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Li N, Tan M, Thuma PE, Grigorenko EL. Pediatric Symptom Checklist-17: Factor Structure and Uniform Differential Item Functioning Across Gender and Age in HIV Orphans and Vulnerable Children in Zambia. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2023; 39:165-175. [PMID: 37485035 PMCID: PMC10361684 DOI: 10.1027/1015-5759/a000707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
This study aimed to investigate the psychometric properties of the Pediatric Symptom Checklist-17 (PSC-17) in a sample of children orphaned or made vulnerable (OVC) by HIV in Zambia. Caregivers of 1,076 OVC (55.1% boys; Mage = 12.91 years) completed the PSC-17. Competing models, including confirmatory factor analysis (CFA), hierarchical CFA, bifactor CFA, exploratory structural equation modeling (ESEM), and bifactor ESEM, were tested to evaluate the optimal factor structure of the PSC-17. Results showed that the bifactor ESEM provided the best approximation of the PSC-17 data with a well-defined general psychosocial problems factor explaining 72% of the reliable variance in the total score and an internalizing factor containing 63% of reliable variance unique from the general factor. The observed overall psychosocial problems score was associated with lower academic achievement and working memory (with small effect sizes), supporting the discriminant validity of score interpretation. Results of multiple indicators multiple causes (MIMIC) analyses revealed that all items functioned equivalently across child gender and age.
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Affiliation(s)
- Nan Li
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Mei Tan
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Philip E. Thuma
- School of Health Systems and Public Health, University of Pretoria, Zambia
| | - Elena L. Grigorenko
- Department of Psychology, University of Houston, Houston, TX, USA
- Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Saint-Petersburg State University, Saint-Petersburg, Russian Federation
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2
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Mensi M, Ahishakiye A, Journeay K, Baiocco R, Betancourt TS, Paganotti GM. HIV-Exposed Uninfected Children: A Systematic Review on Psychological Well-Being and Association with School Performances in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2499. [PMID: 36767866 PMCID: PMC9916290 DOI: 10.3390/ijerph20032499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
There is a growing number of children affected by HIV in Africa. Research on HIV-exposed uninfected children (HEU) is also growing. This systematic review focuses on the psychological well-being of HEU and its association with school intervention, outcomes, and enrollment in the African context, which is where the rate of HIV reaches its highest levels. Research on public databases was conducted according to PRISMA standards. Only studies on HEU primary school children in Africa, both quantitative and qualitative, were included. Out of 1510 papers retrieved, 50 met the inclusion criteria. These studies demonstrate that HEU children are more likely to perform worse in school compared to their counterparts who were not exposed to HIV and to show poorer concentration in the classroom. Children with parents suffering from AIDS are worried for them and have to take household responsibility, resulting in school dropouts, juvenile work, and risky behaviors. Few interventions have been conducted in the school environment with some of them being successful; therefore, future research should involve schools to create an inclusive environment where HEU children could enhance their potential and improve their psychological health.
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Affiliation(s)
- Marina Mensi
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Alain Ahishakiye
- Capacity Building Team, Mental Health Centre, University of Rwanda, Kigali P.O. Box 4285, Rwanda
- Section of Epidemiology, Department of Public Health, Institut de Santé et de Développement, Cheikh Anta Diop University, Dakar 10700, Senegal
- Department of Social Medicine, Harvard University, Boston, MA 02115, USA
| | - Katharine Journeay
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA 02467, USA
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box 45498, Riverwalk, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biomedical Sciences, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
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3
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Chautrakarn S, Ong-Artborirak P, Naksen W, Thongprachum A, Wungrath J, Chariyalertsak S, Stonington S, Taneepanichskul S, Assanangkornchai S, Kessomboon P, Neelapaichit N, Aekplakorn W. Stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among general adult population: the results from the 6 th Thai National Health Examination Survey (NHES VI). J Glob Health 2023; 13:04006. [PMID: 36637802 PMCID: PMC9838688 DOI: 10.7189/jogh.13.04006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors. Methods This study was based on data from the 6th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years. Results We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19). Conclusions We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained.
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Affiliation(s)
| | | | - Warangkana Naksen
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jukkrit Wungrath
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Scott Stonington
- Departments of Internal Medicine and Anthropology, University of Michigan, Michigan, USA
| | | | | | | | | | - Wichai Aekplakorn
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,National Health Examination Survey Office, Bangkok, Thailand
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4
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Jago S, Chirwa JM, Tan M, Thuma PE, Grigorenko EL. Cognitive and academic performance of rural Zambian youth exposed to HIV. AIDS Care 2022; 35:453-460. [PMID: 35509240 PMCID: PMC9633584 DOI: 10.1080/09540121.2022.2050175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Studies focusing on children affected by HIV have shown that they have generally lower academic performance, however, few studies separate children who are HIV exposed and infected (CHEI) and those who are HIV exposed but uninfected (CHEU). Importantly, in rural sub-Saharan Africa, the majority of studies on CHEI and CHEU examine academic performance indirectly based on cognitive test scores. Therefore, studies assessing the effects of HIV on academic achievement directly for CHEI and CHEU are needed. This article evaluates the effects of HIV-infection on cognitive and academic performance by comparing CHEI (n = 82) and CHEU (n = 1045) aged 7-17 years old using cross-sectional data from an ongoing longitudinal study in a rural area of Zambia. Youth completed cognitive and academic assessments; their height and weight were assessed to generate Body Mass Index (BMI). Caregiver questionnaires provided information on youths' years in school and household socio-economic status (SES). Results indicated that while HIV infection status did explain some of the variance in performance between CHEI and CHEU, age, BMI, years of schooling and SES accounted for additional variance. The effect of years of schooling on both cognitive and academic performance demonstrated that CHEI's performance may be greatly improved by consistent school enrollment.
