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Onyia CO, Lethole JS, Olorunfemi G, Ngene NC. Caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a psychiatric tertiary hospital in South Africa. S Afr J Psychiatr 2024; 30:2252. [PMID: 38962558 PMCID: PMC11219544 DOI: 10.4102/sajpsychiatry.v30i0.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/08/2024] [Indexed: 07/05/2024] Open
Abstract
Background Chronic mental illnesses such as schizophrenia affect patients' functioning, making caregiving necessary although burdensome. Aim This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD). Setting Tertiary hospital in Northern Pretoria, South Africa. Methods In this cross-sectional study conducted over 3 months, 300 consecutive family caregivers who attended the POD were administered a 22-item Zarit Burden Interview (ZBI-22), which has a score of 0-88, with higher values indicating more burden. Their sociodemographic characteristics were ascertained. Linear and ordinal logistic regression analyses were performed to identify determinants or predictors of total and severe burdens, respectively. Results Most caregivers were aged 46.0 ± 14 years, females (62%), parents (39%), of low-income status (93.7%), had secondary education (70%), resided with the patient (87%), and helped with all troublesome activities (95.3%). The median ZBI-22 score was 19.0 (interquartile range: 13.0-30.5). The determinants of both total and severe burdens were: caregiver age ≥ 50 years adjusted odds ratio (aOR): 2.55, confidence interval (CI): 1.49-4.36; residential area farther away from the hospital aOR: 1.76, CI: 1.3-2.99; increasing months of caregiving aOR: 1.0, CI: 1.001-1.009, p = 0.006; and not having another family member that needs care aOR: 0.43, CI: 0.24-0.78. Conclusion Having mental healthcare facilities close to residential areas and assisting caregivers aged ≥ 50 years who have multiple family members who need care may alleviate the burden. Contribution Predicting total and severe caregiver burdens contemporaneously is effective for identifying potential burden interventions.
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Affiliation(s)
- Chioma O Onyia
- Department of Psychiatry, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Julia S Lethole
- Department of Psychiatry, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Gbenga Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, Leratong Hospital, Krugersdorp, South Africa
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Matina SS, Manderson L, Brear M, Rusere F, Gómez-Olivé FX, Kahn K, Harling G. Distribution of informal caregiving for older adults living with or at risk of cognitive decline within and beyond family in rural South Africa. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.20.24309077. [PMID: 38947086 PMCID: PMC11213104 DOI: 10.1101/2024.06.20.24309077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Objectives Aging populations in rural areas of low and middle-income countries will increasingly need care. However, formal support is severely limited and adult children are frequently unavailable due to morbidity, early mortality, employment and migration. We aimed to describe how care is shared within and between households for older adults in a rural South African setting. Methods We conducted quantitative interviews with 1012 household members and non-household caregivers of 106 older adults living with or at risk of cognitive decline in rural Mpumalanga, South Africa. Using descriptive statistics and regression analysis, we described how care is shared, with particular attention to generational patterns of care. Results Informal care for older persons was spread among family, friends, and neighbours, with minimal paid support. This care was mostly provided by female relatives one or two generations younger than the recipient, and unemployed. However, a smaller number of paid caregivers, also mostly female, provided the most intensive care. Spouses commonly took on the role of primary caregiver for their partner. Discussion In our study, care mainly came from household members due to close family ties and practical considerations, with support from outside the household. This reflects shared history, reciprocal relationships, and easy access to care tasks within the household. A deeper understanding of how informal care for older adults is shared in low- and middle-income countries is essential for developing targeted interventions.
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Akimanimpaye F, Bimerew MS, Petlhu DR. Challenges experienced by grandparents caring for AIDS orphans in the Western Cape province, South Africa. Health SA 2024; 29:2454. [PMID: 38726063 PMCID: PMC11079348 DOI: 10.4102/hsag.v29i0.2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/23/2023] [Indexed: 05/12/2024] Open
Abstract
Background There is limited understanding of the difficulties and experiences faced by grandparents who assume the responsibility of caring for AIDS orphans. Aim The objective of the study was to investigate and depict the difficulties encountered by grandparents who provide care for AIDS orphans in the Western Cape province of South Africa. Setting The study was conducted in the City of Cape Town Metropolitan and the Overberg Municipality. Methods The study used qualitative approach with an exploratory-descriptive design. A purposive sampling technique was utilised to select 25 grandparents. Semi-structured interviews were conducted, audio-recorded, transcribed verbatim, and analysed thematically using ATLAS.ti, version 7. Results Financial difficulties, a lack of support, HIV and/or AIDS stigma, and dealing with rebellious teenagers were primary challenges affecting the well-being of grandparents. Conclusion The study found that while financial challenges were significant, other factors such as poor family support contributed to the decline in the well-being of grandparents caring for AIDS orphans. Contribution The study's results can lead to improved public health programmes that address the identified challenges and health needs of grandparents providing care to AIDS orphans and the orphans under their care.
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Affiliation(s)
- Furaha Akimanimpaye
- School of Nursing, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Million S. Bimerew
- School of Nursing, Faculty of Community Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Deliwe R. Petlhu
- Department of Nursing Science, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
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Ndongo FA, Kana R, Nono MT, Noah JPYA, Ndzie P, Tejiokem MC, Biheng EH, Ndie J, Nkoa TA, Ketchaji A, Ngako JN, Penda CI, Bissek ACZK, Ndombo POK, Hawa HM, Msellati P, Lallemant M, Faye A. Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon. JOURNAL OF EPIDEMIOLOGY AND POPULATION HEALTH 2024; 72:202193. [PMID: 38523399 DOI: 10.1016/j.jeph.2024.202193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon. METHODS A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem. RESULTS In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070). CONCLUSION This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.
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Affiliation(s)
- Francis Ateba Ndongo
- University of Garoua, Cameroon; Centre Mère-enfant, Fondation Chantal Biya, Yaounde, Cameroon; Ministry of Public Health, Yaounde, Cameroun.
| | - Rogacien Kana
- Media Convergence Consulting Office, Yaounde, Cameroon
| | - Marius Tchassep Nono
- Action for Youths and Family, Douala, Cameroon; University of Douala, Douala, Cameroon
| | | | | | | | | | - Justin Ndie
- Ministry of Public Health, Yaounde, Cameroun
| | | | | | | | | | | | | | | | - Philippe Msellati
- Research Institute for Sustainable Development (IRD), Abidjan, Côte d'Ivoire
| | - Marc Lallemant
- Programs for HIV Prevention and Treatment (PHPT) Foundation - Research Institute for Sustainable Development (IRD), Paris, France
| | - Albert Faye
- Hôpital Universitaire Robert Debré, Paris, France
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Likoko S, Akokuwebe ME, Osuafor GN, Idemudia ES. "Health Outcomes of Grandparents Caring for Double Orphans in South Africa": What Are the Determinants? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7158. [PMID: 38131710 PMCID: PMC10743013 DOI: 10.3390/ijerph20247158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
In the 21st century, grandparenthood is a significant phenomenon in the fields of demography, gerontology, and sociology. It is mainly explored in the context of ageing, as it is poised to become one of the most significant demographic phenomena and social issues in contemporary South Africa. Therefore, this study examined the determinants associated with grandparents who are parenting as caregivers and the health challenges they are exposed to as caregivers. The National Income Dynamics Study (NIDS) Wave 5 dataset was utilised, and a total of 302,476 grandparents aged 25 years and older, who were reported to be primary caregivers of double orphans, were included in the analysis. Both bivariate and multivariate binary logistic regressions were performed to determine the predictors of the determinants of grandparents parenting as caregivers and their health challenges in South Africa. Estimated odds ratios (ORs) with 95% confidence intervals (CIs) were used, and the threshold for statistical significance was established at ρ < 0.05. A majority of the male and female grandparent caregivers were aged 24-34 years, were Black Africans (69.8%), had secondary education (46.9%), reported health challenges (HC) (59.7%), with 26.4% reporting headaches in the last 30 days. Logistic regression revealed that grandparent caregivers aged 55-64 years were 8.9 times more likely to report health challenges compared to those aged 25-34 years. Non-Black African grandparent caregivers were found to be 0.61 times less likely to report health challenges, compared to Black African grandparent caregivers. Those with perceived poor health status were 3.3 times more likely to report health challenges, compared to those with excellent perceived health status. Therefore, there is an urgent need to redesign health interventions to address these health burdens among grandparent caregivers and to take cognisance of providing economic and social support for these vulnerable populations.
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Affiliation(s)
- Salmon Likoko
- Statistics South Africa, ISIbalo House, Pretoria 0002, South Africa;
| | | | - Godswill Nwabuisi Osuafor
- Department of Population Studies and Demography, North-West University, Mafikeng 2735, South Africa;
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van Niekerk K, Stancheva V, Smith C. Caregiver burden among caregivers of children with autism spectrum disorder. S Afr J Psychiatr 2023; 29:2079. [PMID: 37928940 PMCID: PMC10623632 DOI: 10.4102/sajpsychiatry.v29i0.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder with deficits in social communication and interaction, restricted and repetitive patterns of behaviour, interests and activities. Autism spectrum disorder is associated with multiple comorbidities. As a result, caregivers of children with ASD experience increased levels of burden and poor quality of life. However, there is a paucity of information on the burden. Aim The study aimed to describe the sociodemographic profiles and determine the extent of the burden experienced by caregivers of children and adolescents with ASD. Setting The Child, Adolescent and Family Unit (CAFU) outpatient services at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods A quantitative, descriptive, cross-sectional study was done. Two self-administered questionnaires were used: a sociodemographic questionnaire and the 12-item Zarit Burden Interview questionnaire. Results The questionnaires were completed by 77 caregivers, of which the majority were female (n = 56 or 72.3%), mothers to children with ASD (n = 49 or 64.3%) and identified as Christian (p < 0.001). Most had completed secondary school or had a tertiary education (p = 0.003) and were employed (p < 0.001). Among the caregivers, 41.6% experienced mild to moderate burden, 33.8% experienced high burden and only 24.9% reported no to mild burden. Conclusion Caregivers of children and adolescents with a diagnosis of ASD are mostly mothers and experience mild to moderate levels of caregiver burden, suggesting the need for improved screening and psychosocial support programmes. Contribution This study highlights the burden experienced by primary caregivers of children with ASD and is one of the few comprehensive studies on this issue within the context of South Africa.
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Affiliation(s)
- Karli van Niekerk
- Department of Psychiatry, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Venera Stancheva
- Department of Psychiatry, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Cornelia Smith
- Department of Psychiatry, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Sherr L, Macedo A, Tomlinson M, Skeen S, Hensels IS, Steventon Roberts KJ. Parenting in Adversity: Effects of Older Caregivers, Biological Carers and Troubled Carers on Child Outcomes in High HIV-Affected Communities. J Cross Cult Gerontol 2023:10.1007/s10823-023-09482-6. [PMID: 37243786 DOI: 10.1007/s10823-023-09482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/29/2023]
Abstract
Caregiving by older adults is a common phenomenon, enhanced in the era of HIV infection. This longitudinal study was set up to examine the effect of caregiver age, relationship and mental wellbeing on child (4-13 years) outcomes (psychosocial and cognitive) in a sample of 808 caregiver- child dyads in South Africa and Malawi. Respondents were drawn from consecutive attenders at Community Based Organisations (CBOs) and interviewed with standardised inventories at baseline and followed up 12-15 months later. Analysis focused on three separate aspects of the caregiver; age, relationship to the child, and mental wellbeing, results are stratified with regard to these factors. Results showed that compared to younger caregivers, over 50 years were carrying a heavy load of childcare, but caregiver age for the most part was not associated with child outcomes. Being biologically related to the child (such as biological grandparenting) was also not a significant factor in child outcomes measured. However, irrespective of age and relationship, caregiver mental health was associated with differences in child outcome - those children of caregivers with a greater mental health burden were found to report experiencing more physical and psychologically violent discipline. Over time, the use of violent discipline was found to reduce. These data suggest that older caregivers and grandparents are providing comparable care to younger caregivers, for young children in the face of the HIV epidemic and that interventions should focus on mental health support for all caregivers, irrespective of age or relationship to the child.
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Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Ana Macedo
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - 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
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Imca S Hensels
- Department of Psychology, University of Manchester, Manchester, UK
| | - Kathryn J Steventon Roberts
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
- Department for Social Policy and Intervention, University of Oxford, Oxford, UK
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Ali FRM, Rahman FNA. Carer Burden and Burnout in Relation to Behavioral and Emotional Problems in Children’s Homes. OPEN JOURNAL OF SOCIAL SCIENCES 2023; 11:197-220. [DOI: 10.4236/jss.2023.111016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Nabunya P. Social Support Networks for Adolescents Orphaned by HIV: Definitions, Barriers, Challenges and Lessons from Uganda. VULNERABLE CHILDREN AND YOUTH STUDIES 2022; 18:87-99. [PMID: 36684804 PMCID: PMC9851387 DOI: 10.1080/17450128.2022.2163330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Social support is a key element to the health wellbeing of individuals, especially those experiencing major life transitions and crises. Prior evidence has demonstrated that orphaned adolescents are socially isolated with limited supportive networks. This study focused on how orphaned adolescents define social support, the nature of relationships with non-kin ties, barriers and challenges to seeking support. In-depth interviews from 38 orphaned adolescents (14-19 years) were analyzed using thematic analysis. Findings demonstrated that 1) orphaned adolescents define support in terms of "giving and receiving material and non-material assistance", and "helping individuals overcome problems", 2) relationships are initiated by family members, 3) economic hardships, stigma, and lack of trust deter adolescents from seeking support outside of the family unit. Study findings point to the need to integrate social support strengthening components within programming for orphaned adolescents living in HIV impacted communities.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, 63130, St Louis, MO, USA
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Gray CL, Whetten K, Daniels JL, Hudgens MG, Pettifor AE, Hobbie AM, Thielman NM, Dubie ME, Itemba D, Madan I, Vann V, Wasonga AI, Manongi R, Ostermann J, Whetten RA, Pence BW. Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries. Int J Public Health 2022; 66:1604057. [PMID: 34992514 PMCID: PMC8724025 DOI: 10.3389/ijph.2021.1604057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes. Methods: We used the longitudinal, multi-country Positive Outcomes for Orphans cohort to describe adult family living with orphans. Stability was measured by changes in presence of six familial relations over time, and related to three outcomes: 1) incident abuse, 2) cognitive functioning, 3) emotional difficulties. Associations were estimated using generalized linear models fit with generalized estimating equations. For abuse, Poisson regression estimated risk ratios. For continuous scores of cognitive functioning and emotional difficulties, linear models estimated mean differences (MDs) with 95% confidence intervals. Results: Among 1,359 orphans, 53–61% reported living with their mother each year; 7–13% with father; nearly 60% reported ≥1 change in composition over follow-up. Compared to 0 changes, difficulties increased with 1 change [MD: 0.23 (−0.33, 0.79)], 2 changes [MD: 0.57 (0.00, 1.16)] and ≥3 changes [MD: 0.73 (0.18, 1.29)]. No associations were found with abuse or cognitive functioning. Conclusion: Orphan well-being may be improved through supports stabilizing household composition or targeting emotional resilience.
