Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants

P. Chalashika*, C. Essex, D. Mellor, J. A. Swift, S. Langley-Evans

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: A better understanding of the nutritional status of infants who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub-Saharan Africa. Methods: A cross-sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV-exposed), aged 6–24 months, attending routine child health clinics, were recruited. Anthropometric, 24-h dietary intake and socio-demographic data was collected. Anthropometric Z-scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression. Results: Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio-economic status. Conclusions: HEU infants aged 6–24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.

Original languageEnglish
Pages (from-to)779-790
Number of pages12
JournalJournal of Human Nutrition and Dietetics
Issue number6
Early online date28 Sept 2017
Publication statusPublished - 1 Dec 2017

Bibliographical note

This is the peer reviewed version of the following article: Chalashika, P., Essex, C., Duane, M., Swift, J.A. & Langley‐Evans, S. ( 2017) Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants. J Hum Nutr Diet. 30, 779– 790, which has been published in final form at  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.


  • 1000 days
  • Botswana
  • child undernutrition
  • HIV
  • infant feeding practices
  • malnutrition


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