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Affiliation(s)
| | | | - Mei Tan
- Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, TX, USA
| | | | - Elena L Grigorenko
- Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, TX, USA.,Department of Psychology, University of Houston, Houston, TX, USA.,Department of Psychology, Saint-Petersburg State University, Saint Petersburg, RF.,Center for Cognitive Sciences, Sirius University for Science and Technology, Sochi, RF.,Baylor College of Medicine, Houston, TX, USA.,Child Study Center and Haskins Laboratories, Yale University, New Haven, CT, USA.,Moscow State University for Psychology and Education, Moscow, RF
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5
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Santelli JS, Chen IS, Nabukalu D, Lutalo T, Spindler EJ, Chang LW, Grabowski MK, Grilo SA, Kreniske P, Wei Y, Nalugoda F, Hoffman S, Maru M, Chu S, Ssewamala FM, Byansi W, Kagaayi J, Wawer MJ, Gray RH, Serwadda D, Makumbi F. HIV combination prevention and declining orphanhood among adolescents, Rakai, Uganda, 2001-18: an observational community cohort study. Lancet HIV 2022; 9:e32-e41. [PMID: 34973171 PMCID: PMC9125395 DOI: 10.1016/s2352-3018(21)00275-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Orphanhood increased markedly in the 1980s and 1990s in sub-Saharan Africa because of HIV-related mortality. Little is known about the contribution of HIV interventions, such as antiretroviral therapy (ART) and male medical circumcision, to more recent trends in orphanhood. In this study, we examined trends over time in maternal-only, paternal-only, and double orphanhood among adolescents before and after ART and male medical circumcision became widely available in the Rakai region of south-central Uganda. We sought to understand the association between adolescent orphanhood and HIV combination prevention (community-level ART use and prevalence of male medical circumcision). We hypothesised that increasing combination prevention, including greater use of ART and higher prevalence of male medical circumcision, would be associated with a lower probability of orphanhood. METHODS We examined the prevalence of orphanhood among adolescents aged 15-19 years, before and after roll-out of ART in mid-2004 and male medical circumcision in 2007, using data from 28 continuously followed communities within the Rakai Community Cohort Study. We used multinomial logistic regression with clustered SEs to estimate adjusted relative risk ratios (RRs) for maternal-only, paternal-only, and double orphanhood compared with non-orphanhood over 11 survey rounds between 2001 and 2018. Controlling for community HIV prevalence, household socioeconomic status, and adolescent age, we examined the association between community prevalence of ART use among people living with HIV and prevalence of male circumcision, including traditional circumcision. The primary outcome was orphanhood among adolescents aged 15-19 years. FINDINGS Orphanhood declined from 52% (920 of 1768 participants) in 2001-02 to 23% (592 of 2609 participants) by 2016-18 (p<0·0001), while double orphanhood declined from 20% (346 of 1768 participants) to 3% (86 of 2609 participants) (p<0·0001). Community prevalence of ART use among people living with HIV increased from 11% (105 of 945 participants) in 2005-06 to 78% (1163 of 1485 participants) in 2016-18. Male circumcision rates rose from 19% (147 of 790 participants) in 2005-06 to 65% (3535 of 5433 participants) in 2016-18. In the multinomial logistic regression model, a 10% increase in community prevalence of ART use was associated with a decrease in maternal orphanhood (adjusted relative RR 0·90, 95% CI 0·85-0·95) and double orphanhood (0·80, 0·75-0·85). In the post-ART era, a 10% increase in the community prevalence of male circumcision was associated with a decrease in paternal orphanhood (2005-18, adjusted relative RR 0·92, 0·87-0·97) and double orphanhood (0·91, 0·85-0·98). INTERPRETATION Widespread availability and uptake of HIV combination prevention was associated with marked reductions in orphanhood among adolescents. Reductions in orphanhood promise improved health and social outcomes for young people. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases.
