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Eliza IJ, Urmi MA, Anan MTT, Munim MTH, Galib FZI, Islam AAA. eDakterBari: A human-centered solution enabling online medical consultation and information dissemination for resource-constrained communities in Bangladesh. Heliyon 2024; 10:e23100. [PMID: 38163096 PMCID: PMC10756979 DOI: 10.1016/j.heliyon.2023.e23100] [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: 07/16/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
A well-accessible healthcare system is an important measure of the progress of a country, as access to adequate healthcare is one of everyone's very basic human rights. When a community lives below the poverty line, unfortunately, it gets deprived of the basic human rights like healthcare, which is a reality to many resource-constrained communities around the world. The number of such resource-constrained communities in developing countries is large. Orphans present a prominent example in this regard in the context of Bangladesh. Orphans suffer greatly from many diseases due to their resource-constrained environment of livings and they are unable to take a minimum care of their own health. Their lack of resources, inadequate literacy skills, and limited (or no) access to technology leave them in such a position that they are ignorant of healthcare services available for them directly or through technological means. Considering all these unavoidable real aspects and the fact that such resource-constrained communities are very little focused in the literature for aiding them in getting bare minimum healthcare services, in this study, we leverage technology and relevant appropriate intermediaries to bridge the gap between the orphans in the orphanages and healthcare services offered by medical doctors. To accomplish so, we conduct a series of field studies over the intended communities. The orphanage teachers and administrators, being in proximity, are the most effective ones to operate as intermediaries for the orphan children, as revealed through our field studies. Therefore, we use these intermediaries to help the orphans to get basic healthcare services via an Android healthcare app called 'Shastho-sheba'. We also use our findings from the field study to specifically tailor and modify the application for intermediaries to use on behalf of the orphans so that health professionals can provide direct healthcare services to them over the Internet. Finally, we look into our proposed techno-social solution in the context of HCI to ensure that the service is used more effectively.
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Chima V. Socio-demographic determinants of health support services among orphans and vulnerable children in Nigeria. ACTA ACUST UNITED AC 2018. [DOI: 10.5897/jphe2017.0981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sherr L, Hensels I, Tomlinson M, Skeen S, Macedo A. Cognitive and physical development in HIV-positive children in South Africa and Malawi: A community-based follow-up comparison study. Child Care Health Dev 2018; 44:89-98. [PMID: 29047149 PMCID: PMC6086496 DOI: 10.1111/cch.12533] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 09/19/2017] [Accepted: 09/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Child development is negatively impacted by HIV with children that are infected and affected by HIV performing worse than their peers in cognitive assessments. METHODS We conducted a descriptive follow-up comparison study (n=989) in South Africa and Malawi. We tracked child development in 135 HIV-positive children compared to 854 uninfected children aged 4-13 years attending community-based organizations at baseline and again 12-15 months later. RESULTS Children with HIV were more often stunted (58.8% vs. 27.4%) and underweight (18.7% vs. 7.1%). They also had significantly poorer general physical functioning (M=93.37 vs. M=97.00). HIV-positive children scored significantly lower on digit span and the draw-a-person task. CONCLUSIONS These data clearly show that HIV infection poses a serious risk for child development and that there is a need for scaled up interventions. Community-based services may be ideally placed to accommodate such provision and deliver urgently needed support to these children.
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Affiliation(s)
- L. Sherr
- Department of Infection and Population Health, University College London, United Kingdom,Corresponding author: Prof L. Sherr, Rowland Hill Street, NW3 2PF, London, United Kingdom,
| | - I.S. Hensels
- Department of Psychology, University of Manchester, United Kingdom
| | - M. Tomlinson
- Department of Psychology, Stellenbosch University, South Africa
| | - S. Skeen
- Department of Psychology, Stellenbosch University, South Africa,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - A. Macedo
- Department of Infection and Population Health, University College London, United Kingdom
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Jepkemboi G, Jolly P, Gillyard K, Lissanu L. Educating Orphaned and Vulnerable Children in Elgeyo-Marakwet County, Kenya. ACTA ACUST UNITED AC 2017; 92:391-395. [PMID: 28392577 DOI: 10.1080/00094056.2016.1226114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
According to UNICEF, 13.3 million children (0-17 years) worldwide have lost one or both parents to AIDS. Nearly 12 million of these children live in sub-Saharan Africa. Together, with other children who have been severely impacted by the AIDS pandemic, these orphaned and vulnerable children (OVC) are at higher risk of missing out on schooling, living in households with less food security, and suffering from anxiety and depression. Although the needs of OVC are complex and influenced by numerous variables, the provision of education has the potential to address many aspects of a child's well-being, including food and nutrition, health care, social welfare, and protection. Drawing on data collected using the Orphans and Vulnerable Children (OVC) Well-being Tool in one area of Kenya, the authors of this study describe their findings on the educational well-being of the surveyed children and present recommendations for teachers on how to better support the diverse needs of OVCs.
