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Exposure to a multitude of risks, including food insecurity, poverty, and – perhaps most prominently – HIV can be damaging for early childhood survival, healthy growth and development. Yet, guidance regarding the implementation factors that contribute to early child development-focussed programme success is lacking in low- and middle-income countries broadly, and sub-Saharan Africa in particular. Having access to guidelines for practice and implementation could assist in improving the implementation of programmes to improve early childhood development. We conducted a narrative review of the literature with the goal of identifying how implementation features of these early interventions may influence the effectiveness of such work in the complex contexts which characterise this region. Our final review included 197 for final analysis. There were two primary cross-cutting findings. Firstly, the benefit for parents was less clear than they were for children, and secondly, while the benefits for children were clear, those most at risk benefited the most. Home visiting was found to be the predominant service delivery platform, and positive outcomes for children were reported when home visiting programmes were implemented by trained non-professionals, whereas positive parent outcomes were reported more frequently when delivered by professionals. In early childhood care and education programmes, positive outcomes for children and parents were reported when they were implemented by both trained non-professionals and professionals. Trained non-professionals facilitating parent groups produced similar benefits to groups run by professionals. Take-home lessons for successful programmes were that high levels of attendance, regular sessions of at least an hour duration, with the programme continuing for more than 6 months and closer to a year are key for effectiveness. [ABSTRACT FROM AUTHOR]

Adolescents living in low- and-middle incomeand middle-income countries are at a particular risk of poor mental health. Caregiver mental health plays a crucial role in a child's emotional and behavioural development and may directly impact a child's risk for future development of mental health problems. Data collected as part of a two-decade longitudinal multiphase research project were used. Participants, originally women in their third trimester of pregnancy (n = 449), were recruited from a peri-urban impoverished community outside of Cape Town, South Africa, and assessed at several time-points over subsequent years. Data collected during the three phases of the research were used to assess the effects of early and current caregiver depression on adolescent internalising and externalising behaviour. Analyses of Covariance models were used to explore the effect of caregiver depression on adolescent internalising and externalising behaviour, while controlling for multiple covariates. We analysed data for 313 adolescent participants and their primary caregivers. Caregiver depression patterns had a significant main effect on externalising behaviour, F(3,305) = 4.10 (p = 0.007), but not on internalising behaviour, F(3,305) = 2.71 (p = 0.09). Post-hoc analysis showed that those adolescents exposed to early and current caregiver depression scored on average 3.83 points (95% CI [0.99; 6.66]) higher in externalising behaviour than those exposed to no caregiver depression. Also, adolescents who experienced a change in caregiver, compared to those whose biological mother were still their primary caregiver, reported significantly higher levels of externalising behaviour F(1,305) = 5.10, p = 0.03. The study findings provide crucial insight into critical periods of risk, as well as opportunities for prevention. Preventive interventions should ideally target caregivers and adolescents to prevent or reduce behavioural problems and disrupt intergenerational cycles of mental disorders or behavioural problems. [ABSTRACT FROM AUTHOR]

The purpose of this research was to determine whether or not routine home visiting (by the Philani Maternal Child Health and Nutrition Project) influences the prevalence of stunted, wasted and underweight children in Cape Town peri-urban settlements. The study was a cross-sectional cohort in which weight and height measurements were collected for all children from 24 matched neighbourhoods; three years earlier 12 of these neighbourhoods were randomized to receive the home visiting intervention and 12 did not. The research took place at all households located within the 24 neighbourhoods in Khayelitsha and Mfuleni peri-urban settlements. Participants included 8715 children aged 0–6 years old (4694 intervention; 4021 control). A total of 41.3% of children were stunted, 3.1% were underweight and 1.4% were wasted. Children in the intervention group were significantly less likely to be underweight or severely underweight for age than children in the control group. While the rates of stunting were also significantly lower in intervention areas, the effect was not clinically significant, and no significant differences were found between the study arms on the prevalence of wasting. The Philani model is effective in the prevention and rehabilitation of underweight children. Philani could strengthen their intervention by focussing specifically on screening for child stunting in addition to underweight children. The results also suggests that efforts to address the long-term adverse effects of undernutrition require structural and economic transformation, in addition to socio-medical interventions. [ABSTRACT FROM AUTHOR]

Understanding the needs of your child is complicated. Understanding the varied needs of a population of children with whom you have no direct contact is the near impossible challenge policy makers, government planners and donors face when making policy or selecting interventions to fund and implement. They cannot unpack children's individual needs and so must predict what is most important for a given population and which services to prioritise. This can be simplified by assuming that the needs of other people's children are hierarchical: basic needs, such as food and shelter, must be met before considering higher-order needs. This conceptualisation justifies a focus on basic needs and decision makers can ignore higher-order needs and the complex interventions they may require, because both are assumed to be of secondary importance. Assuming a hierarchy of needs is a mistake. By drawing on examples from the literature, we outline how children, our own and other people's, have non-hierarchical needs and thus caring for them is a balancing act, best done by those close to them. This conceptualisation highlights the importance of supporting families to support children. For a subset of families who are struggling, additional family strengthening interventions may be needed. In the relatively rare cases that such interventions are insufficient as family function is severely compromised, more intensive interventions may be necessary, but must be undertaken with great care and skill. Social services are critical because they have the potential to facilitate the intensive interventions when they are required, and while they are not required by all, for some of the most vulnerable children they are essential. The quality standards of such a service will be key in meeting the needs of other people's children. [ABSTRACT FROM AUTHOR]

