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The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher’s exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral.

Reproducibility, the extent to which consistent results are obtained when an experiment or study is repeated, sits at the foundation of science. The aim of this process is to produce robust findings and knowledge, with reproducibility being the screening tool to benchmark how well we are implementing the scientific method. However, the re-examination of results from many disciplines has caused significant concern as to the reproducibility of published findings. This concern is well-founded—our ability to independently reproduce results build trust within the scientific community, between scientists and policy makers, and the general public. Within geoscience, discussions and practical frameworks for reproducibility are in their infancy, particularly in subsurface geoscience, an area where there are commonly significant uncertainties related to data (e.g., geographical coverage). Given the vital role of subsurface geoscience as part of sustainable development pathways and in achieving Net Zero, such as for carbon capture storage, mining, and natural hazard assessment, there is likely to be increased scrutiny on the reproducibility of geoscience results. We surveyed 346 Earth scientists from a broad section of academia, government, and industry to understand their experience and knowledge of reproducibility in the subsurface. More than 85% of respondents recognised there is a reproducibility problem in subsurface geoscience, with >90% of respondents viewing conceptual biases as having a major impact on the robustness of their findings and overall quality of their work. Access to data, undocumented methodologies, and confidentiality issues (e.g., use of proprietary data and methods) were identified as major barriers to reproducing published results. Overall, the survey results suggest a need for funding bodies, data providers, research groups, and publishers to build a framework and a set of minimum standards for increasing the reproducibility of, and political and public trust in, the results of subsurface studies.

Adolescent (10–19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.

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.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.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.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.

Social protection can take many forms. Both cash transfers and food security may have important contributions to child cognitive development. This study examines the potential impact of combinations of cash transfers and food security status on child cognitive development and educational outcomes. Cross-sectional data for 796 HIV-affected children in the Child Community Care study were utilised for this analysis. Children and caregivers completed interview schedules comprised of standardised items on socio-demographics, household data, cash grant receipt and food security status, school achievement, and cognition. A series of logistic and linear regression models and marginal effects analyses were undertaken to explore the impacts of differing levels of social protection (none; either cash grant receipt or food secure status or, both in combination) on child educational and cognitive outcomes. Although all children lived in poverty-stricken households, 20% (157/796) of children did not live in a household in receipt of a cash grant and did not report food security; 32.4% (258/796) reported either component of social protection and, 47.9% (381/796) received both measures of social protection in combination. Compared to no social protection, being in receipt of either component of social protection was found to be significantly associated with being in the correct class for age, higher scores of non-verbal cognition, and higher working memory scores. Receiving both social protection measures in combination was found to be significantly associated with reduced educational risk scores, improved odds of being in the correct class for age, regular school attendance, missing less than a week of school in the previous two weeks, higher scores on measures of nonverbal cognition, higher working memory scores, and learning new things more easily. Educational and cognitive outcomes for children can be bolstered by social protection measures (cash grant receipt or food security). Benefits are enhanced when social protection is received in combination. Such findings support the notion of synergistic social protection responses for children living in environments impacted by high levels of HIV burden and deprivation.

ObjectivesTo evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies.Design and data sourcesSystematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020.Study eligibility criteriaWe focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10–19 years). This included adolescents exposed to interventions or strategies within mental health services.Study appraisal and synthesis methodsStudy quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards.ResultsOf the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use.Conclusions and implicationsThere is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings.PROSPERO registration numberCRD42020161318.