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Affiliation(s)
- Grace Jepkemboi
- Assistant Professor, Early Childhood and Elementary Education, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pauline Jolly
- Professor and Director, University of Alabama at Birmingham Minority Health International Research Training Program (MHIRT)
| | - KaNesha Gillyard
- Student Trainees, University of Alabama at Birmingham Minority Health International Research Training Program (MHIRT)
| | - Lydia Lissanu
- Student Trainees, University of Alabama at Birmingham Minority Health International Research Training Program (MHIRT)
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Skeen S, Sherr L, Tomlinson M, Croome N, Ghandi N, Roberts JK, Macedo A. Interventions to improve psychosocial well-being for children affected by HIV and AIDS: a systematic review. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 12:91-116. [PMID: 29085436 PMCID: PMC5659734 DOI: 10.1080/17450128.2016.1276656] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In addition to its contribution to child mortality, HIV/AIDS has a substantial impact on the psychosocial well-being of children across the globe and particularly in sub-Saharan Africa. We conducted a systematic review of the literature in order to identify studies that assess the effectiveness of interventions developed to improve the psychosocial well-being of children affected by HIV/AIDS, published between January 2008 and February 2016. Studies that were eligible for the review included male and/or female children under the age of 18 years of age, who had lost a parent to HIV/AIDS, were living with a parent with HIV/AIDS, or were vulnerable because of other social and economic factors and living in communities of high HIV and AIDS prevalence, including child and caregiver reports. Studies were included if they documented any intervention to improve the psychosocial well-being of children including psychological therapy, psychosocial support and/or care, medical interventions and social interventions, with psychological and/or social factors as outcomes. We identified 17 interventions to improve the psychosocial well-being of children affected by HIV/AIDS. Of these, 16 studies took place in eight different low and middle-income countries (LMIC), of which 6 were in southern and eastern Africa. One study took place in a high-income setting. Of the total, fifteen showed some significant benefits of the intervention, while two showed no difference to psychosocial outcomes as a result of the intervention. The content of interventions, dosage and length of follow up varied substantially between studies. There were few studies on children under seven years and several focused mostly on girls. Efforts to improve evaluation of interventions to improve the psychosocial well-being of children affected by HIV/AIDS have resulted in a number of new studies which met the inclusion criteria for the review. Most studies are specially designed research projects and not evaluations of existing services. We call for increased partnerships between policy-makers, practitioners and researchers in order to design evaluation studies and can feed into the growing evidence base.
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Affiliation(s)
- S Skeen
- Department of Psychology, Stellenbosch University, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - L Sherr
- Department of Infection and Population Health, University College London, United Kingdom
| | - M Tomlinson
- Department of Psychology, Stellenbosch University, South Africa
| | - N Croome
- Kings College London, United Kingdom
| | - N Ghandi
- Department of Infection and Population Health, University College London, United Kingdom
| | - J K Roberts
- Department of Infection and Population Health, University College London, United Kingdom
| | - A Macedo
- Department of Infection and Population Health, University College London, United Kingdom
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Bryant M, Beard J. Orphans and Vulnerable Children Affected by Human Immunodeficiency Virus in Sub-Saharan Africa. Pediatr Clin North Am 2016; 63:131-47. [PMID: 26613693 DOI: 10.1016/j.pcl.2015.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In Sub-Saharan Africa, 15.1 million children have been orphaned because of human immunodeficiency virus (HIV). They face significant vulnerabilities, including stigma and discrimination, trauma and stress, illness, food insecurity, poverty, and difficulty accessing education. Millions of additional children who have living parents are vulnerable because their parents or other relatives are infected. This article reviews the current situation of orphans and vulnerable children, explores the underlying determinants of vulnerability and resilience, describes the response by the global community, and highlights the challenges as the HIV pandemic progresses through its fourth decade.
