Correlates of the Quality of life of Adolescents in families affected by HIV/AIDS in Benue State, Nigeria

Health-Related Quality of Life Among HIV-Infected Children and Its Association With Socio-Demographic, Clinical and Nutritional Variables: A Comparative Approach

Background: The human immunodeficiency virus (HIV) infection and its treatment impact the child’s life as well as that of their caregivers. As therapeutic advances are made in the field, improved survival has shifted the focus from morbidity and mortality to quality of life. This study aims to compare the health-related quality of life (HRQoL) of children living with HIV in comparison with an HIV-negative control group and determine its relationship with socio-demographic, clinical, and nutritional variables.

Method: This was a multi-center cross-sectional comparative study involving 274 participants (137 per group) carried out in tertiary and secondary level healthcare facilities in Nigeria. Socio-demographic, clinical, and nutritional variables were obtained using a researcher-designed data collection sheet. HRQoL was measured using the Paediatrics Quality of Life Inventory (PedsQL 4.0), while caregivers’ burden was assessed using the Zarit-Burden Interview (ZBI). A comparison of the health-related quality of life of the cases and the control group was done using an independent t-test. The predictors of HRQoL among the cases were measured using multivariate stepwise linear regression analysis.

Result: The overall health-related quality of life of HIV-infected children and those of the HIV-negative control group were similar. However, there was a significant difference in the school and psychosocial functioning domains between the two groups with HIV-positive children scoring lower in these domains. For HIV-positive children, being from upper social class (p = 0.01, R² = 0.098), male gender (p = 0.005, R² = 0.063), higher scores in the caregiver burden scale (p = 0.009, R² = 0.150) and more disease severity (p < 0.001, R² = 0.321) were significant predictors of lower health-related quality of life.

Conclusion: The findings of this study show that the overall health-related quality of life of HIV-positive children was similar to that of age- and sex-matched HIV-negative control group. This finding gives clinicians some optimism that with adequate treatment, HIV-positive children will have better outcomes not only in mortality but in psychosocial variables such as quality of life. In addition, the finding on the relationship between caregiver burden and HRQoL underscores the need to focus on family-based interventions to improve the burden of caregiving on family members involved in the care of HIV-positive children.

Health-related quality of life of children and adolescents living with HIV in Lagos, Nigeria: a cross-sectional study

INTRODUCTION

adolescents living with HIV [ALHIV] face the dual challenges of adolescence and coping with HIV infection. This study aims to evaluate health-related quality of life [HRQoL] of children and adolescents aged 8 - 18 years living with HIV in an HIV treatment centre in Lagos, Nigeria.

METHODS

we conducted a cross-sectional study among children and adolescents living with HIV and receiving antiretroviral therapy. HRQoL was assessed using the Paediatric Quality of Life Inventory [PedQoL™]. Socio-demographic data and HIV related clinical and laboratory characteristics were also obtained and tested based on HRQoL scores in order to determine if there were possible associations.

RESULTS

the study included 113 participants with a mean age of 14 (± 2.9) years. There was male predominance, with a male: female sex ratio of 1.1: 1. The mean duration of ART was 102.9 (±36.9) months and CD4 lymphocyte count was and 741.2 (±335.7) cell/mm³. The majority of participants (62%) were also virally suppressed. Based on self-reported data, the mean physical, psychosocial and total HRQoL scores were 85.0 [± 22.4], 78.5 [±17.5] and 81.6 [±18.4] respectively. Adolescents aged 13-18 years had significantly higher scores than children aged 8-12 years. Male patients who had been on ART for ≥60 months were also significantly associated with higher HRQoL scores (OR=5.46 [CI= 2.24-13.29], p = 0.0009) and OR= 4.80, [CI= 1.58 - 14.56] p = 0.0032).

CONCLUSION

the majority of participants in the study had good HRQoL scores, attesting to the success of highly active antiretroviral therapy for HIV infection and the ease of access and availability to a comprehensive care.

Substance use and Psychosocial Functioning of Adolescents in Benue State, Nigeria: Assessing the role of age

AIM

To assess whether Substance Use (SU) is associated with Psychosocial Function (PF) among adolescent.

METHODS

Using a self-administered validated instrument, we obtained information on demographic, SU (defined as self-reported affirmative use of one or more of any form of alcoholic drinks, cigarettes, hemps etc) and PF [using the adolescent psychosocial functioning inventory comprising of three subscales; optimism and coping strategies (OCS), behaviour and relationship problems (BRP) and general psychosocial dysfunction designed (GPD)] among 2272 apparently healthy adolescents. PF was categorized as 'elevated' if the psychosocial functioning index (PFI) score were >75th percentile, otherwise, 'not elevated' and multivariable-adjusted logistic regression was used to compute odds ratio (OR) and 95% confidence interval (CI) of SU for elevated PF risk. In addition, we applied Johnson Neyman (JN) technique to identifying the JN significance regions at which age moderated the SU-PF relationship at a statistical significance of two-sided P<0.05.

RESULTS

Prevalence of SU and elevated PF was 50.7% and 79.8% respectively. Prevalence of elevated PF differed insignificantly by sex, but the proportion of adolescent with elevated PFI on SU (82.6%) was significantly higher (P<0.001) compared to those with elevated PFI but not on SU (76.9%). Multivariable-adjusted odds of decreased OCS risk given SU exposure was; OR (95%CI): 1.3791 (1.1458-1.6698), P=0.0007. Similarly, multivariable-adjusted odds of elevated PF risk in the light of SU exposure was; OR (95%CI): 1.4286 (1.1617-1.7567), P=0.0007. Furthermore, the JN significance regions for moderated regression analyses of odds of decreased OCS risk was between 10.4years [OR (95%CI): 0.5820 (0.1411-1.0228), P=0.0097] and 16.7years [OR (95%CI): 0.3025 (0.0001-0.6050), P=0.0500].

