HIV-1血清阳性和血清阴性母亲所生孩子的社会人口学特征、儿童保育、儿童喂养方式及生长指标。
对1991年12月至1994年1月在肯尼亚内罗毕为低收入人群服务的普姆瓦尼妇产医院出生的234名HIV-1血清阳性母亲所生孩子（血清阳性和血清阴性）以及139名血清阴性母亲所生孩子进行队列研究。
除少数例外情况外，所有三个队列的孩子出生时其父母特征相似，居住在相似地理区域的相似住房中，主要由母亲照顾，喂养方式相似，生长状况和模式也相似。然而，HIV-1血清阳性母亲年龄稍小（23.8岁对25.0岁，P<0.01），已婚者作为丈夫首任妻子的可能性较小（79%对91%，P = 0.02），居住单间房屋的可能性较大（75%对63%，P = 0.04）。所有三个队列从出生到21个月龄时，年龄别身长和身高别体重的平均Z评分均在正常范围内（≥2.0 Z评分），18个月龄时血清阳性孩子的年龄别身长除外。在所有队列中，年龄别身长比身高别体重受影响更大，到21个月龄时降至约-1.45 Z评分；相比之下，该年龄时身高别体重降至约-0.5 Z评分。三个队列生长指标中唯一具有统计学显著差异的是两组血清阴性孩子之间：血清阴性母亲的孩子在1.5个月龄时年龄别身长受影响较小（平均Z评分=-0.19对-0.48，P<0.05），在6个月龄和18个月龄时身高别体重受影响较大（平均Z评分=0.10对0.45，P<0.05；平均Z评分=-0.73对-0.16，P<0.05）。1.5个月龄时27 - 34%纯母乳喂养；2.5个月龄时52 - 61%除母乳外还食用固体食物。
低收入的HIV-1血清阳性和血清阴性母亲所生孩子来自特征相似和住房环境相似的家庭。各队列相似的生长模式表明具有挑战性的环境和断奶食品的选择对所有三个队列都有影响。对HIV-1血清阳性母亲及其孩子给予的积极照料可能减少了HIV-1疾病对血清阳性孩子生长的进展和影响。需要进一步研究来证实我们的发现，以确定我们的结果不受失访偏倚的影响：我们在所有三个队列中失访比例相同，但无法证实失访孩子的生长模式与留在研究中的孩子相同。
