1. Communication about HIV and death: Maternal reports of primary school-aged children's questions after maternal HIV disclosure in rural South Africa.
- Author
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Rochat, Tamsen J., Mitchell, Joanie, Lubbe, Anina M., Stein, Alan, Tomlinson, Mark, and Bland, Ruth M.
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CHILD Behavior Checklist , *COMMUNICATION , *CONFIDENCE intervals , *HIV infections , *MOTHERS , *MULTIVARIATE analysis , *REGRESSION analysis , *RURAL conditions , *LOGISTIC regression analysis , *DISCLOSURE , *ATTITUDES toward death , *INFORMATION-seeking behavior , *ODDS ratio - Abstract
Introduction Children's understanding of HIV and death in epidemic regions is under-researched. We investigated children's death-related questions post maternal HIV-disclosure. Secondary aims examined characteristics associated with death-related questions and consequences for children's mental health. Methods HIV-infected mothers ( N = 281) were supported to disclose their HIV status to their children (6–10 years) in an uncontrolled pre-post intervention evaluation. Children's questions post-disclosure were collected by maternal report, 1–2 weeks post-disclosure. 61/281 children asked 88 death-related questions, which were analysed qualitatively. Logistic regression analyses examined characteristics associated with death-related questions. Using the parent-report Child Behaviour Checklist (CBCL), linear regression analysis examined differences in total CBCL problems by group, controlling for baseline. Results Children's questions were grouped into three themes: ‘ threats’ ; ‘implications’ and ‘clarifications’ . Children were most concerned about the threat of death, mother's survival, and prior family deaths. In multivariate analysis variables significantly associated with asking death-related questions included an absence of regular remittance to the mother ( AOR 0.25 [CI 0.10, 0.59] p = 0.002), mother reporting the child's initial reaction to disclosure being “frightened” ( AOR 6.57 [ CI 2.75, 15.70] p =<0.001) and level of disclosure (full/partial) to the child ( AOR 2.55 [ CI 1.28, 5.06] p = 0.008). Controlling for significant variables and baseline, all children showed improvements on the CBCL post-intervention; with no significant differences on total problems scores post-intervention (β -0.096 SE 1.366 t = -0.07 p = 0.944). Discussion The content of questions children asked following disclosure indicate some understanding of HIV and, for almost a third of children, its potential consequence for parental death. Level of maternal disclosure and stability of financial support to the family may facilitate or inhibit discussions about death post-disclosure. Communication about death did not have immediate negative consequences on child behaviour according to maternal report. Conclusion In sub-Saharan Africa, given exposure to death at young ages, meeting children's informational needs could increase their resilience. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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