Search

There is evidence that children who are HIV positive (HIV +) are at risk for poor developmental outcomes. The aims of this study were to use developmental screening tools to measure outcomes of children affected by HIV/AIDS attending community-based organisations (CBO) and to determine what types of CBO provision these children were receiving. In a cross-sectional study, we interviewed 979 children and their carers (4 to 13 years) at 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Developmental outcomes were assessed using the Ten Questions childhood disability screening tool and the Strengths and Difficulties Questionnaire. Health-related quality of life was measured using the Paediatric Quality of Life Scale. Overall, 13.8% ( n = 135) were HIV +. HIV + children were more likely to have developmental difficulties and lower health and educational quality of life, controlling for a range of factors. Developmental difficulties and poorer quality of life were predicted by being HIV +, living in South Africa, not attending school regularly, poor housing conditions and living with a sick family member. HIV + children tended to have been enrolled in CBO programmes for a longer period compared to other children but reported lower rates of contact. A greater proportion of HIV + children received medical services, psychosocial interventions and emotional support, compared to HIV − children. However, fewer HIV + children were enrolled in play groups, early childhood intervention programmes and educational programmes. Screening for developmental problems using short tools is possible in community settings in order to identify children with developmental difficulties and plan services for children infected with and affected by HIV. This study highlights the important role of CBOs to intervene to improve child development outcomes. The delivery of evidence-based services that target child development outcomes will enable HIV-infected children to meet their developmental potential and promote their participation in their communities. [ABSTRACT FROM AUTHOR]

There is strong evidence that both adults and children infected with and affected by HIV have high levels of mental health burden. Yet there have been few studies investigating carer mental health outcomes in the context of HIV in Malawi and South Africa. The objective of this study was to assess the mental health of carers of children affected by HIV as a part of the Child Community Care study, which aims to generate evidence on the effectiveness of community-based organisation (CBO) services to improve child outcomes. In a cross-sectional study, we interviewed 952 carers of children (aged 4–13 years) attending 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Psychological morbidity was measured using the Shona Symptom Questionnaire and suicidal ideation was measured using an item from the Patient Health Questionnaire. Carers were asked about care-seeking for emotional problems. Overall, 28% of carers scored above the clinical cut-off for current psychological morbidity and 12.2% reported suicidal ideation. We used logistic regression models to test factors associated with poor outcomes. Household unemployment, living with a sick family member and perceived lack of support from the community were associated with both psychological morbidity and suicidal ideation in carers. Reported child food insecurity was also associated with psychological morbidity. In addition, carers living in South Africa were more likely to present with psychological morbidity and suicidal ideation than carers in Malawi. Rates of help-seeking for mental health problems were low. Carers of children affected by HIV are at risk for mental health problems as a result of HIV, socio-economic, care-giving and community factors. We call for increased recognition of the potential role of CBOs in providing mental health care and support for families as a means to improve equity in mental health care. Specifically, we highlight the need for increased training and supervision of staff at CBOs for children affected by HIV, and the inclusion of CBOs in broader efforts to improve population mental health outcomes. [ABSTRACT FROM PUBLISHER]

Background:Globally, and in low and middle income countries (LMIC) specifically, there is a critical shortage of workers. The use of volunteers to support such care delivery systems has been examined, there is scant literature on the impact of volunteers on child outcome in high human immunodeficiency virus (HIV)-affected communities. Objectives:To examine the differential impact of paid versus volunteer workforce in Community Based Organisations (CBOs) providing care to children and families affected by the HIV epidemic in South Africa and Malawi on child outcomes over time. Methods:This study compared child outcomes for 989 consecutive children attending CBOs (0.7% refusal) at baseline and 854 at follow-up (86.3% response rate). Results:Children attending CBOs with paid staff had higher self-esteem, fewer emotional/behavioural problems and less perceived stigma. Likewise, children attending CBOs with paid staff had fewer educational risks, and 20 heightened cognitive performance, and the digit-span memory test. After controlling for outcome at baseline, gender, age, HIV status, and disability, attending a CBO with paid staff remained a significant independent predictor of higher self-esteem scores, less perceived stigma, as well as fewer educational risks and better performance on the drawing test. We found no associations between CBO attendance – paid or volunteer – and children’s depressive and trauma symptoms. Conclusions:Our findings show that in order to most optimally impact on child outcome 30 community-based workers (CBWs) should ideally be paid with trained staff. Specialised input for more severe child difficulties is needed. [ABSTRACT FROM PUBLISHER]

Background: This study aimed to identify possible entry points for interventions that can act as development accelerators for children and adolescents in South Africa and Malawi. Methods: This study was a secondary data analysis. Data were sourced from the Child Community Care longitudinal study which tracked child well‐being outcomes among 989 children (4–13 years) and their caregivers affected by HIV and enrolled in community‐based organizations in South Africa and Malawi. We examined associations between five hypothesized accelerating services/household provisions—measured as access at baseline and follow‐up and 12 child outcomes that relate to indicators within the Sustainable Development Goals (SDGs) framework. We calculated the adjusted probabilities of experiencing each SDG aligned outcome conditional on receipt of single, combined or all identified accelerators. Results: The results show household food security is associated with positive child education and cognitive development outcomes. Cash grants were positively associated with nutrition and cognitive development outcomes. Living in a safe community was positively associated with all mental health outcomes. Experiencing a combination of two factors was associated with higher probability of positive child outcomes. However, experiencing all three accelerators was associated with better child outcomes, compared with any of the individual factors by themselves with substantial improvements noted in child education outcomes. Conclusions: Combined delivery of specific interventions or services may yield greater improvements in child outcomes across different developmental domains. It is recommended that multiple support avenues in combination like improving food security and safe communities, as well as social protection grants, should be provided for vulnerable children to maximize the impact. [ABSTRACT FROM AUTHOR]

User satisfaction with outpatient mental health services is an important factor in ensuring continued engagement with mental health services for people with mental health conditions. Yet, in many low and middle-income countries, including Malawi, there is a dearth of information about user's experiences of outpatient mental health care services, and little is known about which factors might affect user satisfaction. The aim of the present work was to evaluate user satisfaction with outpatient mental health services in southern Malawi and to explore whether social demographic variables, mental health status, and treatment characteristics explain variance in user satisfaction. This cross-sectional study was conducted in Malawi at one urban (Blantyre) and one rural (Thyolo) outpatient psychiatric clinics. Two-hundred and sixteen randomly sampled service users were enrolled into the study and completed the Charlestone Psychiatric Outpatient Satisfaction Scale (CPOSS). The unadjusted and adjusted associations between user satisfaction as the dependent variable, and participant socio-demographic characteristics as independent variables, were examined. Eighty percent of all participants were satisfied with the outpatient mental health services, although participants presenting to the rural clinic were less likely to be satisfied than participants presenting at the urban clinic, according to the adjusted odds ratio (AOR; AOR = 0.31; 95% confidence interval (CI): 0.13–0.76; p < 0.05). Any admission due to a mental health condition significantly explained variance in user satisfaction at the rural (Thyolo) study site; as those who had been admitted previously were less satisfied than those who had never been admitted (AOR = 0.11; 95% CI: 0.02–0.54; p < 0.05). As may be expected, these findings demonstrate that service user satisfaction is linked to service quality and past service experiences. Further research is required in order to nuance these findings in the context of Malawi's efforts to strengthen service quality. Nonetheless, rural facilities may require additional support to deliver satisfactory care. [ABSTRACT FROM AUTHOR]