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Videman K, Hallamaa L, Heimonen O, Mangani C, Luntamo M, Maleta K, Ashorn P, Ashorn U. Child growth and neurodevelopment after maternal antenatal antibiotic treatment. Arch Dis Child 2022; 107:323-328. [PMID: 34479861 PMCID: PMC8938655 DOI: 10.1136/archdischild-2021-322043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess whether intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) and azithromycin (AZI) in a malaria-endemic area leads to sustained gains in linear growth and development in their offspring. DESIGN Follow-up study of a randomised trial. SETTING Mangochi District in rural southern Malawi. PARTICIPANTS 1320 pregnant women and their offspring. INTERVENTIONS IPTp monthly with SP and twice with AZI (AZI-SP group), monthly with SP but no AZI (monthly SP), or twice with SP (control). No intervention was given to children. MAIN OUTCOME MEASURES Cognitive performance using Raven's Coloured Progressive Matrices (CPM) at 13 years of age; mean height and height-for-age Z-score (HAZ), cumulative incidence and prevalence of stunting (HAZ <-2); weight, body mass index, mid-upper-arm circumference and head circumference. RESULTS At approximately 13 years of age, the mean CPM score was 14.3 (SD 3.8, range 6-29, maximum 36), with no differences between groups. Children in the AZI-SP group were on average 0.4 cm (95% CI -0.9 to 1.7, p=0.6) taller than those in the control group. For cumulative incidence of stunting, the HR in the AZI-SP group was 0.72 (95% CI 0.61 to 0.84, p<0.001) compared with the control and 0.76 (95% CI 0.65 to 0.90, p<0.001) compared with the monthly SP groups. There was no intergroup difference in stunting prevalence or anthropometric measurements. CONCLUSIONS In rural Malawi, maternal intensified infection control during pregnancy reduces offspring's cumulative incidence of ever being stunted by 13 years of age. In this study, there was no evidence of a positive impact on cognitive performance. TRIAL REGISTRATION NUMBER NCT00131235.
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Affiliation(s)
- Karoliina Videman
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland .,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Lotta Hallamaa
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Otto Heimonen
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Charles Mangani
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine Malawi, Blantyre, Malawi
| | - Mari Luntamo
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine Malawi, Blantyre, Malawi
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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Strehlau R, Burke M, van Aswegen T, Kuhn L, Potterton J. Neurodevelopment in early treated HIV-infected infants participating in a developmental stimulation programme compared with controls. Child Care Health Dev 2021; 47:154-162. [PMID: 33150965 PMCID: PMC7854479 DOI: 10.1111/cch.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neurodevelopmental stimulation programmes can improve developmental outcomes. Antiretroviral therapy (ART) started soon after birth potentially limits the invasion of HIV into the central nervous system. A combination of developmental stimulation and early ART initiation may reduce developmental delays in children with perinatally acquired HIV infection. METHODS At a single site in Johannesburg, South Africa, we enrolled 36 HIV-infected neonates on ART into an intervention group (IG) participating in a yearlong home-based, neurodevelopmental stimulation programme. Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III) assessments were conducted at 12 months. Scores were compared with 24 early treated HIV-infected infants in an observational group (OG). BSID-III assessments were also conducted for older children in an OG at 24 or 36 months. Cognitive, language and motor scaled and composite scores were analysed. RESULTS BSID-III scaled and composite scores were all higher in the IG apart from the gross motor scaled score (9.25 vs. 10, p = 0.1954). Receptive communication scaled score was significantly higher in the IG (10.96 vs. 9, p = 0.0331). IG composite scores were all higher than OG scores. OG children assessed at 24 or 36 months had lower composite scores in all subscales than 12-month OG scores. CONCLUSIONS Early treated HIV-infected children participating in a neurodevelopmental stimulation programme achieved higher BSID-III scores at 12 months compared with early treated HIV-infected children who did not receive the programme.