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Affiliation(s)
- Christine L Gray
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States.,Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Julie L Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Audrey E Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy M Hobbie
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nathan M Thielman
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Duke University, Durham, NC, United States
| | | | | | - Ira Madan
- Sahara Centre for Residential Care and Rehabilitation, New Delhi, India
| | - Vanroth Vann
- Development for Cambodian Children, Battambang, Cambodia
| | | | | | - Jan Ostermann
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Rachel A Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Care Burden and Coping Strategies among Caregivers of Paediatric HIV/AIDS in Northern Uganda: A Cross-Sectional Mixed-Method Study. AIDS Res Treat 2021; 2021:6660337. [PMID: 34552767 PMCID: PMC8452441 DOI: 10.1155/2021/6660337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Family caregivers provide the bulk of care to children living with HIV. This places an enormous demand and care burden on the caregivers who often struggle to cope in various ways, some of which may be maladaptive. This may adversely affect their quality of care. Very little literature exists in resource-limited contexts on the burden of care experienced by caregivers on whom children living with HIV/AIDS depend for their long-term care. We assessed care burden and coping strategies among the caregivers of paediatric HIV/AIDS patients in Lira district, northern Uganda. Methods A mixed-method cross-sectional study was conducted among 113 caregivers of paediatric HIV patients attending the ART clinic at a tertiary healthcare facility in Lira district, northern Uganda. A consecutive sampling method was used to select participants for the quantitative study, while 15 respondents were purposively sampled for the qualitative data. Quantitative data were collected using standard interviewer-administered questionnaires, while in-depth interview guides were used to collect qualitative data. Data were entered, cleaned, and analysed using SPSS version 23. Qualitative data were analysed thematically. Results The majority of the caregivers, 65.5% (74), experienced mild-to-moderate burden. The mean burden scores significantly differed by caregivers' age (P=0.017), marital status (P=0.017), average monthly income (P=0.035), and child's school attendance (P=0.039). Accepting social support, seeking spiritual support, and reframing were the three most commonly used strategies for coping. Marital status and occupation were, respectively, positively and negatively correlated with information-seeking as a coping strategy, while monthly income was positively correlated with psychosocial support as a strategy. Seeking community support was negatively correlated with the duration of the child's care. Conclusions Our findings show that care burden is a common problem among the caregivers of children living with HIV in the study context.
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Kosambiya JK, Inamdar S, Modi A. Caregiver's burden of children living with HIV on antiretroviral therapy at an urban setup. Indian J Community Med 2021; 46:744-747. [PMID: 35068748 PMCID: PMC8729272 DOI: 10.4103/ijcm.ijcm_49_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/21/2021] [Indexed: 11/05/2022] Open
Abstract
Context: Availability of antiretroviral therapy (ART) has helped to decrease morbidity and increase the longevity of children living with Human Immunodeficiency Syndrome (CLHIV/CLHA). These children require the special involvement of family members for adherence to care and support programs. Long-term caregiving stress can result in physical, social, emotional, and medical consequences for both the caregiver and the CLHIV. This study explores the burden and needs for support among CLHIV caregivers. Methods: A cross-sectional study was conducted at an ART Centre of Tertiary level Health Care Institute among 126 caregivers of CLHIV pretested and piloted semi-structured questionnaire and Zarit Burden Interview Scale (ZBIS) were employed to assess study objectives. Descriptive statistics and caregiver burden scoring were calculated. ZBIS score of 22 and above were considered additional burden for caregivers. Results: Mean age of caregivers was 34 ± 7.15 years. Among 126 CLHIV caregivers, 116 were female, while 110 had positive HIV serostatus. Ninety-seven percent disclosed their and the child's status to one or more family members. Mean caregiver ZBIS was 25 ± 7.08 with 71.5% caregivers having mild-to-severe levels of burden. Around 85% of caregivers knew correctly about four routes of HIV transmission although 8.7% had misconception regarding HIV transmission. Conclusions: ZBIS assessment shows emotional, financial, and future of child-related burden among CLHIV caregivers. There were gaps in the knowledge about HIV transmission, care and support needs of the CLHIV. The acquisition of HIV from parents in CLHIV suggests the need of strengthening the prevention of parent-to-child transmission program in Indian settings.
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Haas AD, Technau KG, Pahad S, Braithwaite K, Madzivhandila M, Sorour G, Sawry S, Maxwell N, von Groote P, Tlali M, Davies MA, Egger M. Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa. J Int AIDS Soc 2020; 23:e25644. [PMID: 33283916 PMCID: PMC7720277 DOI: 10.1002/jia2.25644] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Mental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders. METHODS Adolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre-screening questions followed by full screening (conditional on positive pre-screening) for depression (Patient Health Questionnaire-9 [PHQ-9]), suicide (Adolescent Innovations Project [AIP]-handbook), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), post-traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC-PTSD-5]) and substance use (CAGE Adapted to Include Drugs [CAGE-AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening. RESULTS Out of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre-screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ-9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD-7 ≥10), 38 (3.2%) for PTSD (PC-PTSD-5 ≥3), 18 (1.7%) for substance use (CAGE-AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load. CONCLUSIONS ALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.
