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Lorenzetti L, Sousa B, Martinez A, Almeida A, Harris V, Mondlane H, Nazare G, Medrano T, Bryant H. Assessing the effect of COVida orphans and vulnerable children support services on viral load coverage and suppression among children and adolescents living with HIV in four provinces in Mozambique. AIDS Care 2024:1-9. [PMID: 39046440 DOI: 10.1080/09540121.2024.2373400] [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: 08/30/2023] [Accepted: 06/21/2024] [Indexed: 07/25/2024]
Abstract
Orphans and vulnerable children (OVC) programs focusing on improving HIV outcomes for children and adolescents living with HIV (C&ALHIV) may improve viral load (VL) testing coverage, a critical step toward achieving VL suppression. In Mozambique, we conducted a retrospective medical record review comparing VL testing coverage and suppression between C&ALHIV receiving OVC support and two cohorts of non-participants constructed using propensity score matching. We collected data for 25,783 C&ALHIV in Inhambane, Maputo City, Nampula, and Tete between October 2020-September 2021. Unadjusted rates of VL testing were 62.9% among OVC participants compared with 39.2% and 50.4% of non-participants in OVC support and non-OVC support districts, respectively. In multivariate models, OVC participants were 18 and 10 percentage points more likely to have received a VL test than non-participants in OVC districts (p < 0.01) and non-OVC districts (p < 0.01), respectively. OVC participants under 5 years old were significantly more likely to have received a VL test than their same-age counterparts in both comparison groups. Overall, the OVC program did not demonstrate significant effects on VL suppression. This approach could be replicated in other contexts to improve testing coverage. It is crucial that clinical partners and governments continue to share data to enable timely monitoring through OVC programming.
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Affiliation(s)
- Lara Lorenzetti
- Global Health & Population Research, FHI 360, Durham, NC, USA
| | - Belmiro Sousa
- COVida - Together for Children, FHI 360, Maputo, Mozambique
| | - Andres Martinez
- Global Health & Population Research, FHI 360, Durham, NC, USA
| | | | - Vance Harris
- Global Health & Population Research, FHI 360, Durham, NC, USA
| | | | | | - Tanya Medrano
- HIV Department, Global Health and Population, FHI 360, Durham, NC, USA
| | - Hayley Bryant
- COVida - Together for Children, FHI 360, Maputo, Mozambique
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Karidar H, Lundqvist P, Glasdam S. The influence of actors on the content and execution of a bereavement programme: a Bourdieu-inspired ethnographical field study in Sweden. Front Public Health 2024; 12:1395682. [PMID: 38846616 PMCID: PMC11153816 DOI: 10.3389/fpubh.2024.1395682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction The death of a parent can have profound negative impacts on children, and a lack of adequate support can exacerbate negative life experiences. Aim To explore the influences of various actors on the content and execution of a bereavement programme within a Swedish context, considering relational and contextual perspectives. Methods An ethnographic field study involving six children, their parents, and eight volunteers. A theory-inspired thematic analysis was conducted, methodically inspired by Braun and Clarke, theoretically inspired by Bourdieu's concepts of position, power, and capital. Results Confidentiality obligation was an essential element in the programme, however, the premisses varied depending on actors' positions. Volunteers and researchers had different outlets to express their experiences in the program. The programme offered the children an exclusive space for talking about and sharing experiences and feelings. Simultaneously, the programme restricted the children by not allowing them to share their experiences and feelings outside the physical space. The physical settings shaped the different conditions for interactions among the actors. The sessions adopted loss-oriented approaches, where communication between volunteers and children was guided by the volunteers. However, children created strategies for additional, voiceless communication with their peers or themselves. During breaks and mingles, shared interests or spaces connected children (and adults) more than their common experience of parental bereavement. Conclusion The participants in the programme were significantly influenced by the structural framework of the programme, and their positions within the programme provided them with different conditions of possibility for (inter)acting. Children's daily activities and interests were both ways to cope with parental bereavement and connect them to other people.
