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Objectives: To explore the factors that influence small for gestational age outcome among HIV exposed infants delivered at the Women and Newborn Hospital, Lusaka, Zambia. Materials and Methods: This was a facility-based unmatched case control study nested in the Zambia Preterm Birth Prevention Study (ZAPPS) conducted at the Women and Newborn Hospital in Lusaka district between October 2017 and February 2021. Convenience sampling was used to select all the 53 HIV exposed small for gestational age infants (as cases) and 152 HIV unexposed small for gestational age infants (as controls). An excel data extraction tool was used to extract categorised variables from the ZAPPS data set into Stata version 19. Chi-square test was used to test for association, foetal and maternal variables with a p-value of 0.2 at univariate analyses were entered into a multiple logistic regression model. Results: The proportion of SGA, though not statistically significant, was found to be 19.9% among the HIV exposed infants compared to 17.3% in the unexposed group (p= 0.34). More than three quarters of participants in both the HIV positive arm (71.7%) and HIV negative arm (81.3%) were aged between 20-35 years. On multivariate analysis, Maternal chronic illness [AOR: 4.39, 95% CI: (1.66 - 11.6), p=0.003] and spontaneous preterm delivery [AOR: 1.58, 95% CI: (1.02 - 2.46), p=0.040] had a strong association with small for gestational age. Tertiary Level of education [AOR: 0.45, (0.24 - 0.85), p=0.014] was found to be significantly protective against small for gestational age. Maternal factors such as married status [AOR: 0.74, (0.48 - 1.13), p=0.164], secondary level of education [AOR: 0.82, (0.54 - 1.24), p=0.743], history of stillbirth [AOR: 1.31, (0.92-1.85), p=0.123] and the Mid-upper arm circumference [AOR: 0.96, (0.92-1.00), p=0.064] was not associated with small for gestational age. Conclusion: There was no association between maternal HIV infection and SGA. Maternal chronic illness and spontaneous preterm birth increase the odds of SGA outcome while tertiary level of education is protective. Further research is needed to broaden the evidence base for addressing small for gestational age as a gateway to improve perinatal mortality, and for policy implementers to devise cost-effective and sustainable ways of reaching the at-risk population.

Background: Low socioeconomic status has generally been associated with adverse birth outcomes worldwide. Adverse birth outcomes significantly contribute to perinatal morbidity and mortality worldwide with some literatures showing conflicting results. At Women and New-born Hospital in Zambia, this relationship had remained unclear among women who experienced poor neonatal outcome; hence the study was done to explore this association between socioeconomic status and adverse birth outcomes. Methods: A retrospective cohort study was conducted. Secondary data from ZAPPS study that had been collected prospectively between August 2015 and September 201 7 was retrieved. Altogether, 1,450 participants' information was retrieved, out of which 1,084 data records were set out for analysis after excluding those not meeting eligibility criteria. Socioeconomic status was an explanatory variable which was estimated using the standardized wealth score derived from principal component analysis of 14 variables. The wealth quintiles were further categorised into poor and not poor. Response variables were low birth weight, preterm birth and small for gestation age. SPSS version 21 was used for data analysis and p value< 0.05 was significant Results: This study found the incidences of SGA, LBW and preterm births to be 164, 124 and 13 5 per 1000 live births respectively. In survival analysis, the proportion of babies who survived LBW among mothers who were poor was lower (82.9%) compared to babies born to rich mothers (87.5%) (p-value = 0.189). Furthermore, the proportion of babies who survived SGA for the poor was lower (79 .1 % ) compared to babies born to none poor mothers (85.8%) (p-value = 0.032) and preterm birth for the poor (78.4%) compared to babies born to mothers who were rich (83 .6%) (p-value = 0.022). In multiple Cox regression analysis socioeconomic status was not a significant risk factor for SGA ( aHR = 1.08; 95% CI; p=0.099), LBW and preterm birth (aHR = 1.17; 95% CI; p= l.41). However, male babies (aHR = 1.80; 95% CI; p=0.012), domestic violence or abuse during pregnancy (aHR = 3.48; 95% CI [1.59 - 7.34]; p = 0.002) and maternal anaemia (aHR = 2.1; 95% CI; p = 0.019) were risk factors for SGA while prior preterm birth ( aHR = 2.02; 95% CI; p = 0.002), HIV infection (aHR = 1.22; 95% CI; p = 0.040) and anaemia (aHR = 1.37; 95% CI; p = 0.009) were predictors of preterm delivery. Conclusion: There was no statistically significant association between low socioeconomic status and adverse birth outcomes although being pregnant with a male baby, HIV infection, anaemia and prior preterm birth were significantly associated with SGAand preterm.

Parental HIV infection may affect even those exposed children who remain uninfected. We investigated early growth, an indicator of overall health, of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health.HIV-infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth, 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV-uninfected mothers (n = 184) and those infants of HIV-infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2-4 years (n = 85).Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV-infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P = 0.04), even after adjustment for their lower gestational age at birth, compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length, and maternal subclinical mastitis, primiparity and weight during pregnancy.Early growth of infants of HIV-infected mothers is less than that of uninfected mothers, in part associated with subclinical mastitis, and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding.