{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T23:19:49Z","timestamp":1775776789384,"version":"3.50.1"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T00:00:00Z","timestamp":1687305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Empirical evidence indicates that both HIV infection and stunting impede cognitive functions of school-going children. However, there is less evidence on how these two risk factors amplify each other\u2019s negative effects. This study aimed to examine the direct effects of stunting on cognitive outcomes and the extent to which stunting (partially) mediates the effects of HIV, age, and gender on cognitive outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>We applied structural equation modelling to cross-sectional data from 328 children living with HIV and 260 children living without HIV aged 6\u201314\u2009years from Nairobi, Kenya to test the mediating effect of stunting and predictive effects of HIV, age, and gender on cognitive latent variables flexibility, fluency, reasoning, and verbal memory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The model predicting the cognitive outcomes fitted well (RMSEA\u2009=\u20090.041, CFI\u2009=\u20090.966, \u03c7<jats:sup>2<\/jats:sup>\u2009=\u2009154.29, DF\u2009=\u200977, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Height-for-age (a continuous indicator of stunting) predicted fluency (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.14) and reasoning (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.16). HIV predicted height-for-age (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.24) and showed direct effects on reasoning (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.66), fluency (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.34), flexibility (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20090.26), and verbal memory (<jats:italic>\u03b2<\/jats:italic>\u2009=\u2009\u22120.22), highlighting that the effect of HIV on cognitive variables was partly mediated by height-for-age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this study, we found evidence that stunting partly explains the effects of HIV on cognitive outcomes. The model suggests there is urgency to develop targeted preventative and rehabilitative nutritional interventions for school children with HIV as part of a comprehensive set of interventions to improve cognitive functioning in this high-risk group of children. Being infected or having been born to a mother who is HIV positive poses a risk to normal child development.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1171851","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T09:52:22Z","timestamp":1687341142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The effects of height-for-age and HIV on cognitive development of school-aged children in Nairobi, Kenya: a structural equation modelling analysis"],"prefix":"10.3389","volume":"11","author":[{"given":"Rachel","family":"Maina","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amina","family":"Abubakar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Perez-Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manasi","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelte M.","family":"Wicherts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,21]]},"reference":[{"key":"ref1","volume-title":"UNICEF-WHO-the World Bank: Joint Child Malnutrition Estimates, Levels and Trends","year":"2021"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1111\/j.1740-8709.2010.00255.x","article-title":"Impact of early and concurrent stunting on cognition","volume":"7","author":"Crookston","year":"2011","journal-title":"Matern Child Nutr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1179\/2046905514Y.0000000158","article-title":"The stunting syndrome in developing countries","volume":"34","author":"Prendergast","year":"2014","journal-title":"Paediatr Int Child Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s43054-020-00043-x","article-title":"Impact of stunting on early childhood cognitive development in Benin: evidence from demographic and health survey","volume":"68","author":"Ekholuenetale","year":"2020","journal-title":"Egypt Pediatric Association Gaz"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.3389\/fpsyg.2019.01582","article-title":"The relationship between executive functions and academic performance in primary education: review and Meta-analysis","volume":"10","author":"Cort\u00e9s Pascual","year":"2019","journal-title":"Front Psychol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cogdev.2017.02.003","article-title":"Executive function predicts school readiness in autistic and typical preschool children","volume":"43","author":"Pellicano","year":"2017","journal-title":"Cogn Dev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/S0140-6736(07)61692-4","article-title":"Maternal and child undernutrition: consequences for adult health and human capital","volume":"371","author":"Victora","year":"2008","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1177\/0956797618774253","article-title":"How much does education improve intelligence?","volume":"29","author":"Ritchie","year":"2018","journal-title":"Psychol Sci Public Interest"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/advances\/nmy101","article-title":"Perspective: what does stunting really mean? 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