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Affiliation(s)
- John S Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ivy S Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Esther J Spindler
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mary Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stephanie A Grilo
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mahlet Maru
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sofia Chu
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Maria J Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ronald H Gray
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Makumbi
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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6
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Jochim J, Meinck F, Steventon Roberts KJ, Wittesaele C, Langwenya N, Toska E, Cluver L. Which factors affect postpartum educational enrollment of adolescent mothers in South Africa? A latent class analysis. PSYCHOL HEALTH MED 2022; 27:138-154. [PMID: 35934947 DOI: 10.1080/13548506.2022.2108085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interrupted education of adolescent mothers remains a major concern, but limited evidence-based programming exists to support postpartum schooling of this group. This study aimed to better understand the factors that render some adolescent mothers vulnerable to school non-enrollment, and how to reduce these risks. Data from 1,046 adolescent and young mothers (10-24 years) from rural and urban communities in South Africa's Eastern Cape was obtained through a questionnaire containing validated and study-specific measures relating to sociodemographic characteristics, schooling, relationships, violence exposure, and health. Using latent class analysis, we explored emerging latent groups and their relationship to mothers' enrollment in school, college, or tertiary education. The analyses revealed three distinct groups of mothers: The 'most disadvantaged' subgroup (39%) experienced multiple risks, including food insecurity, living in informal housing, lacking positive relationships with their caregiver, and the highest distance to school; The 'disadvantaged' subgroup (44%) did not experience food insecurity whilst reporting better caregiver relationships and lower distance to school. However, this group still showed high probabilities of residing in informal housing and in communities that expose them to violence; A 'least disadvantaged' subgroup (17%) was largely unaffected by economic and community risks and experienced good caregiver relationships. Compared to the most disadvantaged mothers, the least disadvantaged mothers showed the highest probability of being enrolled in education (65% versus 45%). Adolescent motherhood can impede continued enrollment in education and individual-centered interventions alone might not be sufficient to mitigate the risks for non-enrollment. Services and provisions that address severe poverty and improve family relationships might provide an opportunity to positively influence schooling among adolescent mothers.
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Affiliation(s)
- Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,Optentia, Faculty of Health Sciences, North-West University, Vanderbijlpark, South Africa
| | - Kathryn J Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Institute for Global Health, University College London, London, UK
| | - Camille Wittesaele
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Sociology, University of Cape Town, Cape Town, South Africa.,Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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7
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Tumwesige W, Namatovu P, Bahar OS, Byansi W, McKay MM, Ssewamala FM. Engaging community and governmental partners in improving health and mental health outcomes for children and adolescents impacted by HIV/AIDS in Uganda. ACTA ACUST UNITED AC 2021; 4. [PMID: 34056575 PMCID: PMC8159177 DOI: 10.21037/pm-20-86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The African region remains the world’s most affected region in the HIV epidemic. A related consequence of HIV/AIDS in sub-Saharan Africa (SSA), including in Uganda, is the high prevalence of children and adolescents who have lost one or both parents to this virus or who have been perinatally infected. Guided by the Practical, Robust Implementation and Sustainability (PRISM) framework, this paper describes the strategies by which we have engaged community and government partners in research using three NIH-funded randomized clinical trials testing an evidence-based combination intervention aimed at improving health and mental health outcomes among children and adolescents impacted by HIV/AIDS in Uganda. We specifically lay out four strategies that have been used to facilitate stakeholder engagement, namely consultative meetings, stakeholder accountability meetings, training of key players (task-shifting), and policymaker engagement. We emphasize that community collaborations and partnerships are especially critical when implementing combination interventions that require a high level of communication and coordination among multiple implementation partners. We underline that building and sustaining long-term relationships and communication with the stakeholders can allow the researchers to successfully design rigorous studies that are responsive to local needs and can make a difference especially in low-resource settings. Finally, we highlight that the process of engagement and collaboration can be guided by conceptual frameworks.
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Affiliation(s)
| | - Phionah Namatovu
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Mary M McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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8
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Merville O, Puangmala P, Suksawas P, Kliangpiboon W, Keawvilai W, Tunkam C, Yama S, Sukhaphan U, Sathan S, Marasri S, Rolland-Guillard L, Sirirungsi W, Le Cœur S. School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand. BMC Public Health 2021; 21:189. [PMID: 33478442 PMCID: PMC7818931 DOI: 10.1186/s12889-021-10189-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents living with perinatal HIV often experience difficult living circumstances that can impact educational achievement and thus their transition to adult life. We explored their school trajectories and evaluated the contribution of perinatal HIV-infection, in Thailand, where education is free and compulsory until the age of 15. METHODS We used data from the Teens Living with Antiretrovirals (TEEWA) study, a cross-sectional case-control study conducted from 2011 to 2014 in Thailand. Participants were 707 adolescents living with perinatal HIV (ALPHIV, cases) aged 12-19 receiving antiretroviral therapy in 19 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected from the general population and individually matched for sex, age, and place of residence. School trajectory disruption was defined as ≥1 year of academic delay or as early school dropout (before 15 years of age). Logistic regression models were used to assess factors independently associated with disrupted school trajectory and to estimate the proportion of school disruption attributable to HIV-infection. We used multivariate imputations by chained equations (MICE) to manage missing data and performed two sensitivity analyses to evaluate the main model's reliability. RESULTS The study population's median age was 14.5 years (58% female). School trajectory disruption was experienced by 37% of ALPHIV and 12% of the controls. After adjusting for sociodemographic factors, ALPHIV were 5 times more likely to experience disruption than controls (ORA =5.2 [3.7-7.2]). About 50% of school trajectory disruption was attributable to HIV-infection. Males and adolescents living in institutions were more likely to experience school trajectory disruption (ORA =1.8 [1.3-2.4] and ORA =11.0 [7.7-15.8], respectively). Among ALPHIV, neurocognitive difficulties and growth delay were significantly associated with disruption (ORA =3.3 [2.1-5.2] and ORA =1.8 [1.3-2.6], respectively). For those living in families, disruption was also associated with having a caregiver who had less than a secondary-level education (ORA =2.1 [1.1-3.9]) or having experienced stigmatization (ORA =1.9 [1.2-3.1]). CONCLUSIONS HIV and contextual factors combine to aggravate the educational disadvantage among ALPHIV. The impact of this disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be further explored.
