Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The global epidemic of HIV continues with an estimated 2.2 million children under 15
years of age worldwide living with HIV and 640 000 newly infected in 2004 (WHO,
2009). HIV crosses the blood–brain barrier which may lead to neuronal damage and
death. There is controversial evidence within available research on effects of HIV on
cognitive and motor development in children because of the limitations imposed by
study designs, study populations and study methodological quality.
The aims of the review were:
- To conduct a systematic review of published research to establish the effects and
the prevalence of HIV infection on cognitive and motor development in children.
- To critically appraise the methodological quality of published research regarding
cognitive and motor development of HIV infected children.
The objectives of the review were:
- To assess evidence on the cognitive and motor development of HIV-1 infected
children
- To describe anthropometric outcomes including: weight for age, weight for
height, height for age and head circumference in children with a HIV infection.
- To assess the methodological quality of studies on the cognitive and motor
development of HIV infected children. The following databases were searched for identification of articles; MEDLINE, Google
Scholar, AIDSTRIALS, AIDSLINE and CINHAL. The search time frame included
published works from inception to July 2011 without language restrictions.
Analytical observational trials that assessed at least one outcome (cognitive or motor
development or 1 of the anthropometric outcomes) between HIV positive and HIV
negative children aged 5 years and below or children with a mean age of less than 5
years were employed.
Two review authors independently searched for eligible studies, evaluated
methodological quality and extracted the data. Meta-analysis was carried out using Rev
Man 5.1 using the risk ratio for categorical data and standard mean difference for
continuous data.
Fifteen studies with a total of 3 086 participants met the inclusion criteria. HIV infected
children were 2.45 times at higher risk of developing cognitive developmental delay than
HIV negative children (RR, 95% CI, 1.95, 3.07, P < 0.00001). Infected children scored -
0.54 less than HIV negative children (SMD 95% CI, -0.70, -0.39, 97, p < 0.00001) for
cognitive development and -0.68 in motor development (SMD 95% CI, -0.82, -0.55, p<
0.00001). The risk of motor developmental delays was 2.95 times in HIV positive
compared with HIV negative children (RR 95% CI, 2.19, 3.99, p < 0.00001).
HIV infected children are slower in aspects of cognitive and motor development
compared to their HIV negative counterparts. They also showed delays in
anthropometric outcomes; weight for age and height for age. Study design influenced
results of the studies with children scoring more on cross sectional than cohort studies.
There is still need to develop culturally appropriate or standardise neurodevelopment
tools as most African studies still rely on international tools. More evidence is needed on
the effectiveness of HAART in reducing cognitive and motor delay. / AFRIKAANSE OPSOMMING: Die wêreldwye MIV epidemie duur voort met ongeveer 2.2 miljoen kinders onder 15
jarige ouderdom wat wêreldwyd met MIV leef en 640 000 onlangs in 2004 geïnfekteerd
(WHO, 2009). MIV strek oor die bloed-brein grens wat kan lei tot neuronale skade en
die dood. Daar is kontroversiële bewys binne beskikbare navorsing oor die effek wat
MIV het op kognitiewe en motoriese ontwikkeling in kinders, vanweë die beperkinge wat
geplaas word deur studie ontwerpe, studie bevolkings en studie metodologiese
kwaliteit.
Die doelwitte van die oorsig is om
- ‘n sistematiese oorsig van gepubliseerde navorsing te doen om sodoende die
effek en voorkoms van MIV infeksie op kognitiewe en motoriese ontwikkeling by
kinders vas te stel
- ’n kritiese waardering van die metodologiese kwaliteit van gepubliseerde
navorsing te doen ten opsigte van die kognitiewe en motoriese ontwikkeling van
MIV geïnfekteerde kinders.
Die doelwitte van die oorsig is om
- assessering te doen van die bewyse van kognitiewe en motoriese ontwikkeling
by MIV-1 geïnfekteerde kinders
- antropometriese uitkomste te beskryf, insluitend: gewig vir ouderdom, gewig vir
hoogte, hoogte vir ouderdom en omtrek van die hoof by kinders met ’n MIV
infeksie
- die metodologiese kwaliteit te assesseer van studies op die kognitiewe en
motoriese ontwikkeling van MIV geïnfekteerde kinders. Die volgende databasisse is nagevors vir die identifisering van artikels: MEDLINE,
Google Scholar, AIDSTRIALS, AIDSLINE en CINHAL. Die tydraamwerk vir navorsing
het gepubliseerde werk ingesluit vanaf aanvang tot Julie 2011 sonder taalbeperkings.
Analitiese waarneembare toetse wat ten minste een uitkoms geassesseer het
(kognitiewe of motoriese ontwikkeling of 1 van die antropometriese uitkomste) tussen
MIV positiewe en MIV negatiewe kinders van 5 jarige ouderdom en jonger, of kinders
met ’n gemiddelde ouderdom van minder as 5 jaar is betrek.
Twee oorsig outeurs het onafhanklik vir geskikte studies gesoek, metodologies
geëvalueer en data getrek. Meta-analise was uitgevoer deur gebruik te maak van Rev
Man 5.1 met behulp van die risiko-ratio vir kategoriese data en die standaard
gemiddelde verskil vir aaneenlopende data.
Vyftien studies met ’n totaal van 3 086 deelnemers met die insluitingskriteria. MIV
geïnfekteerde kinders het 2.45 keer ’n hoër risiko gehad om kognitiewe
ontwikkelingsvertraging te ontwikkel as MIV negatiewe kinders (RR, 95% CI, 1.95, 3.07,
P< 0.0000). Geïnfekteerde kinders het ’n -0.54 telling behaal, minder as MIV negatiewe
kinders (SMD 95% CI, -0.70, -0.39,97 p < 0.00001) vir kognitiewe ontwikkeling en -0.68
vir motoriese ontwikkeling (SMD 95% CI, -0.82, -0.55, p< 0.00001). Die risiko van
motoriese ontwikkelingsvertragings was 2.95 keer by MIV positiewe in vergelyking met
MIV negatiewe kinders (RR 95% CI, 2.19, 3.99. p < 0.00001).
MIV geïnfekteerde kinders is stadiger in aspekte van kognitiewe en motoriese
ontwikkeling in vergeyking met hulle MIV negatiewe eweknieë. Hulle het ook vertragings
getoon in antropometriese uitkomste; gewig vir ouderdom en hoogte vir ouderdom.
Studie ontwerpe het uitslae beïnvloed van die kinders wat ’n hoër telling behaal het met
deursnee as in kohort studies. Daar is nog ’n behoefte om kultureel geskikte of
gestandaardiseerde neuro-ontwikkelingsinstrumente te ontwikkel, omdat die meeste
Afrika-studies nog steeds staat maak op internasionale instrumente. Meer bewyse is
nodig aangaande die effektiwiteit van HAART om kognitiewe en motoriese vertraging te
verminder.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/20089 |
| Date | 03 1900 |
| Creators | Kgomo, Gretta Tumelo |
| Contributors | Khondowe, Oswell, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 100 p. |
| Rights | Stellenbosch University |
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