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Affiliation(s)
- Malcolm Bryant
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Jennifer Beard
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
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Richter L, Louw J, Naicker S. Training and capacity development: the foundation of interventions to support young children affected by HIV and AIDS in sub-Saharan Africa. VULNERABLE CHILDREN AND YOUTH STUDIES 2015; 10:105-117. [PMID: 26430466 PMCID: PMC4566893 DOI: 10.1080/17450128.2015.1029035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/10/2015] [Indexed: 06/05/2023]
Abstract
Many programs to support young children and families affected by HIV and AIDS depend substantially on a model of cascaded training from international nongovernmental organizations, through in-country groups and organizations to services on the ground. In this paper, we describe the training and capacity building - as described in proposals, progress reports, and individualized questionnaires - offered by 10 international organizations funded by the Conrad N. Hilton Foundation to provide supportive services for young children and their families in five southern and eastern African countries. We related the findings to effective features of training described in the literature. Training and capacity development were found to be the most substantial activities in rendering services to children and families, both in terms of effort and human and financial resources. A total of 67 trainings were conducted over a period of 18 months. Almost all trainings combine lecture-based instruction, group work/discussions, and role play, but only half of the trainings report some form of mentoring, supervision or coaching following the training. Drawing on the literature, it is likely that more purposeful planning is required in terms of the selection of trainees, local adaptation and development of materials, participatory training approaches, and techniques to develop and sustain skills as well as knowledge. Demonstration and mentorship in the field together with quality assurance procedures, pre-and post-assessment to evaluate training, processes to transfer learning into subsequent practice, as well as certification, are all fundamental steps to ensure that training plays a supportive role in the behavior changes necessary to support young children affected by HIV and AIDS and their families.
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Affiliation(s)
- Linda Richter
- HIV/STI and TB (HAST) Programme, Human Sciences Research Council, Durban, South Africa
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia Louw
- HIV/STI and TB (HAST) Programme, Human Sciences Research Council, Durban, South Africa
| | - Sara Naicker
- HIV/STI and TB (HAST) Programme, Human Sciences Research Council, Durban, South Africa
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Familiar I, Murray L, Gross A, Skavenski S, Jere E, Bass J. Posttraumatic stress symptoms and structure among orphan and vulnerable children and adolescents in Zambia. Child Adolesc Ment Health 2014; 19:235-242. [PMID: 25382359 PMCID: PMC4219598 DOI: 10.1111/camh.12050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scant information exists on posttraumatic stress disorder (PTSD) symptoms and structure in youth from developing countries. METHODS We describe the symptom profile and exposure to trauma experiences among 343 orphan and vulnerable children and adolescents from Zambia. We distinguished profiles of posttraumatic stress symptoms using latent class analysis. RESULTS Average number of trauma-related symptoms (21.6; range 0-38) was similar across sex and age. Latent class model suggested three classes varying by level of severity: low (31% of the sample), medium (45% of the sample), and high (24% of the sample) symptomatology. CONCLUSIONS Results suggest that PTSD is a continuously distributed latent trait.
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Affiliation(s)
- Itziar Familiar
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
| | - Laura Murray
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
| | - Alden Gross
- Harvard Medical School, Institute for Aging Research, Boston, MA, USA
| | - Stephanie Skavenski
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
| | | | - Judith Bass
- Johns Hopkins School of Public Health, Mental Health, Room 811, 624 N. Broadway ST, Baltimore, MD, 21205, USA
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Kidman R, Nice J, Taylor T, Thurman TR. Home visiting programs for HIV-affected families: a comparison of service quality between volunteer-driven and paraprofessional models. VULNERABLE CHILDREN AND YOUTH STUDIES 2014; 9:305-317. [PMID: 25379052 PMCID: PMC4205849 DOI: 10.1080/17450128.2014.954025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/01/2014] [Indexed: 05/06/2023]
Abstract
Home visiting is a popular component of programs for HIV-affected children in sub-Saharan Africa, but its implementation varies widely. While some home visitors are lay volunteers, other programs invest in more highly trained paraprofessional staff. This paper describes a study investigating whether additional investment in paraprofessional staffing translated into higher quality service delivery in one program context. Beneficiary children and caregivers at sites in KwaZulu-Natal, South Africa were interviewed after 2 years of program enrollment and asked to report about their experiences with home visiting. Analysis focused on intervention exposure, including visit intensity, duration and the kinds of emotional, informational and tangible support provided. Few beneficiaries reported receiving home visits in program models primarily driven by lay volunteers; when visits did occur, they were shorter and more infrequent. Paraprofessional-driven programs not only provided significantly more home visits, but also provided greater interaction with the child, communication on a larger variety of topics, and more tangible support to caregivers. These results suggest that programs that invest in compensation and extensive training for home visitors are better able to serve and retain beneficiaries, and they support a move toward establishing a professional workforce of home visitors to support vulnerable children and families in South Africa.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Preventive Medicine, Health Science Center, Level 3, Stony Brook University, Stony Brook, NY, USA
- Department of Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Corresponding author.