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Affiliation(s)
- Andreas D Haas
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karl-Günter Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shenaaz Pahad
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Braithwaite
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mampho Madzivhandila
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gillian Sorour
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Maxwell
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Putera AM, Irwanto, Maramis MM. Quality-of-Life (QoL) of Indonesian Children Living with HIV: The Role of Caregiver Stigma, Burden of Care, and Coping. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:573-581. [PMID: 33116919 PMCID: PMC7569035 DOI: 10.2147/hiv.s269629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022]
Abstract
Background Treatment of children with HIV infection has increased rapidly by increasing the life span of HIV patients from baby to adult. Improving the quality-of-life (QoL) in children living with HIV is a priority of HIV management in children and caregivers of children living with HIV have important roles. Caregiver stigma, caregiver burden, and caregiver coping affect caregivers in treating children living with HIV. Objective Analyzing the association of caregiver stigma, caregiver burden, and caregiver coping on QoL of Indonesian children living with HIV. Methods Participants in this study were caregivers of Indonesian children living with HIV. Participants were measured for caregiver stigma, caregiver burden, caregiver coping, and QoL of Indonesian children living with HIV. The instrument used in measuring caregiver stigma was people living with HIV/AIDS and caregiver questionnaire, caregiver burden used Zarit Burden questionnaire, caregiver coping used F-COPES questionnaire, and QoL used PedsQL for children aged 2-18 years old. Measurement data were analyzed using logistic regression and independent t tests with P<0.05. Results Indonesian children living with HIV in this study had an average age of 7.7±3.68 years and average participant age of 40.2±11.26 years. All participants stated that Indonesian children living with HIV tend to keep their health status confidential. Most QoL of Indonesian children living with HIV was good (71.7%), caregiver stigma value was 21.7±2.06, and caregiver burden level was moderate, of 50.9%. However, there was no significant association between caregiver stigma (β=0.064; P=0.548) and burden level (β=0.058; P=0.593) on QoL. On the other hand, caregiver coping value was 77.2±7.30, and there was a significant association of caregiver coping on QoL (β=-0.196; P=0.049). Conclusion There is an association of caregiver coping on QoL of Indonesian children living with HIV, in which the higher the caregiver coping, the lower the QoL. Meanwhile, there is no significant association of caregiver stigma and burden on QoL of Indonesian children living with HIV.
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Affiliation(s)
- Azwin Mengindra Putera
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Irwanto
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Margarita Maria Maramis
- Department of Psychiatry, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Maddocks S, Chetty V. Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community. S Afr Fam Pract (2004) 2020; 62:e1-e5. [PMID: 32633994 PMCID: PMC8377773 DOI: 10.4102/safp.v62i1.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Stacy Maddocks
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Mugisha J, Kinyanda E, Osafo J, Nalukenge W, Knizek BL. Health care professionals' perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with HIV/AIDS and mental distress in a rural district in central, Uganda. Child Adolesc Psychiatry Ment Health 2020; 14:26. [PMID: 32518588 PMCID: PMC7271468 DOI: 10.1186/s13034-020-00332-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/26/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little/no research has been conducted in Uganda in particular and sub-Saharan Africa in general on the health professional's perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with a double burden of HIV/AIDS and mental distress. AIM To explore health professionals' perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with HIV/AIDS and mental distress in Masaka, Uganda. METHOD Qualitative research design using key informant interviews with health service managers and staff in agencies working with children and adolescents with HIV/AIDS in Masaka district, Uganda. RESULTS Barriers to treatment seeking reported by health care professionals were quite enormous and are summarized under: family, individual, community and health systems level barriers. The crosscutting finding here is that the societal informal and formal systems of care had been affected by the HIV/AIDs epidemic, and, mental distress aggravates this challenge for the individuals afflicted and families affected by mental distress. CONCLUSION Children and adolescents with both HIV/AIDS and mental distress are vulnerable due to constraints at family, community and health systems levels. Effective public health interventions to address the double burden of HIV/AIDS and mental distress will be vital in the study communities addressing the constraints at family, community and institutional level. Public health interventions should aim at increased access and effective utilization of services for both HIV/AIDS and mental health services. Stigma reduction strategies at individual, family and community levels are also recommended.
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Affiliation(s)
- James Mugisha
- Kyambogo University, Kampala, Uganda
- Butabika National Referral and Teaching Mental Hospital, Kampala, P.O. Box 2958, Kampala, Uganda
| | - Eugene Kinyanda
- MRC/UVRI & LSHTM Uganda Research Unit On AIDS & Senior Wellcome Trust Fellowship, 50-59 Nakiwogo Street, Entebbe, Uganda
- Department of Psychiatry, Makerere University, Mulago Hill, Kampala, Uganda
| | - Joseph Osafo
- College of Humanities, School of Social Sciences, Department of Psychology, University of Ghana, Legon, Accra, Ghana
| | - Winfred Nalukenge
- MRC/UVRI & LSHTM Uganda Research Unit On AIDS & Senior Wellcome Trust Fellowship, 50-59 Nakiwogo Street, Entebbe, Uganda
| | - Birthe Loa Knizek
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Eagle DE, Kinghorn WA, Parnell H, Amanya C, Vann V, Tzudir S, Kaza VGK, Safu CT, Whetten K, Proeschold-Bell RJ. Religion and Caregiving for Orphans and Vulnerable Children: A Qualitative Study of Caregivers Across Four Religious Traditions and Five Global Contexts. JOURNAL OF RELIGION AND HEALTH 2020; 59:1666-1686. [PMID: 31808025 DOI: 10.1007/s10943-019-00955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Studies of caregivers of orphans and vulnerable children (OVC) rarely examine the role religion plays in their lives. We conducted qualitative interviews of 69 caregivers in four countries: Ethiopia, Kenya, Cambodia, and India (Hyderabad and Nagaland), and across four religious traditions: Christian (Orthodox, Roman Catholic, and Protestant), Muslim, Buddhist, and Hindu. We asked respondents to describe the importance of religion for their becoming a caregiver, the way in which religion has helped them make sense of why children are orphans, and how religion helps them face the challenges of their occupation. Using qualitative descriptive analysis, three major themes emerged. Respondents discussed how religion provided a strong motivation for their work, reported that religious institutions were often the way in which they were introduced to caregiving as an occupation, and spoke of the ways religious practices sustain them in their work. They rarely advanced religion as an explanation for why OVC exist-only when pressed did they offer explicitly religious accounts. This study has implications for OVC care, including the importance of engaging religious institutions to support caregivers, the significance of attending to local religious context, and the vital need for research outside of Christian contexts.
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Affiliation(s)
- David E Eagle
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive CB 90392, Durham, NC, 27708, USA.
