The prevalence and sererity of motor dysfunction amongst HIV- infected children aged 6 to 12 years in Katutura Hospital Windhoek, Namibia

Nwagboso, Goodluck
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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.
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,