| | - Johanna Nice
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Tory Taylor
- Department of Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Stein A, Desmond C, Garbarino J, Van IJzendoorn MH, Barbarin O, Black MM, Stein AD, Hillis SD, Kalichman SC, Mercy JA, Bakermans-Kranenburg MJ, Rapa E, Saul JR, Dobrova-Krol NA, Richter LM. Predicting long-term outcomes for children affected by HIV and AIDS: perspectives from the scientific study of children's development. AIDS 2014; 28 Suppl 3:S261-8. [PMID: 24991899 PMCID: PMC10875626 DOI: 10.1097/qad.0000000000000328] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The immediate and short-term consequences of adult HIV for affected children are well documented. Little research has examined the long-term implications of childhood adversity stemming from caregiver HIV infection. Through overviews provided by experts in the field, together with an iterative process of consultation and refinement, we have extracted insights from the broader field of child development of relevance to predicting the long-term consequences to children affected by HIV and AIDS. We focus on what is known about the impact of adversities similar to those experienced by HIV-affected children, and for which there is longitudinal evidence. Cautioning that findings are not directly transferable across children or contexts, we examine findings from the study of parental death, divorce, poor parental mental health, institutionalization, undernutrition, and exposure to violence. Regardless of the type of adversity, the majority of children manifest resilience and do not experience any long-term negative consequences. However, a significant minority do and these children experience not one, but multiple problems, which frequently endure over time in the absence of support and opportunities for recovery. As a result, they are highly likely to suffer numerous and enduring impacts. These insights suggest a new strategic approach to interventions for children affected by HIV and AIDS, one that effectively combines a universal lattice of protection with intensive intervention targeted to selected children and families.
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Affiliation(s)
- Alan Stein
- Section of Child & Adolescent Psychiatry, University of Oxford, Oxford and School of Public Health, University of Witwatersrand
| | - Christopher Desmond
- Human and Social Development Research Programme, Human Sciences Research Council, Durban
| | | | - Marinus H. Van IJzendoorn
- Centre for Child and Family Studies, Graduate School of Social and Behavioural Sciences, Leiden University, The Netherlands
| | - Oscar Barbarin
- Center for Children, Families and Schools, Tulane University, New Orleans
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Aryeh D. Stein
- Hubert Department of Global Health, Emory University, Atlanta
| | - Susan D. Hillis
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta
| | | | - James A. Mercy
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Marian J. Bakermans-Kranenburg
- Centre for Child and Family Studies, Graduate School of Social and Behavioural Sciences, Leiden University, The Netherlands
| | - Elizabeth Rapa
- Section of Child & Adolescent Psychiatry, University of Oxford, Oxford
| | - Janet R. Saul
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta
| | - Natasha A. Dobrova-Krol
- Centre for Child and Family Studies, Graduate School of Social and Behavioural Sciences, Leiden University, The Netherlands
| | - Linda M. Richter
- HIV/AIDS, STIs, and TB Research Programme, Human Sciences Research Council, Durban
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Thurman TR, Kidman R, Taylor TM. Does investment in home visitors lead to better psychological health for HIV-affected families? Results from a quasi-experimental evaluation in South Africa. AIDS Care 2014; 26 Suppl 1:S2-10. [PMID: 24754520 PMCID: PMC4133970 DOI: 10.1080/09540121.2014.906555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Children and families affected by HIV are at considerable risk for psychological distress. Community-based home visiting is a common mechanism for providing basic counseling and other services to HIV-affected families. While programs emphasize home visitor training and compensation as means to promote high-quality service delivery, whether these efforts result in measurable gains in beneficiaries' well-being remains largely unanswered. This study employs a longitudinal quasi-experimental design to explore whether these kinds of investments yield concomitant gains in psychological outcomes among beneficiaries. Baseline and follow-up data were collected over a two-year period from children aged 10–17 at the time of program enrollment and their caregivers, with 80% retention. In this sample of 1487 children and 918 caregivers, the psychological health