CONCLUSION

Adolescents on SU are about one and half times at risk of psychosocial dysfunction and age significantly attenuated the SU-decreased OCS risk link particularly in early adolescence.

Multilevel analysis of psychosocial functioning of Adolescents in families affected by HIV/AIDS in Benue state, Nigeria

Psychosocial functioning is increasing a public health priority issue among young people. Previous reports have focused on the effect of personal health conditions on the psychosocial well-being of children but contextual analysis of environmental or social factors could provide relevant information for interventions. In the context of HIV/AIDS, the present study examined the personal- and contextual-level predictors of Psychosocial Functioning Index (PFI) among adolescents in Benue state, Nigeria. Data on 2,276 adolescents was extracted from a cross-sectional study in Benue State for secondary analysis. The PFI was obtained using the final score of an existing scale (Adolescents Psychosocial Functioning Inventory). Participant's characteristics were summarized using descriptive statistics and compared using Chi-square test. Multilevel logit models were used to assess the individual- and contextual-level predictors of the PFI of adolescents. A nominal p-value ≤0.05 was considered significant in all analyses. Participants were 14.77±2.04 years old and mostly female (53.9%). About 19% of the participants have single parents while 62.1% have self-employed mothers. Proportion with elevated PFI was significantly higher among adolescents who have self-employed mothers (84.4%) and alcohol/substance users (82.7%). In adjusted analysis, adolescents who reported alcohol/substance use (OR=1.65; 95%CI: 1.14 to 2.38) were twice more likely to have elevated psychosocial functioning index compared to non-users. The psychosocial functioning index is high among study participants and differs contextually. Adolescent's psychosocial functioning depends on their life styles and parents' marital and economic situations. Family empowerments and other family level intervention programmes will benefit adolescents in these categories.

The Factor Structure of the Adapted WHO Quality of Life BREF questionnaire in a sample of adolescents in Nigeria

INTRODUCTION

The World Health Organization's Quality of Life Instrument (WHOQOL-BREF) is widely validated and popularly used in assessing perceived quality of life (QOL) of adolescents and the general population. Though the WHOQOL-BREF has been used in some studies in Nigeria, its theoretical structure has not been comprehensively investigated. This study examined the factor structure of the Adopted WHOQOL-BREF questionnaire and it theoretical structure in a large sample of adolescents in Nigeria.

METHODS

Data on demographic characteristics and QOL were extracted from 1,963 adolescents who participated in a state-wide study on psychosocial functioning and quality of life of adolescents in Benue State, Nigeria. Descriptive statistics were used to present the distribution of the data while Cronbach's alpha and Polychoric ordinal alpha were used to describe the internal consistency (reliability) of the adapted WHOQOL-BREF and alpha value of 0.700 was considered reliable. Structural analysis was performed to extract the underlying factors while confirmatory factor analyses were used to assess some hypothesized structure of the adapted WHO-QOL BREF. Relative Chi-square test (χ²/df) value ≤3.0 was regarded a good fit while multiple fit indexes with values ≥0.90 (for acceptable fit) were used for assessing diverse aspects of the models. All analyses were performed at 5% significance level using IBM SPSS statistics version 20, R package and AMOS version 21.

RESULTS

Participants were mostly male (54.8%) and 14.7±1.4 years old with 51.0% residing in rural areas. The overall internal consistency of the 4-factor model was 0.862 (for Cronbach's Alpha) and 0.989 (for Polychoric Alpha) while the 2-factor model had 0.870 (for Cronbach's Alpha) and 0.990 (for Polychoric Alpha). The Cattelle's Scree plot, Horn's parallel analysis and the confirmatory factor analysis revealed a 2-factor model as the best model for the WHO-QOL BREF. The 23-item 2-factor structure had a relative Chi-square test value χ²/df < 3 = 2.98, p < 0.001 with all fit indices within the acceptable range.

CONCLUSION

The adapted WHO QOL BREF can be safely used to assess quality of life among Adolescents in Nigeria and related settings. Using the two factors extracted in the present study may yield better results in settings similar to the present study location.

Psychometric properties and Confirmatory structure of the Strengths and difficulties questionnaire in a sample of adolescents in Nigeria

Though the SDQ has been used in selected studies in Nigeria, its theoretical structure has not been fully and appropriately investigated in the setting. The present study employs Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to investigate the theoretical structure of the self-reported version of the SDQ in a sample of adolescents in Benue state, Nigeria. A total of 1,244 adolescents from different categories of secondary schools in Makurdi and Vandekya Local government areas of Benue state participated in the study. Preliminary data analyses were performed using descriptive statistics while the theoretical structure of the SDQ was assessed using EFA and CFA. Model fits were assessed using Chi-square test and other fit indices at 5% significance level. Participants were 14.19±2.45 (Vandekya) and 14.19±2.45 (Makurdi) years old. Results of the EFA and CFA revealed a 3-factor oblique model as the best model for the sample of adolescents studied (χ²/df =2.20, p<0.001) with all fit indices yielding better results. A correlated 3-factor model fits the present data better than the 5-factor theoretical model of the SDQ. The use of the original 5-factor model of the SDQ in the present setting should be interpreted with caution.