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Affiliation(s)
- Ophélie Merville
- Institut national d'études démographiques (INED), Paris, France.
| | | | | | | | | | | | | | | | | | | | | | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
| | - Sophie Le Cœur
- Institut national d'études démographiques (INED), Paris, France.,Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand.,Institut de recherche pour le développement (IRD) UMI 174-PHPT, Chiang Mai, Thailand
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9
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Zulu JM, Munsaka E, Okonji E, Gaillard C, Ngoma K, Mwamba M, Mudekunye L. Integrating Psychosocial Support for Children in the Education Sector in Zambia: Lessons from the Programme Implementation Process. Community Ment Health J 2020; 56:1215-1224. [PMID: 32683570 DOI: 10.1007/s10597-020-00682-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
Literature suggests that psychosocial support programmes can improve wellbeing and mental health among learners. There is however limited documentation on methodologies and factors that shape integration of such programmes within the education sector. This qualitative study aimed to contribute towards addressing this knowledge gap by analysing the implementation process of the Mainstreaming of Psychosocial Support in the Education Sector programme in Zambia. The study showed that the programme contributed to improved school culture and learning involvement. This transformation led to reduction in school dropout, as well as improved students' wellbeing and performance. These positive results motivated Zambia and other countries to integrate psychosocial support into the education systems. Community engagement, outreach activities, group forums and partnerships were the key programme methodologies that facilitated the integration process. However, limited stakeholder involvement in developing the monitoring process complicated the integration process in the initial stages. In conclusion, effectively facilitating programme integration requires ensuring that the programme is credible, inclusive and has clear implementation guidelines.
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Affiliation(s)
- Joseph M Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
| | - Ecloss Munsaka
- School of Education, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - Emeka Okonji
- Regional Psychosocial Support Initiative, Regional Office, Randburg, South Africa
| | - Carmel Gaillard
- Regional Psychosocial Support Initiative, Regional Office, Randburg, South Africa
| | - Kelvin Ngoma
- Regional Psychosocial Support Initiative, Lusaka, Zambia
| | - Mukuka Mwamba
- Regional Psychosocial Support Initiative, Lusaka, Zambia
| | - Lynette Mudekunye
- Regional Psychosocial Support Initiative, Regional Office, Randburg, South Africa
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10
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Goin DE, Pearson RM, Craske MG, Stein A, Pettifor A, Lippman SA, Kahn K, Neilands TB, Hamilton EL, Selin A, MacPhail C, Wagner RG, Gomez-Olive FX, Twine R, Hughes JP, Agyei Y, Laeyendecker O, Tollman S, Ahern J. Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors. Am J Epidemiol 2020; 189:422-432. [PMID: 31667490 PMCID: PMC7306677 DOI: 10.1093/aje/kwz238] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.
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Affiliation(s)
- Dana E Goin
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
- Bristol Biomedical Research Centre, National Institute for Health Research, Bristol, United Kingdom
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Alan Stein
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Audrey Pettifor
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A Lippman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Erica L Hamilton
- HIV Prevention Trials Network Leadership and Operations Center, Science Facilitation Department, FHI 360, Durham, North Carolina
| | - Amanda Selin
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Catherine MacPhail
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ryan G Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gomez-Olive
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Yaw Agyei
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Ahern
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
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11
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Desmond C, Labuschagne P, Cluver L, Tomlinson M, Richter L, Hunt X, Marlow M, Welte A. Modelling the impact of maternal HIV on uninfected children: correcting current estimates. AIDS Care 2020; 32:1406-1414. [PMID: 32048517 DOI: 10.1080/09540121.2020.1720587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A mathematical model, populated primarily with data from South Africa, was developed to model the numbers of children affected by maternal HIV, and the number who will experience long-term negative developmental consequences. A micro-simulation model generated two scenarios. The first simulated a cohort of women whose HIV status mimicked that of a target population, and mother-child dyads by way of age- and disease-specific fertility rates. Factors defining risk were used to characterize the simulated environment. The second scenario simulated mother-child dyads without maternal HIV. In the first scenario an estimated 26% of children are orphaned, compared to 10% in the absence of HIV. And a further 19% of children whose mother is alive when they turn 18 are affected by maternal HIV. School drop-out among all children increased by 4 percentage points because of maternal HIV, similarly population level estimates of abuse and negative mental health outcomes are elevated. Relative to HIV unaffected children, HIV affected have elevated risk of poor outcomes, however not all will suffer long-term negative consequences. Interventions to protect children should target the proportion of children at risk, while interventions to mitigate harm should target the smaller proportion of children who experience long-term negative outcomes..
