The prevalence and sererity of motor dysfunction amongst HIV- infected children aged 6 to 12 years in Katutura Hospital Windhoek, Namibia
Date
2017
Authors
Nwagboso, Goodluck
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Abstract
Context: Human Immunodeficiency Virus (HIV) has both direct and indirect effect on the
growing immature brain that could lead to impaired neurodevelopmental outcome in children.
The extent of the motor dysfunctions becomes a matter of concern as the children grow up to
school age.
Objective: Our objective was to determine the extent and severity of motor dysfunctions in HIV
infected school-age children at a referral centre in Namibia.
Methodology: A cross sectional prospective study of 60 HIV-infected children aged 6-12 years
attending the paediatric HIV clinic in Windhoek was conducted. Severity of motor dysfunction
was assessed using the Gross Motor Functional Classification System (GMFCS) and the Manual
Ability Classification System (MACS), and clinical data were collected from medical records
and from a care-taker questionnaire.
Result: Of the 60 children enrolled in the study, 28(46.67%) were males. The mean age of the
children was 9.73 years (S.D = 2.024). The median age at the time of diagnosis was 12 months,
with a range of 1 to 73 and a SD of 16.11months. The median age at the time of commencement
of treatment was 20.5 months (males) and 35 months (female) with a P-value of 0.0039.
Over five percent (5.1%) of HIV-infected school age children had motor dysfunction scored at
Level II of the GMFCS while 7% had a score of Level II on the MACS. A positive correlation
existed between time of start of intervention with antiretroviral therapy (ART) and motor
function outcomes (p<0.0001), the serum viral RNA load and the presence of seizures in the
children (correlation coefficient = 0.31; P = 0.00327); serum viral load and developmental delays
among the children (correlation coefficient= 0.4; p-value = 0.00159). The CD4 cell count and
motor dysfunctions were correlated (correlation coefficient: 0.37; p-value <0.0001).The CD4 cell
count at diagnosis had a significant inverse correlation to the outcome of behavioural problems
in the children as well (coefficient = - 0.22; P-value = 0.004912).
Conclusion: A significant proportion of school-age HIV-infected children have
neurodevelopmental challenges and gross motor dysfunction in particular. A study with
standardized tools to ascertain the extent of impairment in the other domains of development is
needed for a more comprehensive understanding of the effects of HIV infection on school-age
children.
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Citation
Nwagboso, Goodluck Chinyere, (2017) The prevalence and severity of motor dysfunction amongst HIV-infected children aged 6 to 12 years in Katutura Hospital Windhoek, Namibia, University of the Witwatersrand, Johannesburg, https://hdl.handle.net/10539/24657