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Affiliation(s)
- Hakima Karidar
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Palliative and Advanced Homecare (ASIH) Lund, Lund, Sweden
| | - Pia Lundqvist
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stinne Glasdam
- Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Shah K, Nakafeero J, Kadota JL, Wambi P, Nanyonga G, Kiconco E, Deus A, Sekadde MP, Nabukenya-Mudiope MG, Tukamuhebwa HA, Mupere E, Mohanty S, Cattamanchi A, Wobudeya E, Shete PB, Jaganath D. The socioeconomic burden of pediatric tuberculosis and role of child-sensitive social protection. BMC Public Health 2023; 23:2339. [PMID: 38007477 PMCID: PMC10675962 DOI: 10.1186/s12889-023-17084-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/27/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Households of children with tuberculosis (TB) experience financial and social hardships, but TB-specific social protection initiatives primarily focus on adults. METHODS We conducted a single-arm, pilot study of multi-component supportive benefits for children with pulmonary TB in Kampala, Uganda. At diagnosis, participants received in-kind coverage of direct medical costs, a cash transfer, and patient navigation. Caregivers were surveyed before diagnosis and 2 months into TB treatment on social and financial challenges related to their child's illness, including estimated costs, loss of income and dissaving practices. RESULTS We included 368 children from 321 households. Pre-diagnosis, 80.1% of caregivers reported that their child's illness negatively impacted household finances, 44.1% of caregivers missed work, and 24% engaged in dissaving practices. Catastrophic costs (> 20% annual income) were experienced by 18.4% (95% CI 13.7-24.0) of households. School disruption was common (25.6%), and 28% of caregivers were concerned their child was falling behind in development. Two months post-diagnosis, 12 households (4.8%) reported being negatively affected by their child's TB disease (difference -75.2%, 95% CI -81.2 to -69.2, p < 0.001), with limited ongoing loss of income (1.6%) or dissavings practices (0.8%). Catastrophic costs occurred in one household (0.4%) at 2 months post-diagnosis. CONCLUSIONS Households face financial and social challenges prior to a child's TB diagnosis, and child-sensitive social protection support may mitigate ongoing burden.
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Affiliation(s)
- Kinari Shah
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | | | - Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - Peter Wambi
- Mulago National Referral Hospital, Kampala, Uganda
| | | | - Emma Kiconco
- Mulago National Referral Hospital, Kampala, Uganda
| | - Atwiine Deus
- Mulago National Referral Hospital, Kampala, Uganda
| | - Moorine P Sekadde
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | | | | | - Ezekiel Mupere
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Swomitra Mohanty
- Departments of Chemical Engineering and Materials Science Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
- Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, Orange, California, USA
| | | | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - Devan Jaganath
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA.
- Division of Pediatric Infectious Diseases, University of California, San Francisco, California, USA.
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Cherewick M, Dahl RE, Bertomen S, Hipp E, Shreedar P, Njau PF, Leiferman JA. Risk and protective factors for mental health and wellbeing among adolescent orphans. Health Psychol Behav Med 2023; 11:2219299. [PMID: 37274749 PMCID: PMC10234133 DOI: 10.1080/21642850.2023.2219299] [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: 07/25/2022] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Background Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing. Study objective The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health. Methods The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures. Results Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (β = -0.53, p = 0.015) and mental wellbeing (β = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (β = -0.34, p = 0.108) and mental wellbeing (β = -0.24, p = 0.405) were not significant. Conclusion In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, USA
| | - Samantha Bertomen
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Emily Hipp
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Priyanka Shreedar
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | | | - Jenn A. Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
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Flaxman S, Kasonka L, Cluver L, Souza AS, Nelson CA, Blenkinsop A, Unwin HJT, Hillis S. List child dependents on death certificates. Science 2023; 380:467. [PMID: 37141363 DOI: 10.1126/science.adh8784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Tutlam NT, Filiatreau LM, Byansi W, Brathwaite R, Nabunya P, Sensoy Bahar O, Namuwonge F, Ssewamala FM. The Impact of Family Economic Empowerment Intervention on Psychological Difficulties and Prosocial Behavior Among AIDS-Orphaned Children in Southern Uganda. J Adolesc Health 2023; 72:S51-S58. [PMID: 37062584 PMCID: PMC10159782 DOI: 10.1016/j.jadohealth.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/22/2022] [Accepted: 01/03/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Children orphaned by AIDS are more likely to have psychological and emotional problems compared to their counterparts. Poverty resulting from orphanhood is linked to the negative psychological outcomes experienced by AIDS-orphaned adolescents. No studies have investigated the impact of an economic empowerment intervention on child psychological and emotional problems and prosocial behavior. Therefore, we aimed to examine the impact of a family economic empowerment intervention on psychological difficulties and prosocial behavior among AIDS-orphaned adolescents. METHODS We analyzed data from a two-arm cluster randomized controlled trial conducted in 10 primary schools in southern Uganda. Schools were randomized to either bolstered usual care (n = 5 schools; 167 participants) or a family-economic empowerment intervention (Suubi-Maka; n = 5 schools; 179 individuals). We used t-test and multi-level mixed effects models to examine the impact of Suubi-Maka on psychological and behavioral outcomes. RESULTS No differences were observed between intervention and control groups in almost all the outcomes at baseline, 12 months, and 24 months. Simple main effects comparisons of 12 months versus baseline within each condition indicate modest to significant declines in emotional symptoms, hyperactivity, peer relationships (Δs = -1.00 to -2.11, all p < .001), and total difficulties (Δs = -4.85 to -4.89, both p < .001) across both groups. DISCUSSION Our analysis found no meaningful difference between intervention and control groups in child psychological difficulties and prosocial behavior postintervention. However, improvements were observed across both control and treatment groups following the intervention. Future studies should investigate the impact of different components of the intervention.