| | - Warren A Kinghorn
- Duke University Medical Center and Duke Divinity School, Durham, USA
| | - Heather Parnell
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive CB 90392, Durham, NC, 27708, USA
| | | | - Vanroth Vann
- Development for Cambodian Children, Battambang City, Cambodia
| | - Senti Tzudir
- Sahara Centre for Residential Care & Rehabilitation, Hyderabad, India
| | | | | | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive CB 90392, Durham, NC, 27708, USA
| | - Rae Jean Proeschold-Bell
- Center for Health Policy and Inequalities Research, Duke University, 310 Trent Drive CB 90392, Durham, NC, 27708, USA
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Caregiving burden and mental health problems among family caregivers of people with dementia in rural Uganda. Glob Ment Health (Camb) 2020; 7:e13. [PMID: 32742671 PMCID: PMC7379317 DOI: 10.1017/gmh.2020.7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 04/07/2020] [Accepted: 04/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias are associated with increasing health burden in low- and middle-income countries. Less well-recognized is the potential health burden experienced by other affected individuals, such as family caregivers. In this study, we sought to profile the burden of care and its association with symptoms of depression and anxiety among informal caregivers of people living with dementia in rural southwestern Uganda. METHOD We conducted a cross-sectional study of 232 family caregivers of people with dementia. The key measured variables of interest were caregiving burden (Zarit Burden Index) and symptoms of depression and anxiety (Depression Anxiety Stress Scales). We fitted multivariable regression models specifying depression and anxiety symptoms as the primary outcomes of interest and caregiving burden as the primary explanatory variable of interest. RESULTS Family caregivers of people with dementia experience significant caregiving burden, with each item on the Zarit Burden Index endorsed by more than 70% of study participants. Nearly half [108 (47%)] of caregivers had Zarit Burden Interview scores >60, suggestive of severe caregiving burden. In multivariable regression models, we estimated a statistically significant positive association between caregiving burden and symptoms of both depression [b = 0.42; 95% confidence interval (CI) 0.34-0.49] and anxiety (b = 0.37; 95% CI 0.30-0.45). CONCLUSION Family caregivers of people with dementia in rural Uganda experience a high caregiving burden, which is associated with symptoms of depression and anxiety. Interventions aimed at reducing caregiving burden may have important collateral mental health benefits.
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Osuorah CI, Ndu I, Nwaneli E, Ekwochi U, Asinobi I, Iloh K, Nduagubam O. Psychosocial burden of caregivers taking care of children in the children's emergency room of two tertiary hospitals in Southeast Nigeria. SOCIAL HEALTH AND BEHAVIOR 2020. [DOI: 10.4103/shb.shb_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Small J, Aldwin C, Kowal P, Chatterji S. Aging and HIV-Related Caregiving in Sub-Saharan Africa: A Social Ecological Approach. THE GERONTOLOGIST 2019; 59:e223-e240. [PMID: 29045750 PMCID: PMC6524476 DOI: 10.1093/geront/gnx159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We reviewed the literature on older adults (OAs) who are caring for persons living with HIV/AIDS in sub-Saharan Africa (SSA), with the goal of adapting models of caregiver stress and coping to include culturally relevant and contextually appropriate factors specific to SSA, drawing on both life course and cultural capital theories. RESEARCH DESIGN AND METHODS A systematic literature search found 81 articles published between 1975 and 2016 which were reviewed using a narrative approach. Primary sources of articles included electronic databases and relevant WHO websites. RESULTS The main challenge of caregiving in SSA reflects significant financial constraints, specifically the lack of necessities such as food security, clean water, and access to health care. Caregiving is further complicated in SSA by serial bouts of caring for multiple individuals, including adult children and grandchildren, in the context of high levels of stigma associated with HIV. Factors promoting caregiver resilience included spirituality, bidirectional (reciprocal) caregiving, and collective coping strategies. DISCUSSION AND IMPLICATIONS The creation of a theoretical model of caregiving which focuses more broadly on the sociocultural context of caregiving could lead to new ways of developing interventions in low-resources communities.
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Affiliation(s)
- Jeon Small
- School of Social and Behavioral Sciences, Oregon State University
| | - Carolyn Aldwin
- Center for Healthy Aging Research, Oregon State University
| | - Paul Kowal
- SAGE, World Health Organization, Geneva, Switzerland
- Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
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21
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Nabunya P, Padgett D, Ssewamala FM, Courtney ME, Neilands T. Examining the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in Uganda. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:579-593. [PMID: 30394541 PMCID: PMC6397685 DOI: 10.1002/jcop.22139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Abstract
In this study, we examined the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in HIV-impacted communities in Uganda. We analyzed data from a cluster randomized experimental study for orphaned adolescents aged 11-17 years. Participants were randomly assigned to either the control condition, which received bolstered standard of care (BSOC) services, or the treatment condition, which received BSOC services plus an economic-strengthening intervention. We conducted binary logistic regression analyses to examine the effect of the intervention on participants' nonkin support networks. Results indicated that the existing social support networks for orphaned adolescents are small, limited, and usually comprised individuals with similar socioeconomic situations and challenges. Because orphaned adolescents are socially isolated and the threshold for nonkin supportive services is very low, the BSOC services provided to the control condition appeared to be instrumental in their survival and well-being. Availability of personal savings was associated with higher odds of identifying at least one supportive nonkin tie. The extended family system is still the primary and major source of social support to orphaned children in HIV-affected communities. In the absence of public safety nets, building social assets, over and above offering economic opportunities to extended families supporting orphaned children, is critical.
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Affiliation(s)
- Proscovia Nabunya
- Brown School of Social Work, Washington University in St. Louis, Campus Box, 1196, One Brookings Drive, St. Louis, MO, 63130,
| | - Deborah Padgett
- New York University Silver School of Social Work, 1 Washington Square North, New York, NY 10003,
| | - Fred M. Ssewamala
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130,
| | - Mark E. Courtney
- The University of Chicago School of Social Service Administration, 969 E. 60th Street, Chicago, IL 60637,
| | - Torsten Neilands
- University of California San Francisco School of Medicine, 550 16th Street, San Francisco, CA 94158,
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Webster KD, de Bruyn MM, Zalwango SK, Sikorskii A, Barkin JL, Familiar-Lopez I, Musoke P, Giordani B, Boivin MJ, Ezeamama AE. Caregiver socioemotional health as a determinant of child well-being in school-aged and adolescent Ugandan children with and without perinatal HIV exposure. Trop Med Int Health 2019; 24:608-619. [PMID: 30809898 DOI: 10.1111/tmi.13221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Caregiver socio-emotional attributes are major determinants of child well-being. This investigation in vulnerable school-aged Ugandan children estimates relationships between children's well-being and their caregiver's anxiety, depression and social support. METHODS Perinatally HIV-infected, HIV-exposed uninfected and HIV-unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA-polymerase chain-reaction test; status was confirmed via HIV rapid diagnostic test when children were 6-18 years old. Five indicators of child well-being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers' socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well-being in relation to caregiver's psychosocial status. RESULTS As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self-esteem/QOL (β = -1.3%/-2.6%; 95%CI: -5.0%,-0.2%) in their children. Child distress/hopelessness increased (β = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self-esteem/QOL decreased 2.3% (β = -2.3%/-4.4%; 95%CI: -7.2%, -1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β = 3%; 95%CI:1.4%, 4.5%) in their children. HIV-infected/exposed children had most caregiver depression-related QOL deficit (β = -5.2%/-6.8%; 95%CI: -12.4%, -0.2%) and HIV-unexposed children had most caregiver social support-related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%). CONCLUSIONS Caregiver anxiety, depressive symptoms and low social support were associated with worse well-being in school-aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well-being of vulnerable children and adolescents in this setting.
