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

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.