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Affiliation(s)
- Chris Desmond
- Centre for Rural Health, University of KwaZulu Natal, Durban, South Africa
| | - Phillip Labuschagne
- The South African DST- NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.,Fred Hutchinson Cancer Research Centre, Vaccine and Infectious Disease Division, Seattle, WA, UAS
| | - Lucie Cluver
- Centre for Evidence-Based Social Intervention in the Department of Social Policy and Intervention, Oxford University, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Linda Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Alex Welte
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa
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12
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Shiau S, Arpadi SM, Burke M, Liberty A, Thurman C, Patel F, Strehlau R, Abrams EJ, Coovadia A, Violari A, Kuhn L. Educational delays among children living with perinatally-acquired HIV in Johannesburg, South Africa. AIDS Care 2019; 32:438-444. [PMID: 31288549 DOI: 10.1080/09540121.2019.1640854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about how growing up with HIV impacts educational outcomes in sub-Saharan African children. We evaluated if South African children living with HIV (CLWH) were in the appropriate school grade-for-age compared to uninfected control children. We observed higher rates of not being in the correct grade-for-age in CLWH compared with controls (OR 3.32, 95% CI: 2.07-5.34), adjusted for study site, sex, whether the child's biological father was alive, and caregiver education. Initiation of ART before 6 months of age reduced but did not eliminate this association. Whether these associations are due to biological factors or other social and environmental determinants, and how best to support CLWH to achieve educational goals, warrants further investigation.
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Affiliation(s)
- Stephanie Shiau
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Arpadi
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cara Thurman
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
| | - Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Kalembo FW, Kendall GE, Ali M, Chimwaza AF. Prevalence and factors associated with emotional and behavioural difficulties among children living with HIV in Malawi: a cross-sectional study. BMC Psychiatry 2019; 19:60. [PMID: 30736758 PMCID: PMC6368705 DOI: 10.1186/s12888-019-2046-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/31/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Approximately 84,000 children under the age of 15 years are living with HIV in Malawi. Although the survival rate of children living with HIV in Malawi has improved due to the increased availability of antiretroviral medications, these children continue to experience numerous challenges negatively impacting on their mental health. The aim of this study was to investigate the prevalence of, and factors associated with, emotional and behavioural difficulties in children aged between 6 and 12 years living with HIV in Malawi. METHODS A random sample of 429 primary caregivers of children living with HIV drawn from the three main administrative regions of Malawi was recruited in a cross-sectional study. They completed a questionnaire about family socio-demographic characteristics, HIV disclosure, and child demographic and clinical characteristics, as well as the Strengths and Difficulties Questionnaire, Life Stress Scale, Support Function Scale, and Impact on Family Scale which were pre-tested and translated into the local Chichewa language. Data were analysed using descriptive statistics and logistic regression. FINDINGS Using the newer band categorisations of the Strengths and Difficulties Questionnaire, parent version, 31% of primary caregivers reported that their child had a slightly raised to very high level of total difficulties. Factors that were associated with difficulties were: primary caregivers' young age (adjusted odds ratio [aOR] 3.6; 95% confidence interval [CI]: 1.4-9.5); low level of education (aOR 2.6; 95% CI: 1.2-5.7); lack of employment (aOR 2.7; 95% CI: 1.2-5.9); the report of a substantial impact of the child's illness on the family (3.1; 95% CI: 1.5-6.5); and a low level of family functional support (aOR 2.0; 95% CI: 1.1-4.1). Neither non-disclosure of HIV status nor any of the child demographic or clinical factors were significant in multivariate analysis (p > .0.05). CONCLUSION Close to one-third of children living with HIV in this study had high scores indicative of emotional and behavioural difficulties. Emotional and behavioural difficulties in children living with HIV were associated with family demographic and psychosocial factors, but not HIV disclosure. Effective policies and programs that promote the mental wellbeing of children living with HIV in Malawi are indicated.
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Affiliation(s)
- Fatch W. Kalembo
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
- Mzuzu University, Mzuzu, Malawi
| | - Garth E. Kendall
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mohammed Ali
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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14
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Herrero Romero R, Hall J, Cluver L. Exposure to violence, teacher support, and school delay amongst adolescents in South Africa. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2018; 89:1-21. [PMID: 29336474 DOI: 10.1111/bjep.12212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many adolescents in South Africa are exposed to multiple types of violence, socio-economic disadvantage, and low-quality education: all risk factors for educational outcomes including school delay (grade enrolment below that which is age-appropriate). Supportive teacher-student relationships are known to be associated with improved academic outcomes in high-income contexts. AIMS To investigate whether the academic and emotional support provided by teachers can protect against school delay for adolescents exposed to multiple types of violence and socio-economic disadvantage in South Africa. SAMPLE High-risk sample of 503 adolescents aged 10-18 exposed to multiple types of violence and socio-economic disadvantage at home, in school, and in their communities. METHODS Multilevel aggregated structural equation modelling was applied to pre/post-RCT data. This investigated whether associations between adolescent exposure to violence and school delay could be lessened by having teachers who were academically and/or emotionally supportive. RESULTS More frequent exposure to 'poly-violence' and receiving more emotional support from teachers were independently associated with greater school delay. On the contrary, higher academic support from teachers was associated with lower school delay. Neither academic nor emotional teacher support was found to moderate the relationship between more frequent exposure to 'poly-violence' and an increased risk of adolescent school delay. CONCLUSION Adolescents' academic support from teachers is low in poorly resourced school contexts in South Africa. School-based secondary prevention programmes assisting teachers with more training and academic support in deprived contexts have potential to reduce the impact of violence and socio-economic disadvantage on adolescents' school delay.