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Affiliation(s)
- Renate Strehlau
- Empilweni Services and Research Unit, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamryn van Aswegen
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, and The Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York City , New York, USA
| | - Joanne Potterton
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Combrinck C, du Preez H. Validation of the ADHD-Behaviour Rating Scale for early childhood teacher use in South African classrooms. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2020.1871249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Celeste Combrinck
- Department of Science, Mathematics and Technology Education (SMTE) and Department of Early Childhood Education (ECE), University of Pretoria, Pretoria, South Africa
| | - Hannelie du Preez
- Department of Science, Mathematics and Technology Education (SMTE) and Department of Early Childhood Education (ECE), University of Pretoria, Pretoria, South Africa
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Richter LM, Orkin FM, Adair LS, Kroker-Lobos MF, Mayol NL, Menezes AMB, Martorell R, Murray J, Stein AD, Victora C. Differential influences of early growth and social factors on young children's cognitive performance in four low-and-middle-income birth cohorts (Brazil, Guatemala, Philippines, and South Africa). SSM Popul Health 2020; 12:100648. [PMID: 32953965 PMCID: PMC7486449 DOI: 10.1016/j.ssmph.2020.100648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background Studies relating childhood cognitive development to poor linear growth seldom take adequate account of social conditions related to both, leading to a focus on nutrition interventions. We aimed to assess the roles of both biological and social conditions in determining early childhood cognition, mediated by birthweight and early linear growth. Methods After exploratory structural equation modelling to identify determining factors, we tested direct and indirect paths to cognitive performance through birthweight and child height-for-age at 2 years, assessed between 4 and 8.5 years of age among 2448 children in four birth cohort studies in low-and-middle-income countries (Brazil, Guatemala, Philippines and South Africa). Determinants were compared across the cohorts. Findings Three factors yielded excellent fit, comprising birth endowment (primarily maternal age and birth order), household resources (crowding, dependency) and parental capacity (parental education). We estimated their strength together with maternal height in determining cognitive performance. Percentage shares of total effects of the four determinants show a marked transition from mainly biological determinants of birth weight (birth endowment 34%) and maternal height (30%) compared to household resources (25%) and parental capacity (11%), through largely economic determinants of height at 2 years (household resources (60%) to cognitive performance being predominantly determined by parental capacity (64%) followed by household resources (29%). The largely biological factor, birth endowment (maternal age and birth order) contributed only 7% to childhood cognitive performance and maternal height was insignificant. In summary, the combined share of social total effects (household resources and parental capacity) rises from 36∙2% on birth weight, to 78∙2% on height for age at 24 m, and 93∙4% on cognitive functioning. Interpretation Across four low- and middle-income contexts, cognition in childhood is influenced more by the parental capacity of families and their economic resources than by birth weight and early linear growth. Improving children's cognitive functioning requires multi-sectoral interventions to improve parental education and enhance their economic wellbeing, interventions that are known to improve also early childhood growth. We aimed to investigate separate and combined biological and social determination of young children’s cognitive performance. We used path analysis of longitudinal data from birth cohort studies in four differing low-and-middle countries. We distinguished biological and social factors, as well as household resources from parental capacity. Biological factors determine birthweight, 2-year height depends on social factors, and the latter drive child cognitive performance. No single domain intervention provides both necessary and sufficient support for young children’s unfolding development.
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Affiliation(s)
- L M Richter
- DSI-NRF Centre of Excellence in Human Development, School of Public Health, University of the Witwatersrand, York Road, 2193, Johannesburg, South Africa
| | - F M Orkin
- Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, York Road, 2193, Johannesburg, South Africa
| | - L S Adair
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - M F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - N Lee Mayol
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Talamban, Cebu City, Cebu, Philippines
| | - A M B Menezes
- Postgraduate Program in Epidemiology and Human Development, Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3 Andar Zip Code: 96020-220, Pelotas, RS, Brazil
| | - R Martorell
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE #5001, Atlanta GA, 30322, USA
| | - J Murray
- Postgraduate Program in Epidemiology and Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3 Andar Zip Code: 96020-220, Pelotas, RS, Brazil
| | - A D Stein
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE #5001, Atlanta, GA, 30322, USA
| | - C Victora
- Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3 Andar Zip Code: 96020-220, Pelotas, RS, Brazil
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Strehlau R, van Aswegen T, Burke M, Kuhn L, Potterton J. A description of early neurodevelopment in a cohort of HIV-exposed uninfected children. AIDS Care 2020; 32:1421-1428. [PMID: 32122174 DOI: 10.1080/09540121.2020.1736257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Successful strategies preventing mother-to-child HIV transmission have resulted in increasing numbers of uninfected children exposed to maternal HIV and ART in-utero, and while breastfeeding. Some reports describe exposure as impacting neurodevelopment. Methods: This cross-sectional analysis included 49 of the 70 HIV-exposed uninfected (HEU) birth-enrolled children as the control arm of an observational cohort study of early treatment in HIV-infected infants in Johannesburg, South Africa. We used the Bayley Scales of Infant and Toddler Development-3rd Edition (BSID-III) to assess neurodevelopment at 12 months of age. Cognitive, language and motor subscale composite scores and performance categories were analysed. We evaluated associations between BSID-III performance categories and cohort variables. Results: Evaluating composite scores according to performance categories showed a higher percentage of scores in the average, high average and superior categories as compared to test reference norms. Maternal BMI ≥ 25 kg/m2 and mid-upper arm circumference ≥ 32 cm were associated with higher than average infant language scores. Six children scored below average (<90) - three in the cognitive and three in the language subscale. Conclusion: No developmental delay was found in ART-exposed HEU children at 12 months of age. A small number of at-risk children suggest ongoing screening, referral and follow-up is needed.
