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Kimani M, Molyneux S, Charo A, Zakayo SM, Sanga G, Njeru R, Davies A, Kelley M, Abubakar A, Marsh V. Layered vulnerability and researchers' responsibilities: learning from research involving Kenyan adolescents living with perinatal HIV infection. BMC Med Ethics 2024; 25:21. [PMID: 38378641 PMCID: PMC10877892 DOI: 10.1186/s12910-023-00972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/16/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Carefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/AIDS, without increasing burdens. Such studies, however, must navigate a 'vulnerability paradox', since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/AIDS (ALH) in Kenya, we develop an account of researchers' responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency as 'interacting layers'. METHODS Using a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders' perspectives on vulnerability and resilience of young people living with HIV/AIDS, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna's layered account of vulnerability. RESULTS ALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences. CONCLUSIONS The most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers' responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities.
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Affiliation(s)
- Mary Kimani
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya.
- Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Anderson Charo
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Scholastica M Zakayo
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gladys Sanga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rita Njeru
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alun Davies
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maureen Kelley
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Aga Khan University, Institute for Human Development, Nairobi, Kenya
| | - Vicki Marsh
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Biology, 3 South Parks Road, Oxford, OX13SY, UK
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Otieno B, Elson L, Matharu AK, Riithi N, Chongwo E, Katana K, Nasambu C, Mutebi F, Feldmeier H, Krücken J, Fillinger U, Abubakar A. Neurocognitive and mental health outcomes in children with tungiasis: a cross-sectional study in rural Kenya and Uganda. Infect Dis Poverty 2023; 12:100. [PMID: 37964353 PMCID: PMC10644620 DOI: 10.1186/s40249-023-01154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Tungiasis, a neglected tropical parasitosis, disproportionately affects children. Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis. Pathophysiology of tungiasis suggests it could detrimentally affect cognition and behaviour. This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis. METHODS This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda. The participants were stratified into infected and uninfected based on the presence of tungiasis. The infected were further classified into mild and severe infection groups based on the intensity of the infection. Adapted, validated, and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data. Statistical tests including a multilevel, generalized mixed-effects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes. RESULTS When adjusted for covariates, mild infection was associated with lower scores in literacy [adjusted β(aβ) = - 8.9; 95% confidence interval (CI) - 17.2, - 0.6], language (aβ = - 1.7; 95% CI - 3.2, - 0.3), cognitive flexibility (aβ = - 6.1; 95% CI - 10.4, - 1.7) and working memory (aβ = - 0.3; 95% CI - 0.6, - 0.1). Severe infection was associated with lower scores in literacy (aβ = - 11.0; 95% CI - 19.3, - 2.8), response inhibition, (aβ = - 2.2; 95% CI - 4.2, - 0.2), fine motor control (aβ = - 0.7; 95% CI - 1.1, - 0.4) and numeracy (aβ = - 3; 95% CI - 5.5, - 0.4). CONCLUSIONS This study provides first evidence that tungiasis is associated with poor neurocognitive functioning in children. Since tungiasis is a chronic disease with frequent reinfections, such negative effects may potentially impair their development and life achievements.
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Affiliation(s)
- Berrick Otieno
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya.