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Affiliation(s)
- Kyle D Webster
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Miko M de Bruyn
- Department of Epidemiology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Sarah K Zalwango
- Directorate of Public Health and Environment, Kampala Capital City Authority, Kampala, Uganda
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jennifer L Barkin
- Department of Community Medicine and Ob/Gyn, Mercer University School of Medicine, Mercer University, Macon, GA, USA
| | - Itziar Familiar-Lopez
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bruno Giordani
- Departments of Psychiatry, Neurology, and Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Boivin
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Amara E Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
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Sakyi KS, Lartey MY, Dension JA, Kennedy CE, Mullany LC, Owusu PG, Kwara A, Surkan PJ. Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana. AIDS Behav 2019; 23:433-444. [PMID: 29968140 PMCID: PMC6710623 DOI: 10.1007/s10461-018-2194-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Care for low birthweight (LBW) infants can contribute to psychological difficulties and stigma among mothers living with HIV, creating challenges for antiretroviral therapy (ART) adherence and retention in HIV care. We explored how caring for LBW infants affects maternal ART adherence and retention in care. We conducted 30 in-depth interviews with postpartum women living with HIV in Accra, Ghana: 15 with LBW infants and 15 with normal birthweight (NBW) infants. Compared to mothers with NBW infants, mothers with LBW infants described how caring for their newborns led to increased caregiver burden, prolonged hospital stays, and stigma-contributing to incomplete ART adherence and missed clinical appointments. For a few women, care for LBW infants created opportunities for re-engagement in HIV care and motivation to adhere to ART. Results suggest women living with HIV and LBW babies in Ghana face increased challenges that impact their adherence to care and ART.
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Affiliation(s)
- Kwame S Sakyi
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Center for Learning and Childhood Development Ghana, AF 3190 Adenta Flats, Accra, Ghana.
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, 3101 Human Health Building, 433 Meadow Brook Rd, Rochester, MI, 48309-4452, USA.
| | - Margaret Y Lartey
- Department of Medicine & Therapeutics, University of Ghana School of Medicine & Dentistry, CHS, P.O. Box GP 4236, Accra, Ghana
| | - Julie A Dension
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Caitlin E Kennedy
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Luke C Mullany
- Center for Learning and Childhood Development Ghana, AF 3190 Adenta Flats, Accra, Ghana
- Department of International Health, Global Epidemiology and Disease Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Prince G Owusu
- Center for Learning and Childhood Development Ghana, AF 3190 Adenta Flats, Accra, Ghana
| | - Awewura Kwara
- Division of Infectious Disease and Global Medicine, Department of Medicine, University of Florida, 2055 Mowry Road, Ste 250, PO Box 103600, Gainesville, FL, USA
| | - Pamela J Surkan
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Learning and Childhood Development Ghana, AF 3190 Adenta Flats, Accra, Ghana
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Seffren V, Familiar I, Murray SM, Augustinavicius J, Boivin MJ, Nakasujja N, Opoka R, Bass J. Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS. AIDS Care 2018; 30:888-895. [PMID: 29471677 PMCID: PMC9850497 DOI: 10.1080/09540121.2018.1441969] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p < .001) and problem-focused (PF: p = .01) coping were associated with more depressive symptoms while greater family support (EF: p = .002; PF: p = .003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p < .001; PF: p = .02) and higher community support (EF&PF: p = .01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.
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Affiliation(s)
- Victoria Seffren
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Itziar Familiar
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Sarah M Murray
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jura Augustinavicius
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Michael J Boivin
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
- f Departments of Psychiatry and Neurology & Ophthalmology , Michigan State University , East Lansing , MI , USA
- g Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | | | - Robert Opoka
- e Department of Pediatrics and Child Health , Makerere University , Kampala , Uganda
| | - Judith Bass
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Kalomo EN, Liao M. Burden of Care among Caregivers of Persons Living with HIV/AIDS in Rural Namibia: Correlates and Outcomes. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:70-84. [PMID: 29297790 DOI: 10.1080/19371918.2017.1415180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined the correlates of burden of caregivers providing care to people living with HIV/AIDS in rural northern Namibia and the consequences of caregivers' burden on their physical health and mental health. A purposive sampling method was used to recruit a total of 97 primary caregivers (N = 97) in rural Namibia. We found that hunger and HIV stigma were both positively associated with caregiver burden. Caregiver burden was positively related to depression and negatively related to quality of life. The findings underscore the complex relationships between food insecurity and HIV stigma on caregiver burden and the outcomes of burden on quality of life and depressive symptoms. Policy and practice implications are also discussed.
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Affiliation(s)
| | - Minli Liao
- b School of Social Work , Morgan State University , Baltimore , Maryland , USA
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26
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Gichane MW, Sullivan KA, Shayo AM, Mmbaga BT, O' Donnell K, Cunningham CK, Dow DE. Caregiver role in HIV medication adherence among HIV-infected orphans in Tanzania. AIDS Care 2017; 30:701-705. [PMID: 29058461 DOI: 10.1080/09540121.2017.1391986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Youth living with HIV in sub-Saharan Africa face numerous challenges in adhering to HIV treatment. The AIDS epidemic has left many of these youth orphaned due to AIDS-related death of one or both parents. It is imperative to understand the family context of youth living with HIV in order to develop responsive interventions to improve adherence to antiretroviral therapy. We conducted qualitative in-depth interviews with 17 HIV-infected AIDS orphans, ages 13-24 years, screened positive for mental health difficulties according to the Patient Health Questionaire-9 (PHQ-9) or UCLA PTSD Reaction Index (PTSD-RI), and receiving outpatient HIV care at an adolescent medical clinic in Moshi, Tanzania. Treatment-related support varied by orphan status. Paternal orphans cared for by their biological mothers and maternal orphans cared for by grandmothers described adherence support such as assistance taking medication and attending clinic. Double orphans did not report adherence support. Several maternal and double orphans faced direct interference from caregivers and household members when they attempted to take their medications. Caregivers play a significant role in treatment adherence and must be considered in interventions to increase medication adherence in HIV-infected orphans. Findings from this study informed caregiver participation in Sauti ya Vijana (The Voice of Youth), a mental health intervention for youth living with HIV in Tanzania.
