Maternal HIV Infection and Low Birthweight Outcomes among Children born to Adolescent and Young Adult Mothers in Zambia: A Multi-level Analysis

Abstract Infants born with LBW are at a higher risk of dying within their first month of life, and those who survive are prone to lifelong challenges, including stunted growth, lower IQ, and an increased risk of chronic conditions in adulthood, such as obesity and diabetes. Infants with LBW may have digestive and breathing problems and complications in eating, gaining weight, and fighting off infections compared with normal birth weight infants. The aim of this study was to find out the effects of maternal HIV infection on low birthweight among children born to adolescents and young adult mothers in Zambia. The study used a cross-sectional study design using the Zambia demographic health survey which was conducted in all the 10 provinces. The study population comprised of children born to adolescent and young adult mothers five years preceding the survey. Overall, LBW prevalence did not differ significantly by HIV status, with HIV-positive mothers recording 9.6% and HIV-negative mothers 8.7%. Provincial variation was observed, with LBW among HIV-infected mothers highest in Eastern (15.0%) and Northern (14.2%) and lowest in Muchinga (0%) and Luapula (1.6%). Among non-infected mothers, Lusaka (10.7%) and Muchinga (10.0%) reported the highest LBW prevalence, while Northern had the lowest (3.9%). A multi-level analysis confirmed that maternal HIV status was not significantly associated with LBW (OR = 0.95, 95% CI: 0.50–1.79, p = 0.871). Instead, LBW was strongly predicted by socio-economic and maternal factors: mothers in the middle wealth index had higher odds of LBW (OR = 1.69, 95% CI: 1.16–2.47, p = 0.006), home deliveries had reduced odds (OR = 0.28, 95% CI: 0.14–0.59, p = 0.001), and multiple births increased the odds more than eight-fold (OR = 8.05, 95% CI: 3.64–17.83, p < 0.001). The study indicates that HIV infection alone may not be a principal factor influencing LBW outcomes in this age group in Zambia rather, LBW is more strongly shaped by socio-economic conditions, delivery setting, and multiple birth risks. These results are essential for shaping future HIV/AIDS interventions, guidelines, and policies designed to avert LBW in at-risk populations. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The 2018 Zambia Demographic Health Survey data survey protocols were approved by the ICF Institutional Review Board (IRB) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data for this study were obtained from the Zambia Demographic and Health Survey (ZDHS), which is part of the Demographic and Health Surveys (DHS) Program. The data were originally accessed through the DHS Program website (https:// dhsprogram.com/).