Emotional development and nutritional status of HIV/AIDS orphaned children aged 6-12 years old in Thailand

Cross-cultural assessment of HIV-associated cognitive impairment using the Kaufman assessment battery for children: a systematic review

INTRODUCTION

Despite improved efficacy of, and access to, combination antiretroviral therapy (cART), HIV-associated cognitive impairments remain prevalent in both children and adults. Neuropsychological tests that detect such impairment can help clinicians formulate effective treatment plans. The Kaufman Assessment Battery for Children (KABC), although developed and standardized in the United States, is used frequently in many different countries and cultural contexts to assess paediatric performance across various cognitive domains. This systematic review investigated the cross-cultural utility of the original KABC, and its 2nd edition (KABC-II), in detecting HIV-associated cognitive impairment in children and adolescents.

METHODS

We entered relevant keywords and MeSH terms into the PubMed, PsycInfo, EBSCOHost, ProQuest, and Scopus databases, with search limits set from 1983-2017. Two independent reviewers evaluated the retrieved abstracts and manuscripts. Studies eligible for inclusion in the review were those that (a) used the KABC/KABC-II to assess cognitive function in children/adolescents aged 2-18 years, (b) featured a definition of cognitive impairment (e.g. >2 SD below the mean) or compared the performance of HIV-infected and uninfected control groups, and (c) used a sample excluded from population on which the instruments were normed.

RESULTS AND DISCUSSION

We identified nine studies (eight conducted in African countries, and one in the United Kingdom) to comprise the review's sample. All studies detected cognitive impairment in HIV-infected children, including those who were cART-naïve or who were cART treated and clinically stable. KABC/KABC-II subtests assessing simultaneous processing appeared most sensitive. Evaluation of the methodological quality of the selected studies by two independent reviews suggested that shortcomings included reporting and selection biases.

CONCLUSIONS

This systematic review provides evidence for the cross-cultural utility of the KABC/KABC-II, particularly the simultaneous processing subtests, in detecting cognitive impairment in HIV-infected children (including those who are clinically stable). Although the current results suggest there is justification for using the KABC/KABC-II primarily in East Africa, further investigation is required to explore the instrument's utility in other HIV-prevalent regions of the globe.

The intersection of abandonment, HIV-positive status and residential care for a group of perinatally infected adolescents

Although anti-retroviral treatments have significantly reduced the incidence of mother-to-child transmission of HIV and AIDS, there remains, for the foreseeable future, a group of adolescents who have been perinatally infected. Noting the paucity of information regarding the impact of paediatric AIDS and its intersection with residential care, this paper investigates the lived realities of 20 South African adolescents who were vertically infected with HIV and AIDS, were abandoned, and have been raised in residential care. The exploratory study highlights that for these youth the dimensions of their adolescence, HIV-positive status and associated abandonment as well as life in residential care are mutually reinforcing and interconnected. Issues of race and class also interact with these social dimensions. Ultimately, these dimensions intersect to create a particular form of social exclusion. Intentional, critical intervention is required on the micro level to support these teens develop a coherent identity. On the meso level, the residential facility should actively facilitate community integration, particularly with the adolescents' communities (and where possible, families) of origin. Governments need to strengthen intersectoral, rights-based responses and in particular, address the consequences of cognitive impairment associated with perinatal transmission.

Nutritional status of orphaned and separated children and adolescents living in community and institutional environments in uasin gishu county, kenya

Objective

To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya.

Methods

The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children’s Institutions (CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores ≤-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in the previous year, time living with current guardian, and intra-household clustering for adequacy of diet and moderate-severe malnutrition.