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Affiliation(s)
| | - James Hall
- Southampton Education School, University of Southampton, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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15
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Osuji HL, Nabunya P, Byansi W, Parchment TM, Ssewamala F, McKay MM, Huang KY. Social support and school outcomes of adolescents orphaned and made vulnerable by HIV/AIDS living in South Western Uganda. VULNERABLE CHILDREN AND YOUTH STUDIES 2018; 13:228-238. [PMID: 30083221 PMCID: PMC6075833 DOI: 10.1080/17450128.2018.1439211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The goal of this study is to examine the role of social support from multiple sources, including the extended family, caregivers, classmates, peers and teachers, in improving the school outcomes (grades and attendance) of children orphaned by AIDS in Uganda. Data for this study comes from a 4-year randomized control trial, called Suubi-Maka (Hope for families), conducted in the Southwestern part of Uganda from 2008 to 2012. Using multivariate regression modeling - controlling for several individual-level and school-level characteristics, we find that social support (perceived emotional and information support received from parents, classmates and teachers), caregiver's acceptance and warmth, and family cohesion have positive effects on children's school grades and attendance. This finding underscores the importance of strengthening relationships within the extended family and the school environment to serve as a net of strength that can influence not only family functioning but also vulnerable adolescents' educational trajectories.
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Affiliation(s)
- Hadiza L. Osuji
- McSilver Institute for Poverty Policy and Research, and NYU Sliver School of Social Work, New York, NY, USA
| | | | - William Byansi
- Brown School of Social Work, Washington University, St Louis, MO, USA
| | | | - Fred Ssewamala
- Brown School, Washington University, St. Louis, MO, USA
- International Center for Child Health and Development, Brown School of Social Work, Washington University St. Louis, MO, USA
| | - Mary M. McKay
- Brown School of Social Work. Washington State University, St. Louis, MO, USA
| | - Keng-Yen Huang
- Population Health and Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, USA
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16
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Bireda AD, Pillay J. Daily life with early orphanhood from HIV/AIDS: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2017.1399967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Jace Pillay
- South African Research Chair: Education and Care in Childhood, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
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17
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Sherr L, Tomlinson M, Macedo A, Skeen S, Hensels IS, Cluver LD. Can cash break the cycle of educational risks for young children in high HIV-affected communities? A cross-sectional study in South Africa and Malawi. J Glob Health 2017; 7:020409. [PMID: 29302316 PMCID: PMC5735773 DOI: 10.7189/jogh.07.020409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Household cash grants are associated with beneficial outcomes; enhanced if provided in combination with care. OBJECTIVES This study describes the impact of cash grants and parenting quality on 854 children aged 5-15 (South African and Malawi) on educational outcomes including enrolment, regular attendance, correct class for age and school progress (controlling for cognitive performance). Consecutive attenders at randomly selected Community based organisations were recruited. The effects of cash plus good parenting, HIV status and gender were examined. RESULTS Overall 73.1% received a grant - significantly less children with HIV (57.3% vs 75.6% (χ2 = 17.21, P < 0.001). Controlling for cognitive ability, grant receipt was associated with higher odds of being in the correct grade (odds ratio (OR) = 2.00; 95% confidence interval (CI) = 1.36, 2.95), higher odds of attending school regularly (OR = 3.62; 95% CI = 1.77, 7.40), and much higher odds of having missed less than a week of school recently (OR = 8.95; 95% CI = 2.27, 35.23). Grant receipt was not associated with how well children performed in school compared to their classmates or with school enrolment. Linear regression revealed that grant receipt was associated with a significant reduction in educational risk (B = -0.32, t(420) = 2.84, P = 0.005) for girls. CONCLUSION Cash plus good parenting affected some educational outcomes in a stepwise manner, but did not provide additive protection.
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Affiliation(s)
- Lorraine Sherr
- Research Department of Global Health, University College London, London, United Kingdom
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Ana Macedo
- Research Department of Global Health, University College London, London, United Kingdom
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape town, South Africa
| | - Imca Sifra Hensels
- Department of Psychology, University of Manchester, Manchester, United Kingdom
| | - Lucie Dale Cluver
- Department of Psychiatry and Mental Health, University of Cape Town, Cape town, South Africa
- Centre for Evidence–Based Intervention, Department of Social Policy & Social Intervention, University of Oxford, Oxford, United Kingdom
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18
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Goldberg RE, Short SE. What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature. AIDS Care 2017; 28 Suppl 2:130-41. [PMID: 27392008 PMCID: PMC4991228 DOI: 10.1080/09540121.2016.1176684] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long-term effects of adult HIV on children's needs and circumstances will be important to ongoing discussions about equity in policies and interventions.
