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BACKGROUND: 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's 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. METHODOLOGY: We applied structural equation modelling to cross-sectional data from 328 children living with HIV and 260 children living without HIV aged 6-14 years 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. RESULTS: The model predicting the cognitive outcomes fitted well (RMSEA = 0.041, CFI = 0.966, χ2 = 154.29, DF = 77, p 

Original publication




Journal article


Front Public Health

Publication Date





HIV, executive functioning, flexibility, lower & middle-income countries, lower school students, mediation, reasoning, stunting, Female, Humans, Child, HIV Infections, Latent Class Analysis, Kenya, Cross-Sectional Studies, Growth Disorders, Cognition