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Affiliation(s)
- Margaret W Gichane
- a Center for Health Policy & Inequalities Research, Duke Global Health Institute , Duke University , Durham , USA.,b Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Kristen A Sullivan
- a Center for Health Policy & Inequalities Research, Duke Global Health Institute , Duke University , Durham , USA.,c Department of Social Medicine , University of North Carolina at Chapel Hill , Chapel Hill , USA
| | - Aisa M Shayo
- e Pediatric and Child Health Department , Kilimanjaro Christian Medical Centre , Moshi , Tanzania
| | - Blandina T Mmbaga
- d Kilimanjaro Christian Medical Centre-Duke Collaboration , Moshi , Tanzania.,e Pediatric and Child Health Department , Kilimanjaro Christian Medical Centre , Moshi , Tanzania
| | - Karen O' Donnell
- a Center for Health Policy & Inequalities Research, Duke Global Health Institute , Duke University , Durham , USA.,f Center for Child & Family Health , Duke University , Durham , USA
| | - Coleen K Cunningham
- g Department of Pediatrics, Division of Pediatric Infectious Diseases , Duke University Medical Center , Durham , USA.,h Duke University Global Health Institute , Durham , USA
| | - Dorothy E Dow
- d Kilimanjaro Christian Medical Centre-Duke Collaboration , Moshi , Tanzania.,g Department of Pediatrics, Division of Pediatric Infectious Diseases , Duke University Medical Center , Durham , USA.,h Duke University Global Health Institute , Durham , USA
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27
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Kidman R, Heymann J. Caregiver supportive policies to improve child outcomes in the wake of the HIV/AIDS epidemic: an analysis of the gap between what is needed and what is available in 25 high prevalence countries. AIDS Care 2017; 28 Suppl 2:142-52. [PMID: 27392009 PMCID: PMC4991222 DOI: 10.1080/09540121.2016.1176685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the wake of the HIV/AIDS epidemic, caregivers are struggling to support HIV-affected children. For reasons of equity and efficiency, their needs can be best met through strong social protections and policies. This paper presents a conceptual framework to help address the needs of HIV-affected caregivers and to prioritize policies. We describe the needs that are common across diverse caregiving populations (e.g., economic security); the needs which are intensified (e.g., leave to care for sick children) or unique to providing care to HIV-affected children (e.g., ARV treatment). The paper then explores the types of social policies that would facilitate families meeting these needs. We outline a basic package of policies that would support HIV-affected families, and would meet goals agreed to by national governments. We examine the availability of these policies in 25 highly affected countries in sub-Saharan Africa. The majority of countries guarantee short-term income protection during illness, free primary school, and educational inclusion of children with special needs. However, there are significant gaps in areas critical to family economic security and healthy child development. Fewer than half of the countries we analyzed guarantee a minimum wage that will enable families to escape poverty; only six have eliminated tuition fees for secondary school; and only three offer paid leave to care for sick children. Filling these policy gaps, as well as making mental health and social services more widely available, is essential to support caregiving by families for HIV-affected children. As part of the HIV agenda, the global community can help national governments advance towards their policy targets. This would provide meaningful protection for families affected by HIV, as well as for millions of other vulnerable families and children across the region.
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Affiliation(s)
- Rachel Kidman
- a Program in Public Health and Department of Family, Population & Preventative Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Jody Heymann
- b Fielding School of Public Health , University of California Los Angeles , Los Angeles , CA , USA
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28
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Fauk NK, Mwakinyali SE, Putra S, Mwanri L. The socio-economic impacts of AIDS on families caring for AIDS-orphaned children in Mbeya rural district, Tanzania. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2017. [DOI: 10.1108/ijhrh-01-2017-0002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose
The purpose of this paper is to explore the socio-economic impacts of AIDS on families caring for AIDS-orphaned children in Mbeya rural district, Tanzania.
Design/methodology/approach
A qualitative inquiry employing one-on-one in-depth interviews was conducted in 2015. Purposive sampling technique was used to recruit participants (n=24) comprising 20 heads of families caring for AIDS-orphaned children, two local government staff and two staff from Isangati Agricultural Development Organisation – a non-government organisation. Qualitative data were analysed using thematic and framework approach.
Findings
Results demonstrated that families caring for AIDS-orphaned children experienced severe socio-economic impacts of the epidemic. Reduction in household savings, increase in living expenses on health care and increased education fees were the identified economic impacts on these families. Social impacts included labour shortage, withdrawal of children from school and increased demand for food.
Social implications
There is a need for urgent responses and for scaling up programmes delivered by organisations, institutions and the government of Tanzania to help families cope with these impacts.
Originality/value
This study provides evidence on socio-economic impacts of AIDS on families caring for AIDS-orphaned children in Tanzania. An understanding of these impacts can help governmental and non-governmental institutions and programme planners to address the problem in their policies and develop evidence-based strategies and interventions in responding to the problem in Mbeya and Tanzania. Moreover, responses to reducing the impacts of AIDS on families require a holistic approach that encourages the involvement of all sectors and agents outside of the health sector.
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Molebatsi K, Ndetei DM, Opondo PR. Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study. J Child Adolesc Ment Health 2017; 29:117-127. [DOI: 10.2989/17280583.2017.1340301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - David M. Ndetei
- Department of Psychiatry, University of Nairobi; Africa Mental Health Foundation. Nairobi, Kenya
| | - Phillip R. Opondo
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
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30
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Murray SM, Familiar I, Nakasujja N, Winch PJ, Gallo JJ, Opoka R, Caesar JO, Boivin MJ, Bass JK. Caregiver mental health and HIV-infected child wellness: perspectives from Ugandan caregivers. AIDS Care 2016; 29:793-799. [PMID: 27951734 DOI: 10.1080/09540121.2016.1263722] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prior studies indicate a substantial link between maternal depression and early child health but give limited consideration to the direction of this relationship or the context in which it occurs. We sought to create a contextually informed conceptual framework of this relationship through semi-structured interviews with women that had lived experience of caring for an HIV-infected child while coping with depression and anxiety symptoms. Caregivers explained their role in raising healthy children as complex and complicated by poverty, stigma, and isolation. Caregivers discussed the effects of their own mental health on child well-being as primarily emotional and behavioral, and explained how looking after a child could bring distress, particularly when unable to provide desired care for sick children. Our findings suggest the need for investigation of the reciprocal effects of child sickness on caregiver wellness and for integrated programs that holistically address the needs of HIV-affected families.
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Affiliation(s)
- S M Murray
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - I Familiar
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - N Nakasujja
- c Department of Psychiatry , Makerere University , Kampala , Uganda
| | - P J Winch
- d Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - J J Gallo
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - R Opoka
- e Department of Pediatrics and Child Health , Makerere University , Kampala , Uganda
| | - J O Caesar
- f Global Health Uganda , Kampala , Uganda
| | - M J Boivin
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - J K Bass
- a Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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31
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Sibeko G, Milligan PD, Temmingh H, Lund C, Stein DJ, Mall S. Caregiving for mental health service users: A study exploring the perceptions of mental health service users and their caregivers in Cape Town, South Africa. Int J Soc Psychiatry 2016; 62:512-21. [PMID: 27282176 DOI: 10.1177/0020764016651458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our study explores perceptions of the caregiver support for mental health service users (MHSUs) in a low- to middle-income country setting. MATERIALS We conducted in-depth individual interviews with 16 MHSUs and their treatment partners/caregivers from a treatment partner and text-message intervention study. DISCUSSION Treatment partners/caregivers felt obligated to care for MHSUs, but had a limited understanding of mental illness. They found supporting adherence to treatment difficult due to a number of factors including violence, food insecurity and substance abuse. CONCLUSION Socioeconomic and environmental factors affecting the lives of MHSUs have impact on caregiver relationships with MHSUs in their care.