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Affiliation(s)
- Rachel E Goldberg
- a Department of Sociology , University of California Irvine , Irvine , CA , USA
| | - Susan E Short
- b Department of Sociology and Population Studies and Training Center , Brown University , Providence , RI , USA
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Schmid J, Chiba J. The intersection of abandonment, HIV-positive status and residential care for a group of perinatally infected adolescents. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 16:47-56. [PMID: 28367745 DOI: 10.2989/16085906.2017.1296476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Jeanette Schmid
- a Centre for Social Development in Africa , University of Johannesburg , Auckland Park , South Africa.,b Grandview Court , Nanaimo , British Columbia , Canada
| | - Jenita Chiba
- a Centre for Social Development in Africa , University of Johannesburg , Auckland Park , South Africa
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20
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Fauk NK, Mwakinyali SE, Putra S, Mwanri L. Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania. Infect Dis Poverty 2017; 6:21. [PMID: 28173857 PMCID: PMC5297121 DOI: 10.1186/s40249-016-0233-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/26/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them. METHODS This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010. RESULTS The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local NGO) and the local government respectively. CONCLUSIONS The current study identified challenges that adoptive families as well as the AIDS-orphaned children themselves faced in Mbeya Rural District, Tanzania. Recognition of these issues highlights the need for targeted interventions to address the underlying social determinants of human immunodeficiency virus or HIV and AIDS in affected populations in order to prevent further imposition of social, cultural and economic disadvantages on families that provide care for AIDS-orphaned children and the children themselves. These findings may prove useful in provoking discussions that may lead to HIV/AIDS prevention and the development of broader mitigation strategies to alleviate the impact of this scourge on families and communities in rural Tanzania, and in similar settings across the world.
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Affiliation(s)
- Nelsensius Klau Fauk
- Institute of Resource Governance and Social Change, Jl. R. W. Monginsidi II, No. 2, Kel. Kelapa Lima, Kec. Kelapa Lima, Kupang, Nusa Tenggara Timur Indonesia
| | | | - Sukma Putra
- Binus University International, Jl. Hang Lekir I No. 6, Senayan, Jakarta, 10270 Indonesia
| | - Lillian Mwanri
- Discipline of Public Health, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001 South Australia Australia
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Kaljee L, Zhang L, Langhaug L, Munjile K, Tembo S, Menon A, Stanton B, Li X, Malungo J. A randomized-control trial for the teachers’ diploma programme on psychosocial care, support and protection in Zambian government primary schools. PSYCHOL HEALTH MED 2016; 22:381-392. [DOI: 10.1080/13548506.2016.1153682] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Skovdal M. "It's because they care": understanding pathways to classroom concentration problems among HIV-affected children and youth in Western Kenya. AIDS Care 2016; 28 Suppl 2:42-8. [PMID: 27391998 PMCID: PMC4991234 DOI: 10.1080/09540121.2016.1159651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/24/2016] [Indexed: 11/25/2022]
Abstract
Children and young people living in households affected by HIV are experiencing poorer educational outcomes compared to their peers. This article explores how different forms of marginalisation interface and manifest themselves in classroom concentration problems, undermining their education. This mixed qualitative methods study was conducted with teachers and pupils from three primary and three secondary schools in the Siaya County of Western Kenya. Specifically, it involved 18 teachers through individual interviews and 51 HIV-affected children and youth through individual interviews (n = 47) and Photovoice (n = 51). Verbatim transcripts were imported into NVivo10 for thematic indexing and analysis. The analysis revealed three core pathways to classroom concentration problems amongst HIV-affected pupils. One, a general 'lack of care' and neglect in the context of household poverty and illness, meant that many of the participating pupils went to school hungry, unable to follow classes. Others were teased by peers for looking visibly poor, and felt anxious when in school. Two, some HIV-affected pupils play a key role in keeping their household afloat, generating food and income as well as providing practical support. 'Caregiving' pupils often reported coming to school exhausted, with limited physical and mental energy left for learning. Three, many participating pupils had their minds at home ('caring about'). They were concerned about sick or frail household members, thinking about their next meal and care needs. Although the pupils demonstrated an admirable attentiveness to the needs of others, this came at a heavy price, namely their ability to concentrate in class. The paper argues that care ethics, household poverty and familial HIV are central to understanding the classroom concentration problems of HIV-affected pupils. To ensure school-going children and youth affected by HIV have the same opportunities as their peers, education initiatives must simultaneously alleviate both household poverty and other challenges pertaining to familial HIV.
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Affiliation(s)
- Morten Skovdal
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hensels IS, Sherr L, Skeen S, Macedo A, Roberts KJ, Tomlinson M. Do not forget the boys - gender differences in children living in high HIV-affected communities in South Africa and Malawi in a longitudinal, community-based study. AIDS Care 2016; 28 Suppl 2:100-9. [PMID: 27392005 PMCID: PMC4991231 DOI: 10.1080/09540121.2016.1176680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/23/2016] [Indexed: 01/11/2023]
Abstract
Gender is an important factor in child development. Especially in sub-Saharan Africa, girls have often been shown to be less likely to access education compared to boys. The consequence of this has been that that programmes addressing child development are often aimed at girls in order to redress gender imbalances. This study examines the effect of gender on the development of children attending community-based organisations in high HIV-affected areas, and explores whether community-based organisation attendance was associated with any changes in gender differences over time. Baseline data from 989 children and 12-15 month follow from 854 (86% response rate) were used to examine gender differences in children from Malawi and South Africa. At baseline, where there were differences by gender, these tended to disadvantage boys. It was found that boys were significantly more often found to be subjected to violence. Boys showed worse performance at school and more behavioural problems than girls. These gender differences persisted from baseline to follow-up. At follow-up, boys self-reported significantly worse average quality of life than girls. Only harsh discipline differed by gender in progression over time: boys experienced a stronger reduction in harsh physical discipline than girls from baseline to follow-up. Since harsh discipline was associated with boys' worse educational outcomes and behavioural problems, our data cautiously suggests that gender differences could be reduced over time. In conclusion, our data suggests that, perhaps due to the narrow equity approach focusing on provision for girls, boys may be overlooked. As a result, there are some specific experiences where boys are generally worse off. These differences have distinct ramifications for the educational and emotional development of boys. A broader equity approach to child development might be warranted to ensure that the needs of both girls and boys are considered, and that boys are not overlooked.