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Affiliation(s)
- Nhial T Tutlam
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Lindsey M Filiatreau
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - William Byansi
- Boston College, School of Social Work, Chestnut Hill, Massachusetts
| | - Rachel Brathwaite
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri.
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Marapin RS, van der Horn HJ, van der Stouwe AMM, Dalenberg JR, de Jong BM, Tijssen MAJ. Altered brain connectivity in hyperkinetic movement disorders: A review of resting-state fMRI. Neuroimage Clin 2022; 37:103302. [PMID: 36669351 PMCID: PMC9868884 DOI: 10.1016/j.nicl.2022.103302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hyperkinetic movement disorders (HMD) manifest as abnormal and uncontrollable movements. Despite reported involvement of several neural circuits, exact connectivity profiles remain elusive. OBJECTIVES Providing a comprehensive literature review of resting-state brain connectivity alterations using resting-state fMRI (rs-fMRI). We additionally discuss alterations from the perspective of brain networks, as well as correlations between connectivity and clinical measures. METHODS A systematic review was performed according to PRISMA guidelines and searching PubMed until October 2022. Rs-fMRI studies addressing ataxia, chorea, dystonia, myoclonus, tics, tremor, and functional movement disorders (FMD) were included. The standardized mean difference was used to summarize findings per region in the Automated Anatomical Labeling atlas for each phenotype. Furthermore, the activation likelihood estimation meta-analytic method was used to analyze convergence of significant between-group differences per phenotype. Finally, we conducted hierarchical cluster analysis to provide additional insights into commonalities and differences across HMD phenotypes. RESULTS Most articles concerned tremor (51), followed by dystonia (46), tics (19), chorea (12), myoclonus (11), FMD (11), and ataxia (8). Altered resting-state connectivity was found in several brain regions: in ataxia mainly cerebellar areas; for chorea, the caudate nucleus; for dystonia, sensorimotor and basal ganglia regions; for myoclonus, the thalamus and cingulate cortex; in tics, the basal ganglia, cerebellum, insula, and frontal cortex; for tremor, the cerebello-thalamo-cortical circuit; finally, in FMD, frontal, parietal, and cerebellar regions. Both decreased and increased connectivity were found for all HMD. Significant spatial convergence was found for dystonia, FMD, myoclonus, and tremor. Correlations between clinical measures and resting-state connectivity were frequently described. CONCLUSION Key brain regions contributing to functional connectivity changes across HMD often overlap. Possible increases and decreases of functional connections of a specific region emphasize that HMD should be viewed as a network disorder. Despite the complex interplay of physiological and methodological factors, this review serves to gain insight in brain connectivity profiles across HMD phenotypes.
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Affiliation(s)
- Ramesh S Marapin
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Harm J van der Horn
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - A M Madelein van der Stouwe
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Jelle R Dalenberg
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Bauke M de Jong
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Marina A J Tijssen
- University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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Darsana, S VK. Psychosocial Intervention Among Orphans: A Meta-Analysis. Psychol Rep 2022:332941221141309. [PMID: 36426544 DOI: 10.1177/00332941221141309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There has been an increase in the number of orphans around the world as a result of natural or man-made causes. Orphans are likely to face a number of challenges throughout their lives that go unrecognized. Considering these challenges, much focus needs to be given to manage their mental health issues. PURPOSE The aim of the study is to examine the effectiveness of various psychosocial interventions in managing post-traumatic stress symptoms, emotional and behavioural problems, and depression among orphans. METHOD Electronic searches on seven databases was done to identify studies investigating the effectiveness of interventions among orphans. The effectiveness of psychosocial interventions to reduce post-traumatic stress symptoms, emotional and behavioural problems, and depression was analyzed in seventeen studies. The risk of bias was assessed using the Cochrane risk of bias tool. RESULT The overall intervention effect size of post-traumatic stress symptoms was found to be high with high heterogeneity, while low effect size for emotional and behavioural problems, and depression with substantial heterogeneity. Publication bias and exploratory moderating effects of study design and intervention type were also analyzed. CONCLUSION Psychosocial interventions were more effective in reducing post-traumatic stress symptoms when compared to emotional and behavioural problems and depression.