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Affiliation(s)
- Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamryn van Aswegen
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Joanne Potterton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.,Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Springer PE, Kalk E, Pretorius C, Chirehwa MT, Kruger M, Cotton MF, Laughton B. Value of the Goodenough Drawing Test as a research tool to detect developmental delay in South African preschool children. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1177/0081246319850683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a need for simple, cost-effective research tools to detect developmental delay in preschool children in low- and middle-income countries where insufficient resources are often a barrier to detection and management. The Goodenough Draw-a-Person test is freely available, easily administered, and requires limited language ability and equipment; it is thus potentially useful in resource-constrained settings. We aimed to determine the diagnostic accuracy of the Draw-a-Person test to identify developmental delay in 5-year-old preschool children using the Griffiths Mental Developmental Scales-Extended Revised eye-hand coordination subquotient as the gold standard. This was a cross-sectional analysis of drawings by South African preschool children from low-income families, whose Griffiths Mental Developmental Scales-Extended Revised assessments included a human figure drawing. Draw-a-Person test quotients were estimated independently by a developmental paediatrician and two medical officers to calculate inter-rater agreement. The paediatrician’s scores were used to determine the diagnostic accuracy of the Draw-a-Person test quotient (<85) to predict developmental delay with the eye-hand coordination subquotient (<75). A total of 125 children were included, with a mean age of 60.8 months (range 59–66 months) of which 48.8% were boys. The mean Draw-a-Person test score was 94 (standard deviation 15) with 28 Draw-a-Person test scores below 85. Applying the Draw-a-Person test cut-off of 85, sensitivity of the Draw-a-Person test to the eye-hand coordination subquotient was 80% and specificity 89%. The area under the receiver operator characteristic curve was 0.87 (95% confidence interval [0.78–0.96]). The Goodenough Draw-a-Person test could thus be a useful research tool for detecting fine motor and visuoperceptual delay in South African preschool children.
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Affiliation(s)
- Priscilla Estelle Springer
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | | | - Maxwell Tawanda Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Mark Frederic Cotton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
- Family Clinical Research Unit and Tygerberg Hospital,Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health and Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University
- Family Clinical Research Unit and Tygerberg Hospital,Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Hoosen N, Davids EL, de Vries PJ, Shung-King M. The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation. Child Adolesc Psychiatry Ment Health 2018; 12:6. [PMID: 29344084 PMCID: PMC5765647 DOI: 10.1186/s13034-017-0212-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Child and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa. METHODS A comprehensive scoping review methodology was used to identify all peer-reviewed studies ever published that have used the SDQ in Africa. Data were extracted and analysed to assess the countries, languages and SDQ versions used, the purpose of the SDQ studies, psychometric properties of the SDQ, and to consider knowledge gaps for future in-country and cross-country studies. RESULTS Fifty-four studies from 12 African countries were identified, most from South Africa. Many different languages were used, but authorized SDQs in those languages were not always available on the SDQinfo website. Authors frequently commented on challenges in the translation and backtranslation of mental health terminology in African languages. The SDQ was typically used to investigate internalisation/externalization disorders in different clinical populations, and was most frequently used in the evaluation of children and adolescents affected by HIV/AIDS. Sixteen studies (29.6%) administered the SDQ to participants outside the intended age range, only 4 (7.4%) used triangulation of all versions to generate assessments, and eight studies (14.8%) used only subscales of the SDQ. Only one study conducted thorough psychometric validation of the SDQ, including examination of internal consistency and factor analysis. Where 'caseness' was defined in studies, UK cut-off scores were used in all but one of the studies. CONCLUSIONS The SDQ may be a very useful tool in an African setting, but the scoping review suggested that, where it was used in Africa researchers did not always follow instrument guidelines, and highlighted that very little is known about the psychometric properties of the SDQ in Africa. We recommend comprehensive evaluation of the psychometric properties of the SDQ in various African languages, including internal consistency, factor structure, need for local cut-off values and ensuring cultural equivalence of the instrument.
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Affiliation(s)
- Nikhat Hoosen
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Eugene Lee Davids
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Petrus J. de Vries
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Maylene Shung-King
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
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