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Integrated early childhood development (ECD) programs boost child health and developmental outcomes. However, the factors contributing to the successful implementation of such programs in informal urban settlements are not well researched. We conducted 14 focus group discussions and 13 key informant interviews with 125 caregivers of children under the age of 5 years and stakeholders, exploring their views on enablers and barriers to implementing an integrated ECD program in an informal settlement in Kenya. Strategic engagement, capacity building, transparency, fair compensation of ECD workforce, communication skills, and the need to tailor ECD programs to local realities were discussed. An equity-focused implementation approach for integrated ECD programs is timely. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of community home‐based care (CHBC) on self‐management outcomes for chronically ill patients in rural Malawi. A pre‐ and post‐evaluation survey was administered among 140 chronically ill patients with HIV and non‐communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self‐Management Programme to evaluate patient's self‐management outcomes (health status and self‐efficacy), at four time points over a 12‐month period, between April 2016 and May 2017. The patient's drop‐out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self‐efficacy following CHBC interventions. The results indicate a reduction in patient‐reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self‐efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition‐related; whereby self‐efficacy for non‐HIV and multimorbid patients was much lower. The odds for self‐efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self‐efficacy. Programmes maintaining regular home visits had higher patient satisfaction levels. Our findings suggest that there were differential changes in self‐management outcomes following CHBC interventions. While self‐management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition‐related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self‐management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Families, parents and caregivers play a central role in child health and development, especially during the first 1000 days of life (from pregnancy to age 3 years), a critical period that lays the foundation for future health, learning and well-being. Many agencies, including the World Bank, the United Nations Children's Fund, and the World Health Organization (WHO), have recognized parenting education programmes as a priority for improving child development outcomes in low- and middle-income countries. In the Lancet series on early childhood development, the concept of nurturing care was introduced, which encompasses health, nutrition, security and safety, responsive caregiving, and early learning (Black et al., 2017). It is a crucial entry point for multisectoral collaborations to support families and reach young children living in marginalized communities, including transitional or refugee contexts. [ABSTRACT FROM AUTHOR]

Background: The high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other sub-Saharan African countries, calls for a shift in how health care services are designed and delivered. Patient-centred care and patient self-management are critical elements in chronic care, and are advocated as universal strategies. In sub-Saharan Africa, there is need for more evidence around the practice of patient self-management, and how to best support patients with chronic conditions in the African context. Our study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource-constrained setting in Malawi. Methods: This is primarily a qualitative study, involving patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients (from the third of four-part data collection series), 14 in-depth interviews, and four focus-group discussions with patients (n = 31 respondents). A framework approach was used for qualitative analysis, and descriptive statistical analysis was performed on survey data. Results: Patients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included: 1) ability to acquire appropriate disease knowledge; 2) poverty level; 3) the presence of support from family caregivers and community-based support initiatives; 4) the nature of one’s social relations; and 5) the ability to deal with stressors and stigma. NCD and HIV comorbid patients were more disadvantaged in their access to care, as they experienced frequent drug stock-outs and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of (multiple) care challenges. Conclusion: Our findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. We recommend expanding current peer-patient and support group initiatives to patients with NCDs, and further investments in the decentralisation of integrated health services to primary care level in Malawi. [ABSTRACT FROM AUTHOR]

Several measures of adolescent optimism exist. However, none of these measures have been developed in the African setting, and only a few of the available measures have been validated for use in this setting. We aimed to develop and validate a culturally appropriate measure for this context. We employed an exploratory sequential mixed methods design using a five-step approach to tool development, comprising literature reviews, construct clarification, item development, piloting, and scale evaluation. We constructed a six-item scale, the Mabrouk's Measure of Adolescent Optimism (MMAO). In a sample of 1616 adolescents from Kenya, the MMAO demonstrated adequate internal consistency (both Cronbach's alpha and McDonald's Omega > 0.80) and test-retest reliability (ICC = 0.46). Factor analysis supported a unidimensional scale with adequate criterion and divergent validity as well as measurement invariance across sex, age (younger vs. older adolescents), residence (rural vs. urban), schooling status (in-school vs. out-of-school adolescents), and language of administration (Swahili vs. English). We report on the development and validation of a new scale of adolescent optimism that can be used to assess optimism among adolescents in Kenya and similar contexts. Preliminary evidence shows support for this new measure's reliability and validity, although additional tests are needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.