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Affiliation(s)
- Darsana
- Research Scholar, School of Behavioural Sciences, Kannur University, Kannur, India
| | - Vinod Kumar S
- Professor, School of Behavioural Sciences, 29318MG University, Kottayam, India
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Hillis S, N’konzi JPN, Msemburi W, Cluver L, Villaveces A, Flaxman S, Unwin HJT. Orphanhood and Caregiver Loss Among Children Based on New Global Excess COVID-19 Death Estimates. JAMA Pediatr 2022; 176:1145-1148. [PMID: 36066897 PMCID: PMC9449868 DOI: 10.1001/jamapediatrics.2022.3157] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study assesses estimates of new orphanhood based on excess deaths to provide a comprehensive measure of the COVID-19 pandemic’s long-term impact on orphanhood and caregiver loss.
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Affiliation(s)
- Susan Hillis
- Global Reference Group on Children Affected by COVID-19, University of Oxford, Oxford, United Kingdom
| | | | - William Msemburi
- Division of Data, Analytics, and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Lucie Cluver
- Department of Social Policy and Intervention, Oxford, and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Andrés Villaveces
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - H. Juliette T. Unwin
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, United Kingdom
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Shah GH, Etheredge GD, Maluantesa L, Waterfield KC, Ikhile O, Engetele E, Mulenga A, Tabala A, Bossiky B. Socioeconomic status and other factors associated with HIV status among OVC in Democratic Republic of Congo (DRC). Front Public Health 2022; 10:912787. [PMID: 36262234 PMCID: PMC9574395 DOI: 10.3389/fpubh.2022.912787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/05/2022] [Indexed: 01/22/2023] Open
Abstract
Background Orphans and vulnerable children (OVC) are a high-risk group for HIV infection, particularly in Sub-Saharan Africa. Purpose This study aims to portray the socioeconomic profile of OVC and examine the association of household and parent/guardian characteristics with the HIV status of OVC. Methods For this quantitative retrospective study, we obtained data from ICAP/DRC for a total of 1,624 OVC from households enrolled for social, financial, and clinical services between January 2017 and April 2020 in two provinces of the Democratic Republic of Congo, Haut-Katanga and Kinshasa. We computed descriptive statistics for OVC and their parents' or guardians' characteristics. We used the chi-square test to determine bivariate associations of the predictor variables with the dichotomous dependent variable, HIV positivity status. To analyze the association between these independent variables and the dichotomous dependent variable HIV status after controlling for other covariates, we performed firth's logistic regression. Results Of the OVC included in this study, 18% were orphans, and 10.9% were HIV+. The chi-square analysis showed that among parents/guardians that were HIV+, a significantly lower proportion of OVC (11.7%) were HIV+ rather than HIV- (26.3%). In contrast, for parents/guardians with HIV- status, 9.0% of OVC were HIV-negative, and 11.7% of OVC were OVC+. The firth's logistic regression also showed the adjusted odds of HIV+ status were significantly lower for OVC with parents/guardians having HIV+ status themselves (AOR, 0.335; 95% CI, 0.171-0.656) compared with HIV-negative parents/guardians. The adjusted odds of HIV+ status were significantly lower for OVC with a monthly household income of < $30 (AOR, 0.421; 95% CI, 0.202-0.877) compared with OVC with a monthly household income > $30. Conclusions Our results suggest that, with the exception of a few household and parent/guardian characteristics, the risk of HIV+ status is prevalent across all groups of OVC within this study, which is consistent with the existing body of evidence showing that OVC are in general vulnerable to HIV infection. With a notable proportion of children who are single or double orphans in DRC, HIV+ OVC constitute a high-risk group that merits customized HIV services. The findings of this study provide data-driven scientific evidence to guide such customization of HIV services.