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Affiliation(s)
- Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Peter D Milligan
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sumaya Mall
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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32
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Familiar I, Murray S, Ruisenor-Escudero H, Sikorskii A, Nakasujja N, Boivin MJ, Opoka R, Bass JK. Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda. AIDS Care 2016; 28:1541-1545. [PMID: 27240825 DOI: 10.1080/09540121.2016.1191609] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Women living with HIV are at increased risk for psychosocial distress, especially among social and economically disadvantaged women living in rural areas. Little is known about how social support and wealth impacts the mental health of women caring for young children in low- and middle-income countries. The purpose of this paper was to assess demographic, socio-economic, and social support correlates of depression and anxiety in HIV-infected+ female caregivers living in rural Uganda. Depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25), two-domains of social support (family and community) were measured with the adapted Multidimensional Scale for Perceived Social Support, and wealth was measured using a checklist of material possessions and housing quality among 288 women. Multivariable linear regression models assessed the association of depression and anxiety with demographic and social predictors. Sixty-one percent of women reported clinically significant symptoms of depression or anxiety using the standard HSCL-25 cut-off of >1.75. Lower wealth (p = .01) and family support (p = .01) were significantly associated with more depressive symptoms, with greater family support being more protective of depression in the highest wealth group (top 20%) compared to the lowest. More anxiety symptoms were associated with lower wealth (p = .001), lower family support (p = .02), and higher community support (p = .003). Economic and social support factors are important predictors of caregiver mental health in the face of HIV disease in rural Uganda. Findings suggest that interventions should consider ways to increase economic opportunities and strengthen family support for HIV+ caregivers.
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Affiliation(s)
- Itziar Familiar
- a Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Sarah Murray
- b Mental Health Department , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Alla Sikorskii
- c Department of Statistics and Probability , Michigan State University , East Lansing , MI , USA
| | - Noeline Nakasujja
- d Department of Psychiatry , College of Health Sciences, Makerere University , Kampala , Uganda
| | - Michael J Boivin
- a Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Robert Opoka
- e Department of Pediatrics and Child Health , College of Health Sciences, Makerere University , PO Box 7072, Kampala , Uganda
| | - Judith K Bass
- b Mental Health Department , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Chandran V, Madi D, Chowta N, Ramapuram J, Bhaskaran U, Achappa B, Jose H. Caregiver Burden among Adults Caring for People Living with HIV/AIDS (PLWHA) in Southern India. J Clin Diagn Res 2016; 10:OC41-3. [PMID: 27437270 DOI: 10.7860/jcdr/2016/20076.7865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In India, family caregivers provide bulk of care to People Living With HIV/AIDS (PLWHA). Caregiver burden refers to the physical, emotional and financial hardships associated with providing care to a diseased individual. Attending to the needs of PLWHA can place a significant burden on family members. This may adversely affect their Quality of Life (QOL). AIM The main aim of our study was to assess the caregiver burden and QOL among the family members of PLWHA in Southern India. We also determined the impact of caregiver burden on QOL. MATERIALS AND METHODS This facility based cross-sectional study was carried out at Kasturba Medical College (KMC) Mangalore. The study was conducted over a period of 18 months starting from October 2013. A total of 360 caregivers participated in our study. The data were collected by face-to-face interview. Caregiver burden was assessed using the Zarit Burden scale & WHOQOL-BREF scale was used to assess the QOL of caregivers. The collected data was entered and analysed using SPSS version 11.5. A p-value of less than 0.05 was considered statistically significant. RESULTS The mean age of caregivers was 36.09± 10.18 years. Most of the caregivers were females 279 (77.5%). Majority of caregivers 184 (51.1%) belonged to Middle/Lower Middle socioeconomic class (Kuppuswamy class III). Majority of PLWHA 155 (43.1%) had Stage 2 disease. Mean CD4 count of the patients was 405.2± 240 cells/μL. In our study 88(24.4%) caregivers had moderate to severe burden and 36(10%) had very severe burden. Physical domain of QOL showed maximum score of 60.28±13.08, while a minimum score of 51.88 ± 14.20 was seen in social domain. With increase in caregiver burden, the mean QOL scores decreased which was statistically significant. CONCLUSION Our study highlights the need to counsel the caregivers on how to deal with PLWHA in the family. Family care plays a major role in the general wellbeing of PLWHA. Majority of national HIV programmes all over the world focus mainly on PLWHA. National programmes should immediately address the mental health issues of caregivers thereby reducing caregiver burden. More studies on this topic have to be conducted in developing countries.
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Affiliation(s)
- Vishnu Chandran
- Junior Resident, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Deepak Madi
- Associate Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Nithyananda Chowta
- Additional Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - John Ramapuram
- Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Unnikrishnan Bhaskaran
- Professor, Department of Community Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Basavaprabhu Achappa
- Associate Professor, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
| | - Hyma Jose
- Junior Resident, Department of Medicine, KMC Mangalore, Manipal University , Karnataka, India
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Gray CL, Whetten K, Messer LC, Whetten RA, Ostermann J, O'Donnell K, Thielman NM, Pence BW. Potentially traumatic experiences and sexual health among orphaned and separated adolescents in five low- and middle-income countries. AIDS Care 2016; 28:857-65. [PMID: 26936018 PMCID: PMC4917905 DOI: 10.1080/09540121.2016.1147013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in sub-Saharan Africa and Asia. Over 153 million children worldwide have lost one or both parents, including 17 million orphaned by AIDS, and millions more have been separated from their parents. As younger orphans enter adolescence, their sexual health and HIV-related risk behaviors become key considerations for their overall health. Importantly, their high prevalence of exposure to potentially traumatic events (PTEs) may put OSC at additional risk for adverse sexual health outcomes. The Positive Outcomes for Orphans study followed OSC randomly sampled from institution-based care and from family-based care, as well as a convenience sample of non-OSC, at six sites in five low-and middle-income countries. This analysis focused on the 90-month follow-up, during which adolescents 16 and older were assessed for sexual health, including age at sexual debut, past-year sex, past-year condom use, and perceptions of condom use. We specifically examined the relationship between PTEs and sexual health outcomes. Of the 1258 OSC and 138 non-OSC assessed, 11% reported ever having sex. Approximately 6% of participants reported recent sex and 5% reported having recent unprotected sex. However, 70% of those who had recent sex reported that they did not use a condom every time, and perceptions of condom use tended to be unfavorable for protection against sexual risk behavior. Nearly all (90%) of participants reported experiencing at least one lifetime PTE. For those who experienced “any” PTE, we found increased prevalence of recent sex (PR = 1.39 [0.47, 4.07]) and of recent unprotected sex (PR = 3.47 [0.60, 19.91]). This study highlights the need for caregivers, program managers, and policymakers to promote condom use for sexually active OSC and identify interventions for trauma support services. Orphans living in family-based care may also be particularly vulnerable to early sexual debut and unprotected sexual activity.
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Affiliation(s)
- Christine L Gray
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA
| | - Kathryn Whetten
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,c Terry Sanford Institute of Public Policy, Duke University , Durham , NC , USA
| | - Lynne C Messer
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.,b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,d College of Urban and Public Affairs , Portland State University , Portland , OR , USA
| | - Rachel A Whetten
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA
| | - Jan Ostermann
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA
| | - Karen O'Donnell
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,e Center for Child and Family Health , Duke University , Durham , NC , USA
| | - Nathan M Thielman
- b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA.,f Department of Medicine, Division of Infectious Diseases and International Health , Duke University , Durham , NC , USA
| | - Brian W Pence
- a Department of Epidemiology, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA.,b Center for Health Policy , Duke Global Health Institute, Duke University , Durham , NC , USA
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