| | - Lynne Elson
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Abneel K Matharu
- International Centre of Insect Physiology and Ecology (ICIE), Human Health Theme, Nairobi, Kenya
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Naomi Riithi
- International Centre of Insect Physiology and Ecology (ICIE), Human Health Theme, Nairobi, Kenya
| | - Esther Chongwo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Khamis Katana
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
| | - Carophine Nasambu
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
| | - Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala , Uganda
| | | | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology (ICIE), Human Health Theme, Nairobi, Kenya
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Molinaro M, Adams HR, Mwanza-Kabaghe S, Mbewe EG, Kabundula PP, Mweemba M, Birbeck GL, Bearden DR. Evaluating the Relationship Between Depression and Cognitive Function Among Children and Adolescents with HIV in Zambia. AIDS Behav 2021; 25:2669-2679. [PMID: 33630200 PMCID: PMC8456506 DOI: 10.1007/s10461-021-03193-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
Depression is common among people living with HIV. Multiple studies demonstrate a link between depression and cognitive dysfunction in adults with HIV, but the association has been minimally investigated in children and adolescents with HIV in Africa. We conducted a cross-sectional analysis as part of the HIV-associated Neurocognitive Disorders in Zambia study, a prospective cohort study in Lusaka, Zambia. We included 208 perinatally-infected children with HIV ages 8-17 taking antiretroviral therapy and 208 HIV-exposed uninfected (HEU) controls. Cognition was assessed with a comprehensive neuropsychological battery. Depressive symptoms were evaluated using self-report and parent-report versions of the NIH Toolbox Sadness module and the Patient Health Questionnaire-9 (PHQ-9). Risk factors for depression and associations between depressive symptoms and cognition were evaluated in bivariable and multivariable regression models. Participants with HIV demonstrated higher levels of depressive symptoms than controls (mean NIH Toolbox Sadness T-Score 50 vs. 44, p < 0.01; mean PHQ-9 score 2.0 vs. 1.5, p = 0.03), and were more likely to have cognitive impairment (30% vs. 13%, p < 0.001). Risk factors for depressed mood included self-reported poor health (OR 7.8, p < 0.001) and negative life events (OR 1.3, p = 0.004) Depressed mood was associated with cognitive impairment in participants with HIV (OR = 2.9, 95% CI 1.2-7.2, p = 0.02) but not in HEU participants (OR 1.7, 95% CI 0.18-15.7, p = 0.6). In conclusion, depressed mood is common among youth with HIV in Zambia, and is associated with cognitive impairment. Depression may be a result of HIV-related stress and stigma, or may be part of the spectrum of HIV-associated neurocognitive disorders. The causal relationship between depressed mood and cognitive impairment is unclear and should be evaluated in future longitudinal studies.
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Affiliation(s)
| | - Heather R Adams
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 631, Rochester, NY, 14642, USA
| | | | - Esau G Mbewe
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia
| | | | - Milimo Mweemba
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - Gretchen L Birbeck
- Division of Epilepsy, Department of Neurology, Rochester, NY, USA
- University of Zambia School of Medicine, Lusaka, Zambia
| | - David R Bearden
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 631, Rochester, NY, 14642, USA.
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia.
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Alteration of the gut fecal microbiome in children living with HIV on antiretroviral therapy in Yaounde, Cameroon. Sci Rep 2021; 11:7666. [PMID: 33828220 PMCID: PMC8027858 DOI: 10.1038/s41598-021-87368-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/15/2021] [Indexed: 02/08/2023] Open
Abstract
Multiple factors, such as immune disruption, prophylactic co-trimoxazole, and antiretroviral therapy, may influence the structure and function of the gut microbiome of children infected with HIV from birth. In order to understand whether HIV infection altered gut microbiome and to relate changes in microbiome structure and function to immune status, virological response and pediatric ART regimens, we characterized the gut microbiome of 87 HIV-infected and 82 non-exposed HIV-negative children from Yaounde, a cosmopolitan city in Cameroon. We found that children living with HIV had significantly lower alpha diversity in their gut microbiome and altered beta diversity that may not be related to CD4+ T cell count or viral load. There was an increased level of Akkermansia and Faecalibacterium genera and decreased level of Escherichia and other Gamma proteobacteria in children infected with HIV, among other differences. We noted an effect of ethnicity/geography on observed gut microbiome composition and that children on ritonavir-boosted protease inhibitor (PI/r)-based ART had gut microbiome composition that diverged more from HIV-negative controls compared to those on non-nucleoside reverse-transcriptase inhibitors-based ART. Further studies investigating the role of this altered gut microbiome in increased disease susceptibility are warranted for individuals who acquired HIV via mother-to-child transmission.
