Prechtl’s Observed General Movements in HIV and Antiretroviral Therapy Exposed Uninfected Infants in Blantyre, Malawi

Abstract

Background Malawi is one of the countries with a high prevalence of human immunodeficiency virus (HIV) in the sub-Saharan region. As more HIV-reactive mothers bear children, more infants are being exposed to HIV and antiretroviral therapy (ART) leading to an increase in the number of ART- and HIV- exposed uninfected (AHEU) children. This scenario, coupled with the reports about detected neurodevelopmental challenges among the AHEU infants makes it worthwhile to study this at-risk group of infants. It is now possible to identify infants at risk of neurodisability at an early stage of development through the use of Prechtl’s General Movements Assessment (GMA). This study therefore was aimed at determining the association between HIV and ART exposure on the quality of observed general movements of infants. Objectives ● To describe the quality of general movement patterns observed among AHEU and HIV unexposed uninfected (HUU) infants. ● To investigate the association between gender and general movements. ● To compare general movement patterns of AHEU infants to those of HUU infants Method This was a cross-sectional study. A sample size of 65 participants was identified from Zingwangwa Health Centre. These infants were categorised into AHEU and HUU. A 3-minute video of each child was taken when they displayed spontaneous movements. Coded video clips were then analysed by two trained independent assessors. Results The study found a high level of agreement between scorers for general movement assessment (Kappa = 0.731, p = 0.000). All participants, aged between nine to 16 weeks with a mean of 11 weeks, were breastfed (n = 65). All infants were HIV negative, with nearly equal numbers of HUU and AHEU participants. The majority exhibited iv normal general movement scores, with no significant differences observed based on gender (p = 0.276) or HIV/ART exposure (p = 0.605). Conclusion In this study comparing AHEU and HUU infants, normal general movements were prevalent, indicating a low risk of cerebral palsy. Gender showed no significant association with GMA scores. Larger samples and longitudinal studies are recommended to confirm these findings and understand long-term effects of HIV and ART exposure on infant neurodevelopment.