Results

Included are data from 2862 participants (1337 in CCI’s, 1425 in HH’s, and 100 street youth). The population was 46% female with median age at enrolment of 11.1 years. Only 4.4% of households and institutions reported household food security; 93% of children in HH reported an adequate diet vs. 95% in CCI’s and 99% among street youth. After adjustment, OSCA in HH were less likely to have an adequate diet compared to those in CCI’s (AOR 0.4, 95% CI 0.2–1.0). After adjustment, there were no differences between the categories of children on weight-for-age, weight-for-height, or BMI-for-age. Children living in HH (AOR 2.6, 95% CI: 2.0–3.4) and street youth (AOR: 5.9, 95% CI: 3.6–9.5) were more likely than children in CCI’s to be low height-for-age.

Conclusion

OSCA in HH are less likely to have an adequate diet compared to children in CCI’s. They and street children are more likely to be moderately-severely low height-for-age compared to children in CCI’s, suggesting chronic malnutrition among them.

[Does orphanhood by aids or by homicide effect nutritional status of children?]

The aims of this paper were to evaluate the nutritional status of children orphaned by aids or homicides in the city of São Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. The study was a household survey carried out between 2006 and 2007. We sampled 484 children representative of São Paulo, 5-14 years old who lost either or both of their parents from aids or homicides between 2000 and 2004. We selected body-mass-index-for-age (BMI) and height-for-age (height) as outcomes for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating BMI-for-age and height-for-age associated factors. Children from aids and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar between groups. Underweight accounted for 1.3% and 2.1% of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7% and 4.0% of children and adolescents, respectively. Overweight accounted for 19% and 20% of children and adolescents, respectively. BMI and height were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in the hierarchical model. Economic status was the main determinant of the nutritional profile. Nutritional status of children orphaned by aids or homicides in São Paulo was similar and mainly influenced by economic status. The nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhood-related variables.

Estimating the impact of expanded access to antiretroviral therapy on maternal, paternal and double orphans in sub-Saharan Africa, 2009-2020

Background

HIV/AIDS has orphaned 11.6 million children in sub-Saharan Africa. Expanded antiretroviral therapy (ART) use may reduce AIDS orphanhood by decreasing adult mortality and population-level HIV transmission.

Methods

We modeled two scenarios to measure the impact of adult ART use on the incidence of orphanhood in 10 sub-Saharan African countries, from 2009 to 2020. Demographic model data inputs were obtained from cohort studies, UNAIDS, UN Population Division, WHO and the US Census Bureau.

Results

Compared to current rates of ART uptake, universal ART access averted 4.37 million more AIDS orphans by year 2020, including 3.15 million maternal, 1.89 million paternal and 0.75 million double orphans. The number of AIDS orphans averted was highest in South Africa (901.71 thousand) and Nigeria (839.01 thousand), and lowest in Zimbabwe (86.96 thousand) and Côte d'Ivoire (109.12 thousand).

Conclusion

Universal ART use may significantly reduce orphanhood in sub-Saharan Africa.

Childhood adversities of populations living in low-income countries: prevalence, characteristics, and mental health consequences

PURPOSE OF REVIEW

Although an association between childhood adversity and psychiatric disorder has been documented, most research has centered upon those living in developed countries and the types of adversities those populations experience. Most of the world's youth, however, live in the poorest countries and face additional types of adversity for which limited data are available. The aim of this review is to synthesize recently published research and policy documents regarding the prevalence, characteristics, and mental health consequences of childhood adversity in low-income countries.

RECENT FINDINGS

Many youth in low-income countries are exposed to war-related violence, are orphaned by AIDS, work long hours in dangerous conditions, and, among girls in Africa, undergo female genital mutilation. These children have more posttraumatic stress disorder and depression than unexposed youth. Family violence, discrimination, and poverty may exacerbate the effects of war-related trauma and AIDS orphanhood upon mental health.

CONCLUSION

Research on the psychological consequences of childhood adversity in low-income countries is increasing, but is limited by the range of mental health outcomes evaluated and by small nonrepresentative samples. Further research is warranted to inform child advocacy and to guide public policy and the actions of nongovernmental agencies involved in the protection and welfare of children.