Malnutrition and related factors among syphilis-exposed uninfected infants and young children in Hunan province from 2018 to 2020

Objective To investigate the prevalence of malnutrition among syphilis-exposed uninfected (SEU) infants and young children in Hunan province and explore its related factors.

Methods A total of 5 404 infants and young children born to mothers infected with syphilis, registered in the Hunan Provincial Management Information System for Prevention of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B from January 2018 to December 2020, were included in this study. These children were followed up regularly until 18 months of age. Data collected included maternal demographic characteristics, gestational and delivery information, syphilis infection and treatment status, infant birth information, infant prophylactic medication use, syphilis testing results, and length and weight measurements at different follow-up time points (3, 6, 9, 12, and 18 months of age). Malnutrition among SEU infants and young children was assessed based on the WHO 2006 Child Growth Standards. Generalized estimating equations were used to fit logistic regression models to analyze the related factors.

Results The prevalence of malnutrition among SEU infants and young children at 3, 6, 9, 12, and 18 months of age was 7.5% (403/5 404), 6.1% (309/5 092), 4.2%(193/4 554), 3.8% (148/3 928), and 3.7% (125/3 348), respectively. The prevalence of stunting was 5.2% (280/5 404), 4.7% (241/5 092), 3.3% (149/4 554), 3.0% (116/3 928), and 2.8% (95/3 348), respectively. The prevalence of underweight was 2.5% (135/5 404), 1.2% (62/5 092), 0.9%(40/4 554), 0.4% (15/3 928), and 0.4% (12/3 348), respectively. The prevalence of wasting was 2.0% (107/5 404), 1.2% (62/5 092), 0.9% (42/4 554), 0.8% (32/3 928), and 0.9% (30/3 348), respectively. The prevalence of malnutrition was higher in younger SEU infants and children. Maternal first antenatal care visit at ≥28 weeks of gestation (adjusted odds ratio OR_adj=1.63, 95%CI: 1.27–2.09), low birth weight (OR_adj=2.35, 95%CI: 1.77–3.13), and preterm birth (OR_adj=1.83, 95%CI: 1.45–2.31) were risk factors for malnutrition in SEU infants and young children. Maternal standard syphilis treatment during pregnancy (OR_adj0.78, 95%CI: 0.62–0.97) and female sex of the child (OR_adj=0.62, 95%CI: 0.53–0.71) were protective factors against malnutrition.

Conclusions The prevalence of malnutrition among SEU infants and young children was relatively low. Late first antenatal care visit (≥28 weeks), standard syphilis treatment during pregnancy, low birth weight, preterm birth, and female sex were factors influencing malnutrition in SEU infants and young children.