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Affiliation(s)
- Gulzar H. Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | | | - Kristie C. Waterfield
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | - Osaremhen Ikhile
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | | | - Alice Tabala
- ICAP, Columbia University, New York, NY, United States
| | - Bernard Bossiky
- National Multisectoral HIV/AIDS program (PNMLS), HIV Program, Presidency of DRC, Kinshasa, Congo
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Unwin HJT, Hillis S, Cluver L, Flaxman S, Goldman PS, Butchart A, Bachman G, Rawlings L, Donnelly CA, Ratmann O, Green P, Nelson CA, Blenkinsop A, Bhatt S, Desmond C, Villaveces A, Sherr L. Global, regional, and national minimum estimates of children affected by COVID-19-associated orphanhood and caregiver death, by age and family circumstance up to Oct 31, 2021: an updated modelling study. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:249-259. [PMID: 35219404 PMCID: PMC8872796 DOI: 10.1016/s2352-4642(22)00005-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND In the 6 months following our estimates from March 1, 2020, to April 30, 2021, the proliferation of new coronavirus variants, updated mortality data, and disparities in vaccine access increased the amount of children experiencing COVID-19-associated orphanhood. To inform responses, we aimed to model the increases in numbers of children affected by COVID-19-associated orphanhood and caregiver death, as well as the cumulative orphanhood age-group distribution and circumstance (maternal or paternal orphanhood). METHODS We used updated excess mortality and fertility data to model increases in minimum estimates of COVID-19-associated orphanhood and caregiver deaths from our original study period of March 1, 2020-April 30, 2021, to include the new period of May 1-Oct 31, 2021, for 21 countries. Orphanhood was defined as the death of one or both parents; primary caregiver loss included parental death or the death of one or both custodial grandparents; and secondary caregiver loss included co-residing grandparents or kin. We used logistic regression and further incorporated a fixed effect for western European countries into our previous model to avoid over-predicting caregiver loss in that region. For the entire 20-month period, we grouped children by age (0-4 years, 5-9 years, and 10-17 years) and maternal or paternal orphanhood, using fertility contributions, and we modelled global and regional extrapolations of numbers of orphans. 95% credible intervals (CrIs) are given for all estimates. FINDINGS The number of children affected by COVID-19-associated orphanhood and caregiver death is estimated to have increased by 90·0% (95% CrI 89·7-90·4) from April 30 to Oct 31, 2021, from 2 737 300 (95% CrI 1 976 100-2 987 000) to 5 200 300 (3 619 400-5 731 400). Between March 1, 2020, and Oct 31, 2021, 491 300 (95% CrI 485 100-497 900) children aged 0-4 years, 736 800 (726 900-746 500) children aged 5-9 years, and 2 146 700 (2 120 900-2 174 200) children aged 10-17 years are estimated to have experienced COVID-19-associated orphanhood. Globally, 76·5% (95% CrI 76·3-76·7) of children were paternal orphans, whereas 23·5% (23·3-23·7) were maternal orphans. In each age group and region, the prevalence of paternal orphanhood exceeded that of maternal orphanhood. INTERPRETATION Our findings show that numbers of children affected by COVID-19-associated orphanhood and caregiver death almost doubled in 6 months compared with the amount after the first 14 months of the pandemic. Over the entire 20-month period, 5·0 million COVID-19 deaths meant that 5·2 million children lost a parent or caregiver. Our data on children's ages and circumstances should support pandemic response planning for children globally. FUNDING UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, and Medical Research Council), Oak Foundation, UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.
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Affiliation(s)
- H Juliette T Unwin
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Susan Hillis
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Lucie Cluver
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, UK
| | | | | | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | | | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK; Department of Statistics, University of Oxford, Oxford, UK
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, UK
| | | | - Charles A Nelson
- Harvard Medical School and Boston Children's Hospital, Harvard University, Boston, MA, USA
| | | | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK; Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrés Villaveces
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
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Affiliation(s)
- Rachel A Kentor
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030-2399, USA.
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Hillis SD, Unwin HJT, Chen Y, Cluver L, Sherr L, Goldman PS, Ratmann O, Donnelly CA, Bhatt S, Villaveces A, Butchart A, Bachman G, Rawlings L, Green P, Nelson CA, Flaxman S. Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study. Lancet 2021; 398:391-402. [PMID: 34298000 PMCID: PMC8293949 DOI: 10.1016/s0140-6736(21)01253-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. METHODS We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60-84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection-fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. FINDINGS Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000-1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000-1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15-50 years. Between two and five times more children had deceased fathers than deceased mothers. INTERPRETATION Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. FUNDING UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.
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Affiliation(s)
- Susan D Hillis
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - H Juliette T Unwin
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College, London, UK
| | - Yu Chen
- Department of Mathematics, Imperial College, London, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | | | | | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College, London, UK; Department of Statistics, University of Oxford, Oxford, UK
| | - Samir Bhatt
- MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College, London, UK; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andrés Villaveces
- CDC COVID-19 Response Team, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gretchen Bachman
- Office of Global HIV/AIDS, US Agency for International Development, Washington, DC, USA
| | | | | | - Charles A Nelson
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | - Seth Flaxman
- Department of Mathematics, Imperial College, London, UK; Department of Computer Science, University of Oxford, Oxford, UK
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