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Affiliation(s)
- I. S. Hensels
- Department of Infection and Population Health, University College London, London, UK
| | - L. Sherr
- Department of Infection and Population Health, University College London, London, UK
| | - S. Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - A. Macedo
- Department of Infection and Population Health, University College London, London, UK
| | - K. J. Roberts
- Department of Infection and Population Health, University College London, London, UK
| | - M. Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Sharp C, Jardin C, Marais L, Boivin M. Orphanhood by AIDS-Related Causes and Child Mental Health: A Developmental Psychopathology Approach. ACTA ACUST UNITED AC 2015; 1. [PMID: 27668289 DOI: 10.16966/2380-5536.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
While the number of new HIV infections has declined, the number of orphans as a result of AIDS-related deaths continues to increase. The aim of this paper was to systematically review empirical research on the mental health of children affected by HIV/AIDS in the developing world, specifically with an eye on developing a theoretical framework to guide intervention and research. Articles for review were gathered by following the Preferred Reporting Items for Systemic Reviews and Meta Analyses (PRISMA standards), reviewed and then organized and synthesized with a Developmental Psychopathology framework. Results showed that the immediate and longterm effects of AIDS orphanhood are moderated by a number of important risk and protective factors that may serve as strategic targets for intervention. Research and clinical implications are discussed.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, Houston, TX 77024, USA
| | - Charles Jardin
- Department of Psychology, University of Houston, Houston, TX 77024, USA
| | - Lochner Marais
- Centre for Development Support, University of the Free State, South Africa
| | - Michael Boivin
- Department of Neurology & Ophthalmology, Michigan State University, USA
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Abubakar A. Biomedical risk, psychosocial influences, and developmental outcomes: lessons from the pediatric HIV population in Africa. New Dir Child Adolesc Dev 2015; 2014:23-41. [PMID: 25512044 DOI: 10.1002/cad.20071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sub-Saharan Africa is home to millions of HIV-affected children. These children are likely to experience multiple developmental delays. In this chapter, I present data highlighting compromised neurobehavioral, mental health, and scholastic outcomes for children affected by HIV. Furthermore, I discuss biomedical factors (e.g., disease severity and nutritional status) that may exacerbate the adverse effects of HIV on childhood outcomes. I also present evidence on how psychosocial risk factors such as poor maternal mental health, orphanhood, and poverty may aggravate the effects of HIV. The concluding section of the chapter highlights conceptual and methodological refinements in research on the impact of HIV on child development in Sub-Saharan Africa.
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Affiliation(s)
- Amina Abubakar
- Centre for Geographic Medicine Research-Coast, KEMRI/Wellcome Trust Research Progamme, Kilifi, Kenya
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The effect of maternal and child early life factors on grade repetition among HIV exposed and unexposed children in rural KwaZulu-Natal, South Africa. J Dev Orig Health Dis 2015; 7:185-96. [PMID: 26449271 DOI: 10.1017/s2040174415007230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Receiving an education is essential for children living in poverty to fulfil their potential. Success in the early years of schooling is important as children who repeat grade one are particularly at risk for future dropout. We examined early life factors associated with grade repetition through logistic regression and explored reasons for repeating a grade through parent report. In 2012-2014 we re-enrolled children aged 7-11 years in rural KwaZulu-Natal who had been part of an early life intervention. Of the 894 children included, 43.1% had repeated a grade, of which 62.9% were boys. Higher maternal education (aOR 0.44; 95% CI 0.2-0.9) and being further along in the birth order (aOR 0.46; 95% CI 0.3-0.9) reduced the odds of grade repetition. In addition, maternal HIV status had the strongest effect on grade repetition for girls (aOR 2.17; 95% CI 1.3-3.8), whereas for boys, it was a fridge in the household (aOR 0.59; 95% CI 0.4-1.0). Issues with school readiness was the most common reason for repeating a grade according to parental report (126/385, 32.7%), while school disruptions was an important reason among HIV-exposed boys. Further research is needed to elucidate the pathways through which HIV affects girls' educational outcomes and potentially impacts on disrupted schooling for boys. Our results also highlight the importance of preparation for schooling in the early years of life; future research could focus on gaining a better understanding of mechanisms by which to improve early school success, including increased quality of reception year and investigating the protective effect of older siblings.
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