Browsing by Author "Herlihy, Julie M."

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A Home-Based Nurturing Care Intervention for Children born HIV-Exposed but Uninfected in Zambia: A Randomized Clinical Trial
Zulu, Ethan M.; Rockers, Peter C.; Forman, Leah; Musonda, Namwiya; Nthele, Charles; Shimaingwa, Frazer; Bartrum, Megan; Masempela, Carol B.; Thea, Donald M.; Herlihy, Julie M.
Research demonstrates neurodevelopmental differences in children who are HIV-exposed, but uninfected (CHEU) compared to their peers born unexposed. CHEUs are at higher risk for prematurity and low birth weight, both known risk factors for developmental delays. Despite increasing evidence, HIV exposure remains underrecognised as a risk factor for poor development by policy-makers and early childhood development (ECD) programs. We trialed an ECD intervention for CHEUs based on the Nurturing Care Framework developed by WHO, UNICEF, and the World Bank to improve neurodevelopmental outcomes in this vulnerable population. Design We conducted a randomized controlled trial of an ECD intervention for mothers living with HIV and their children born HIV-exposed, aged six to 24 months, living in peri-urban Lusaka. The intervention was delivered through bi-weekly home visits over 18 months using the curriculum adapted from the Nurturing Care Framework. The curriculum addressed nutrition, maternal wellness, child health, developmental milestones, and interactive caregiving. Method The primary outcome was measured by the Malawi Developmental Assessment Tool (MDAT) at six and 18 months post enrollment, which assesses developmental scores via a context-validated, direct observation tool across four domains: gross motor, fine motor, language, and social development. Participants were also assessed at six, 12 and 18 months post enrollment using the Caregiver Reported Early Development Instrument (CREDI). MDAT assessors were blinded to the intervention and control arm. Results We enrolled 308 mother-infant pairs, randomized 1:1 into an ECD intervention (CHEU control, n = 155; CHEU intervention, n = 153). At six months post enrollment, the intervention was associated with modest improvements in two developmental domains, particularly cognitive (Adjusted 0.28, 95% CI: 0.09 to 0.46; p= 0.004) and social-emotional development (Adjusted 0.29, 95% CI: 0.08 to 0.49; p= 0.07). At 18 month post enrollment, adjusted models demonstrated a moderate positive effect with gross motor development, with participants showing a 0.24 standard deviation higher score compared with the control group (95% CI: 0.02–0.46; p=0.034). Conclusion The findings indicate that the intervention may have a moderate impact on cognitive and social-emotional outcomes after six months, as well as on gross motor functions after eighteen months of intervention.
Present or Absent: Risks and protective factors of sudden infant death syndrome (SIDS) in the Zambian context.
(2025-May-13) Zulu, Ethan M.; Mwananyanda, Lawrence; Pieciak, Rachel C.; Forman, Leah S.; Shah, Janaki ; Heeren, Tim; Gill, Christopher J.; Chilengi, Roma; Payne-Lohman, Barbara; Duffy, Cassandra R.; Osei-Poku, Godwin; Thea, Donald M.; Wa Somwe, Somwe; Herlihy, Julie M.
BACKGROUND: Despite a reduction in Sudden Unexplained Infant Death (SUID) in high-income countries, the incidence of SUID and the prevalence of its risk and protective factors remain poorly understood in Zambia due to limited research. The aim of our study was to describe the infant sleep positions and sleep environments in an urban Zambian population to gain a better understanding of the modifiable risk factors for SUID. METHODS: Data from the Zambian Infant Cohort Study (ZICS), a prospective birth cohort, were collected to describe infant sleep practices in Chawama, a densely populated peri-urban community in Lusaka, Zambia. During the 20-week study visit a structured questionnaire was administered to obtain data about the sleeping and environmental risks associated with SUID. RESULTS: Data were collected from 596 caregivers and 605 infants. Only 6.4% of caregivers did attain an education beyond secondary school, and a significant proportion of infants (20.2%) had low birth weights, with 10.7% of infants confirmed by ultrasound as preterm. Furthermore, 96.5% of infants were placed to sleep on their side or in a prone position, and 98.2% of infants shared a sleep surface with their caregiver. Breastfeeding, a protective factor, was highly prevalent, with 90.2% of infants receiving some form of breastfeeding at the 24-week visit. CONCLUSION: The results of this study show that both modifiable (bed-sharing and prone sleep position) and non-modifiable risk factors (low birthweight and prematurity) of SUID are prevalent in this low socioeconomic setting in Zambia. Public health strategies to prevent SUID will need to be innovative and culturally congruent in addressing modifiable risks, such as bedsharing, in settings where there is a lack of space. TRIAL REGISTRATION: Trial number: 1R01HD094650.