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de Beer CC, Krüger E, van der Linde J, Eccles R, Graham MA. Developmental outcomes of HIV-exposed infants in a low-income South African context. Afr Health Sci 2020; 20:1734-1741. [PMID: 34394233 PMCID: PMC8351828 DOI: 10.4314/ahs.v20i4.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Effective HIV transmission prevention strategies have led to a growing population of vulnerable HIV- and antiretroviral-exposed infants in sub-Saharan Africa, however uncertainty exists regarding their development. Objective To determine the developmental outcomes of HIV-exposed (HE) infants in a low-income South African context, when compared to HIV-unexposed (HU) counterparts. Methods In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age=8.4 months, SD=2.1 months) from a low-income context was assessed. Caregivers were interviewed using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants' development. Results Most HE participants had age-appropriate overall development (90.2%;n=37). Some HE participants, however, presented with delays in domains of communication (9.8%;n=4), daily living skills (2.4%;n=1), socialisation (19.5%;n=8), and motor development (7.3%;n=3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant between-group differences regarding development were found. Conclusion Findings were reassuring and suggested that HE and HU participants had similar development. Developmental differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggested that the entire sample was vulnerable, highlighting the importance of developmental surveillance in low-income contexts, irrespective of HIV and antiretroviral exposure status.
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Affiliation(s)
- Carmen Cornelia de Beer
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Renata Eccles
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Pretoria, South Africa
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Harding R, Wei G, Gwyther L, Miti E. Improving psychological outcomes for orphans living with HIV in Tanzania through a novel intervention to improve resilience: findings from a pilot RCT. AIDS Care 2018; 31:340-348. [PMID: 30332895 DOI: 10.1080/09540121.2018.1533630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Parental death and HIV are associated with poor mental health for orphans in sub-Saharan Africa. This study aimed to evaluate a theory-based intervention for orphaned children on treatment in Tanzania, in terms of feasibility, acceptability and preliminary outcomes. A pilot RCT with nested focus group (FGD) allocated 48 children to usual care or residential "Memory Work Therapy". Children completed outcome measures at T0 (baseline), T1 (2 weeks following intervention) and T2 (9 weeks from T0). Forty percent of eligible children assented. T1 intervention effects were found on all total measures: Brief Symptom Inventory d = 0.99, p < .001; Rosenberg Self Esteem Scale d = 0.65, p = .001; Strengths and Difficulties Questionnaire d = 0.64, p = .002; Self-efficacy questionnaire for children both "social" and "emotional" subscales, d = 0.54, p = .008 and d = 0.63, p = .002, respectively. At T2, significant effects remained for all measures and SES effect increased from medium to large (T1 = 0.65, T2 = 1.33). FGD data found children valued a calm environment that met their basic needs, enabling them to reflect, highlight support resources, and strengthen ability to recognize personal skills. The intervention has strong feasibility and acceptability, with no attrition or missing data. Memory Work Therapy has high potential effect size and should be tested in a fully powered trial. Clinical trials.gov NCT02180750.
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Affiliation(s)
- Richard Harding
- a Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care , Cicely Saunders Institute, Kings College London , London , UK.,b Department of Palliative Care, Policy & Rehabilitation , Cicely Saunders Institute, Kings College London , London , UK
| | - Gao Wei
- a Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care , Cicely Saunders Institute, Kings College London , London , UK.,b Department of Palliative Care, Policy & Rehabilitation , Cicely Saunders Institute, Kings College London , London , UK
| | - Liz Gwyther
- c Palliative Medicine Programme, School of Family Medicine and Public Health , University of Cape Town , Cape Town , South Africa
