Prevalence and cofactors of developmental delay among preschool aged children who are HIV exposed and uninfected in Kenya

Abstract

Background: HIV-exposed uninfected children (CHEU) represent a growing population in sub-Saharan Africa following scale-up of maternal antiretroviral therapy (ART). Emerging evidence suggests increased risk for developmental delays, particularly in expressive language and motor domains. However, data from preschool-aged CHEU in low-resource settings remain limited. Methods: We conducted a cross-sectional analysis of 706 children aged 3–5 years (634 CHEU, 72 children not exposed to HIV [CHU]) enrolled at 11 sites in three counties in Kenya. Development was assessed using the Ages and Stages Questionnaire (ASQ-3), which screens for delays in gross and fine motor, communication, problem-solving and personal social domains. We compared the prevalence of domain-specific and global delays among CHEU and CHU and identified correlates of delay among CHEU. Results: Overall, 42% of CHEU and 35% of CHU children had a delay in at least one developmental domain (p = 0.30). Fine motor delays were significantly more prevalent among CHEU (15% vs. 2.8%, adjusted prevalence ratio 4.16 (95% CI: 1.05–16.53). Gross motor delays were only observed in CHEU (10% vs 0% p = 0.002). There were no differences among CHEU and CHU in the other domains. Among CHEU, developmental delays were associated with stunting, reduced head circumference, previous neurological conditions, and delayed milestone attainment in early childhood. Longer breastfeeding duration and access to multiple play materials were protective. No significant associations were found with maternal ART regimen or timing. Conclusion: Preschool-aged children in Kenya face a high burden of developmental delays, and CHEU are more vulnerable. Findings highlight the importance of integrating early developmental screening and interventions into child care. Targeted services addressing modifiable risk factors can improve outcomes and school readiness in this vulnerable group.