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. 2025 Jul 24;25(1):567.
doi: 10.1186/s12887-025-05895-z.

Assessing the combined impact of pesticide exposure and HIV/ART on child neurodevelopment in Eastern and Southern Africa: a systematic review

Peter Martin Chilipweli  1 , Msilikale Walter Manyiri  2 , Namanya Basinda  3 , Benson R Kidenya  4 , Elias C Nyanza  5 , Karim Manji  6 , Aiwerasia Vera Ngowi  7
Affiliations

Assessing the combined impact of pesticide exposure and HIV/ART on child neurodevelopment in Eastern and Southern Africa: a systematic review

Peter Martin Chilipweli et al. BMC Pediatr. .

Abstract

Background: Environmental exposures, particularly pesticides, have been implicated in neurodevelopmental disorders (NDDs). Additionally, children who are HIV-exposed but uninfected (HEU) are at increased risk of neurodevelopmental delays. However, there is limited research exploring the combined effects of HIV/antiretroviral therapy (ART) exposure and pesticide exposure, especially in children from agricultural communities in Southern and Eastern Africa. This systematic review investigates the potential impact of pesticide exposure on neurodevelopmental outcomes in HEU children from these regions.

Methods: A systematic review methodology was employed, following PRISMA guidelines. Studies published between 2008 and July 2024 were retrieved from databases including PubMed, Scopus, Embase, AJOL, conference proceedings, and grey literature. The review focused on children born to smallholder horticultural farmers exposed to both maternal HIV/ART and environmental pesticides. The protocol was registered in PROSPERO. Boolean operators and tailored search strategies were used to identify relevant literature.

Results: Of 1,324 articles screened, 21 met the inclusion criteria. Most studies reported significant neurodevelopmental effects linked to pesticide exposure, with cognitive delays being the most frequently reported outcome. Children exposed to both pesticides and maternal HIV/ART exhibited increased risks of attention deficits and delayed milestones. Due to high heterogeneity in study design, populations, and outcome measures, meta-analysis was not feasible. South Africa showed the highest dual exposure burden, raising concerns about synergistic neurodevelopmental harm.

Discussion: The review highlights strong evidence linking organophosphate exposure and certain ART regimens to adverse neurodevelopmental outcomes such as ADHD and cognitive impairment in HEU children. Yet, few studies have evaluated their combined effects.

Conclusion: Findings from Southern and Eastern Africa suggest a convergence of neurotoxic risks. Multidisciplinary, region-specific research is urgently needed to clarify the interactions between pesticide exposure and HIV/ART in early childhood neurodevelopment.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12887-025-05895-z.

Keywords: (HEU); (NDDs); Cognitive development; HIV-Exposed uninfected; Horticulture growers; Neurodevelopmental disorders; Pesticides exposure; Southern and Eastern Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Data used have acquired the ethical approve from ethical review boards but some of the studies used have attained an approval to use the information published from the authors. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pesticides and neurodevelopment disorders in Southern and Eastern Africa
Fig. 2
Fig. 2
Types of pesticides used
Fig. 3
Fig. 3
Prevalence estimates and confidence intervals for studies
Fig. 4
Fig. 4
Comparison of HIV/ART and pesticides with neurodevelopment in the Eastern and Southern Africa
See this image and copyright information in PMC

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