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Abubakar A, Van de Vijver FJR, Hassan AS, Fischer R, Nyongesa MK, Kabunda B, Berkley JA, Stein A, Newton CR. Cumulative Psychosocial Risk is a Salient Predictor of Depressive Symptoms among Vertically HIV-Infected and HIV-Affected Adolescents at the Kenyan Coast. Ann Glob Health 2018; 83:743-752. [PMID: 29248090 PMCID: PMC6626548 DOI: 10.1016/j.aogh.2017.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Little is known of mental health outcomes among vertically HIV-infected or HIV-affected adolescents in Africa. OBJECTIVES The current study set out to describe depressive symptoms and their correlates among vertically HIV-infected and HIV-affected adolescents at the Kenyan Coast. METHODS 130 adolescents (vertically HIV-infected [n = 44], HIV-affected [n = 53], and unexposed [n = 33]) and their caregivers participated in this cross-sectional study. An adapted version of the Beck Depression Inventory-11 (BDI) was administered to examine depressive symptoms in both adolescents and caregivers, together with measures of sociodemographic, medical, and anthropometric characteristics. FINDINGS Our analysis indicated a main effect of HIV status on mean BDI scores in HIV-infected (18.4 [SD = 8.3) and HIV-affected (16.8 [SD = 7.3]) adolescents compared to the community controls (12.0 [SD = 7.9]), F (2, 127) = 6.704, P = .002, η2 = .095. Post hoc analysis showed that BDI scores of HIV-infected adolescents were higher than those of community controls (P < .001). Similarly, HIV-affected adolescents had BDI scores that were higher than those of community controls (P = .007). However, there was no difference in BDI scores between HIV-infected and HIV-affected adolescents (P = .304). A path analytic model indicated that cumulative psychosocial risk (orphanhood, family poverty, and caregiver depressive symptoms) were positive predictors of BDI scores among adolescents, while nutritional status had a limited role. CONCLUSIONS Both HIV-infected and HIV-affected adolescents are at a high risk of experiencing depressive symptoms, largely due to the multiple psychosocial risk factors in their environment. The provision of adequate psychosocial support and counseling needs to become an integral part of the care program for adolescents from families living with HIV/AIDS at the Kenyan coast and other similar settings.
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Affiliation(s)
- Amina Abubakar
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kenya; Tilburg University, The Netherlands; Pwani University, Kenya; Department of Psychiatry, University of Oxford, UK.
| | - Fons J R Van de Vijver
- Tilburg University, The Netherlands; North-West University, South Africa; University of Queensland, Australia
| | - Amin S Hassan
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kenya
| | | | - Moses K Nyongesa
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kenya
| | - Beatrice Kabunda
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kenya
| | - James A Berkley
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kenya
| | - Alan Stein
- Department of Psychiatry, University of Oxford, UK
| | - Charles R Newton
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute, Kenya; Department of Psychiatry, University of Oxford, UK
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Mlambo T, Jelsma J, Rusakaniko S, Dale N, Chingono A. Predictors of Zimbabwean children’s neuro-cognitive performance on the Detroit Tests of Learning Aptitude fourth edition (DTLA-4): Implications for policy, practice and research. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2017. [DOI: 10.1080/14473828.2017.1315500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tecla Mlambo
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Simba Rusakaniko
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Naomi Dale
- University College of London, London, UK
| | - Alfred Chingono
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Alcock KJ, Abubakar A, Newton CR, Holding P. The effects of prenatal HIV exposure on language functioning in Kenyan children: establishing an evaluative framework. BMC Res Notes 2016; 9:463. [PMID: 27733206 PMCID: PMC5062875 DOI: 10.1186/s13104-016-2264-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV infection has been associated with impaired language development in prenatally exposed children. Although most of the burden of HIV occurs in sub-Saharan Africa, there have not been any comprehensive studies of HIV exposure on multiple aspects of language development using instruments appropriate for the population. METHODS We compared language development in children exposed to HIV in utero to community controls (N = 262, 8-30 months) in rural Kenya, using locally adapted and validated communicative development inventories. RESULTS The mean score of the younger HIV-exposed uninfected infants (8-15 months) was not significantly below that of the controls; however older HIV-exposed uninfected children had significantly poorer language scores, with HIV positive children scoring more poorly than community controls, on several measures. CONCLUSIONS Our preliminary data indicates that HIV infection is associated with impaired early language development, and that the methodology developed would be responsive to a more detailed investigation of the variability in outcome amongst children exposed to HIV, irrespective of their infection status.
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Affiliation(s)
- K J Alcock
- Department of Psychology, Fylde College, Lancaster University, Lancaster, LA1 4YF, UK.
| | - Amina Abubakar
- Department of Psychology, Fylde College, Lancaster University, Lancaster, LA1 4YF, UK.,Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R Newton
- Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Penny Holding
- Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi, Kenya.,Saving Brains Platform Team, Mombasa, Kenya
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