Motor development and growth status of 2 to 6-year old children infected with human immunodeficiency virus (HIV)
Botha, Jo-Anne Elizabeth
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Research indicates that children with Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) display a variety of neuro-developmental, cognitive, motor and nutritional deficiencies (Epstein el al., 1986:678; Davis-McFarland, 2000:20; Blanchette et al., 2001:50). Research also substantiates a need for additional intervention strategies such as improved nutrition and exercise programmes to improve the quality of life for HIV-infected children (Brady, 1994: 18; Stein et al., 1995:3 1 ; Parks & Danoff, 1999:527). The maintenance of motor skills in above-mentioned children is an important objective for intervention programmes, especially gross motor skills (Parks & Danoff, 1999:525). Literature indicates that growth retardation, exhaustion of fat storage and neuro-developmental deficiencies are related to HIV/AIDS (Aylward et al., 1992:218; Miller & Garg, 1998:368; Davis-McFarland, 2000:20; Miller et al., 200 1 : 1287). The monitoring of growth status is of outmost importance as children with serious stunting and wasting run the risk of early death. Growth retardation can also be an indication of infection or fast disease progression (Bobat et al, 200! :209). The aim of this study was firstly to determine the state of the motor development of 2, to 6-year old children infected with HIV and to compare it with that of affected (in that they are not infected with HIV, but have lost one or both parents to AIDS-related diseases) and non-affected children. Secondly the study aimed to determine the effect of a motor intervention programme for 2 to 6-year old children infected with and affected by HIV. A third aim was to determine the growth status of 2 to 6-year old children infected with HIV and to compare it with that of affected and non-affected children; and the last aim was to monitor the developmental tendencies of body composition and growth of 2 to 6-year old children infected with HIV in the course of nine months and to compare it with that of affected and non-affected children. The Peabody Developmental Motor Scales-:! (PDMS-2) (Folio & Fewell, 2000), which consist of six subtests, was used to determine the motor development of the children. Regarding the growth status the children were subjected to a series of anthropometric measurements of height, weight, circumference (upper arm - both tonic and relaxed), as well as skin folds (triceps, sub-scapular, calf), in accordance with standard procedures as prescribed by the International Society of Advanced Kinanthropometry (ISAK). The data was analysed using Statistica for Windows (Statsoft-, Inc S.A., 2001) and SAS (2000- 2003). Descriptive statistics were used to determine means (M), standard deviations (SD) and maximum and minimum values. One-way variance of analysis, forward stepwise discriminant analysis, independent T-testing, dependant T-testing and an ANCOVA, repeated measures ANOVA, and Bonferroni post hoc analysis were used to analyse the data in accordance with the above-mentioned aims. The level of statistic significance was set at p<0,05. Practical significance of differences (ES) between the testing sessions was calculated by dividing the mean difference (M) between the two testing sessions by the largest standard deviation (SD), as recommended by Cohen (1988) and Steyn (1999). Cohen (1988) set the following guidelines for interpreting practical significance, namely ES = 0,2 (small effect); ES = 0,5 (medium effect) and ES = 0,8 (large effect). Due to the small number of subjects it was considered practically significant if this effect size indicated a medium and larger effect. From the results of the study it seemed that the HIV-infected children performed the poorest of the groups regarding gross motor, fine motor and total motor skills. This group's gross motor skills showed larger deficits than their fine motor skills, while loco-motor skills contributed the most to the discrimination between the groups. The motor intervention programme led to a statistically significant improvement in loco-motor, fine motor, as well as total motor skills. The infected children showed better improvement compared to the affected children. The infected group displayed the poorest growth status of the three groups compared to the Centre for Disease Control (CDC) growth profiles, although they did not differ significantly from the affected children. The infected children differed significantly regarding height percentile, fat percentage and height-for-age 2-score (HAZ) from non-affected children. The infected group also displayed the least significant effects in the form of growth increases over the nine months monitoring period. It can be concluded from the results that motor deficiencies and growth impediments are part OF the life of HIV infected children. To address these problems, intervention strategies, such as motor intervention and nutrition programmes are needed.
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