outcomes of those enrolled in programs with home visitors who receive intensive training, organizational support, and regular compensation (termed “paraprofessional”) were compared to those enrolled in programs offering limited home visiting services from lay volunteers. Applying multilevel logistic regression, no measurable improvements were found among paraprofessional enrollees, and three outcomes were significantly worse at follow-up regardless of program model. Children's behavior problems became more prevalent even after adjusting for other factors, increasing from 29% to 35% in girls and from 28% to 43% in boys. Nearly one-quarter of girl and boys reported high levels of depression at follow-up, and this was a significant rise over time for boys. Rates of poor family functioning also significantly worsened over time, rising from 30% to 59%. About one-third of caregivers reported high levels of negative feelings at follow-up, with no improvements observed in the paraprofessional group. Results highlight that children's and caregivers' psychological outcomes may be relatively impervious to change even in paraprofessional home visiting models. Findings underscore the need for programs serving HIV-affected families toadd focused evidence-based psychological interventions to supplement traditional home visiting.
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Affiliation(s)
- Tonya R Thurman
- a School of Social Work , Tulane University , New Orleans , LA , USA
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Jepkemboi G, Aldridge J. Effect of HIV/AIDS on Children's Attitudes Toward Learning: Voices of Teachers and Caregivers in Western Kenya. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/00094056.2014.910993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reynolds LJ. 'Low-hanging fruit': counting and accounting for children in PEPFAR-funded HIV/AIDS programmes in South Africa. Glob Public Health 2014; 9:124-43. [PMID: 24498970 DOI: 10.1080/17441692.2013.879670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The article traces the social life of a policy that aimed to define and circumscribe the ambiguous and contested category of 'orphaned and vulnerable children' (or OVC) in South Africa at the height of the 'emergency response' to HIV/AIDS. Drawing on several months of institutional ethnographic research conducted over the course of five years with South African organisations receiving funding from the US President's Emergency Plan for AIDS Relief to provide services to 'OVC', the project interrogates the influence of governmental forms of counting and accounting on health policy and practice in South Africa. Focusing on the experiences of one organisation, the article describes a process of policy 'translation' typified by a series of disconnects between the intentions of a policy and the exigencies of implementation, structured by the ambiguous and flexible nature of the 'OVC' category. In this context, the article argues that the uncertainty produced by the implementation of the guidelines was not simply an artefact of a poorly designed policy, but rather signals an underlying epistemological tension in the practice of 'global health', in which quantitative metrics designed for monitoring and evaluation are often incapable of approximating the complexities of everyday life.
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Affiliation(s)
- Lindsey J Reynolds
- a Department of Sociology and Social Anthropology , Stellenbosch University , Matieland , South Africa
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Murray LK, Familiar I, Skavenski S, Jere E, Cohen J, Imasiku M, Mayeya J, Bass JK, Bolton P. An evaluation of trauma focused cognitive behavioral therapy for children in Zambia. CHILD ABUSE & NEGLECT 2013; 37:1175-85. [PMID: 23768939 PMCID: PMC3823750 DOI: 10.1016/j.chiabu.2013.04.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 05/31/2023]
Abstract
To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5-18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision.
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Affiliation(s)
- Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Itziar Familiar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Stephanie Skavenski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Elizabeth Jere
- Catholic Relief Services, Zambia, Longolongo Rd. Lusaka, Zambia 10101,
| | - Judy Cohen
- Drexel University College of Medicine, Allegheny General Hospital, Department of Psychiatry, Four Allegheny Center, 8th Floor, Pittsburgh, PA 15212, USA,
| | | | - John Mayeya
- Ministry of Health, City Airport Road, Lusaka, ZAMBIA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD, 21205, ; ; ;
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8 Floor, Baltimore, MD 21205
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