Throughout the rapid and intense changes that adolescents experience, their parents retain important influence over how they interact with the complex factors that shape their development. How parents care for their adolescent children has a deep and lasting impact on their well-being and development. Yet, parents often require support to meet their own and their adolescent children's needs, which can be achieved through parenting support programmes. Parenting support programmes are delivered to parents of younger children across different contexts and populations, but the benefit of these programmes for parents of adolescents is not well-recognised or prioritised. Given the clear need for these interventions during adolescence and the substantial evidence for effectiveness in this age group, it is time to move the field forward. Increased resources to support parents of adolescents would maximise adolescents' developmental potential and promote their well-being. We highlight four pressing areas for action: including parents of adolescents in parenting initiatives; involving parents in adolescent programming; strengthening efforts to address poverty and inequality, violence, and gender inequality; and engaging in strategic research to intensify the impact of programming. [ABSTRACT FROM AUTHOR]

Reactive attachment disorder (RAD) is a psychiatric disorder developing in early or middle childhood as a consequence of significant failures in the caregiving environment. RAD results in children failing to relate socially, either by exhibiting markedly inhibited behaviour or by indiscriminate social behaviour and is associated with significant socio-behavioural problems in the longer term. This study examined RAD in South Africa, a setting with high environmental risks. We recruited a sub-sample of 40 10-year-old children from a cohort enrolled during pregnancy for whom early attachment status was known. Children were purposefully selected to represent the four attachment categories using the data available on the strange situation procedure (SSP) at 18 months. The Manchester Child Attachment Story Task (MCAST) assessed current attachment and RAD was diagnosed using a standardised assessment package. A high proportion of the children (5/40% or 12.5%) fulfilled diagnostic criteria for RAD; all were boys and were displaying the disinhibited type. SSP classification at 18 months was not significantly associated with RAD symptoms at age of 10 years, while current MCAST classifications were. This suggests that children in this sample are at much higher risk of RAD than in high-income populations, and despite a fairly typical attachment distribution in this population at 18 months, RAD was evidenced in later childhood and associated with current attachment disorganisation. The strengths of this research include its longitudinal nature and use of diagnostic assessments. Given increasing evidence that RAD is relatively stable over time and introduces longer term socio-behavioural risks; the high rate of RAD in this sample (12.5%) highlights potential developmental threats to children in low- and middle-income countries (LMICs). Our results should be interpreted with caution given sample size and risk of selection bias. Further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

In addition to its contribution to child mortality, HIV/AIDS has a substantial impact on the psychosocial well-being of children. We conducted a systematic review 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 were eligible for the review if they included children under the age of 18 years, who had lost a parent to HIV/AIDS, were living with a parent with HIV/AIDS, or were vulnerable because of other factors and living in communities of high HIV/AIDS prevalence. Studies documented any intervention to improve the psychosocial well-being of children including psychological, psychosocial, medical, 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 8 different low- and middle-income countries (LMIC), and 6 in Southern and Eastern Africa. Of the total, 15 showed some significant benefits of the intervention, while 2 showed no difference to psychosocial outcomes. The content of interventions, dosage and length of follow-up varied substantially between studies. There were few studies on children under 7 years and several focused mostly on girls. Due to the variability between interventions, it was not possible to make consolidated recommendations for programming based on the results of this review. However, we note that 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 were research projects and not evaluations of existing services. We call for increased partnerships between policymakers, practitioners, and researchers in order to design evaluation studies that can feed into the growing evidence base. [ABSTRACT FROM AUTHOR]

Paraprofessional home visitors trained to improve multiple outcomes (HIV, alcohol, infant health and malnutrition) have been shown to benefit mothers and children over 18 months in a cluster randomised controlled trial. These longitudinal analyses examine the mechanisms which influence child outcomes at 18 months post-birth in Cape Town, South Africa. The results were evaluated using structural equation modelling, specifically examining the mediating effects of prior maternal behaviours and a home visiting intervention post-birth. Twelve matched pairs of neighbourhoods were randomised within pairs to: (1) the control condition, receiving comprehensive health care at community primary health care clinics (n = 12 neighbourhoods;n = 594 pregnant women), or (2) the Philani Intervention Program, which provided home visits by trained, paraprofessional community health workers, here called Mentor Mothers, in addition to clinic care (n = 12 neighbourhoods;n = 644 pregnant women). Recruitment of all pregnant neighbourhood women was high (98%) with 88% reassessed at 6 months and 84% at 18 months. Infants’ growth and diarrhoea episodes were examined at 18 months in response to the intervention condition, breastfeeding, alcohol use, social support and low birth weight, controlling for HIV status and previous history of risk. We found that randomisation to the intervention was associated with a significantly lower number of recent diarrhoea episodes and increased rates and duration of breastfeeding. Across both the intervention and control conditions, mothers who used alcohol during pregnancy and had low birth weight infants were significantly less likely to have infants with normal growth patterns, whereas social support was associated with better growth. HIV infection was significantly associated with poor growth and less breastfeeding. Women with more risk factors had significantly smaller social support networks. The relationships among initial and sustained maternal risk behaviours and the buffering impact of home visits and social support are demonstrated in these analyses. [ABSTRACT FROM PUBLISHER]