Parental concepts are crucial in understanding family, relationships and psychological functioning of parents. How these evolve and manifest may vary according to family and personal experience. This study of adults who were abandoned as infants explores three perspectives—their concepts of their biological parents who have abandoned them, their concepts of their adoptive parents who have raised them and finally their concepts of themselves as parents on the birth of their own children. Qualitative interviews with 16 adult survivors of infant abandonment were conducted and thematically analysed to explore parenting. The interviews revealed that although some justified and felt forgiveness for their biological mothers, others sustained feelings of anger and resentment. Participants reported a desire for further knowledge regarding their biological mother, with some reporting a desire for a reunion and others highlighting concerns regarding their genetic health. The majority had no views or thoughts on their biological father. Relationships with adoptive parents were mixed—some were supportive and loved yet others were distant and troubled. For most who had children of their own, such births represented the first moment of true biological and genetic continuity and were reported as precious. Others, however, were challenged or avoided parenting altogether. This study is the one of the first steps to understanding the long-term effects of abandoned infants in terms of the parenting they receive and the intergenerational effects on the parenting they provide in turn to the next generation. Such insight should inform parenting preparation for adoptive parents in the case of those abandoned and subsequently adopted as well as support for survivors of infant abandonment when they reach adulthood and become parents themselves.

Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, pp Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

Social protection interventions (inclusive of cash grant receipt and care provision) have been found to be effective in response to some of the negative implications of the HIV epidemic on children and families. This study explores the impact of cash grant receipt and care provision (operationalised as good parenting) on child nutritional outcomes. In this cross-sectional study, 854 children and younger adolescents (5–15 years) and caregivers affected by HIV, attending community-based organisations in South Africa and Malawi, were interviewed. Interviews comprised inventories on socio-demographic information, family data, cash grant receipt and child nutrition. Parenting was measured using a composite scale. Logistic regression and marginal effects analyses were used to explore the associations between differing levels of social protection (none; either cash or good parenting; cash and good parenting) and child nutritional outcomes. One hundred and sixty children (20.3%) received neither cash nor good parenting; 501 (63.5%) received either cash or good parenting and 128 (16.2%) received both cash and good parenting. In comparison to no intervention, receipt of either cash or good parenting was significantly associated with child non-stunting, the child having sufficient food, and the child not looking thin. Three (3/7) nutritional outcomes showed increased improvement amongst children receiving both cash and good parenting care including child-reported non-hunger, child non-stunting and parental report of sufficient food. Marginal effects analyses further identified an additive effect of cash and good parenting on child nutritional outcomes. This study indicates that receipt of combined cash and good parenting, when compared to cash grant receipt alone, has positive effects on nutrition-related child outcomes.

Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question.Methods The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97-0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98-1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92-0.97, pConclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

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.

Background: There is very little insight into the emotional effects of adult survivors of infant abandonment. The rate and reasons for abandonment differ by country, region and economic background. Depending on country, age and era, abandoned children may be cared for by a series of alternative arrangements, ranging from care homes, institutions, foster care, alternative care environments or even reside as street children. As abandonment is relatively rare in the UK, formal procedures, documentation, provision and handling are often overlooked in policy guidance. Method: A qualitative study was conducted with 16 adult survivors of infant abandonment drawn from a UK sample. Participant interviews were recorded verbatim and transcribed. The full transcripts were coded for emerging (n = 14) and then higher order (n = 3) themes. Results: Higher order themes suggest that interpersonal issues relating to relationship formation and personal emotional coping were key factors. Both positive and negative emotions and actions were documented at the personal and interpersonal levels. Of specific note were effects resulting from formal health and welfare systems as they navigated through documentation, medical encounters and contact with agencies. Their recollections encompassed extensive internal grief over the course of many years. Yet, for many, there were simultaneous threads of resilience and adaptation. Conclusions: Support pathways are wanting and these findings suggest a number of potential interventions and/or provision required from an early age to ameliorate or obviate such emotional strain. Given the rarity of abandonment, this insight may assist in policy change, especially with regard to support provision. Documentation needs to be maintained for the longer term - with the current practice of five-year limits unhelpful to this group. It may be many years after the abandonment that they embark on searches for information. Lessons for adoptive parents regarding the unique situation of abandoned babies may also be of benefit.

Greater severities of gambling behaviour and poorer mental health have been identified in the literature as risk factors for suicidality within gambling disorder (GD) populations. This is the first known study within the UK to use empirical data, taken from a UK treatment clinic for GD to explore the associations between current suicidality (thoughts and plans) and measures assessing gambling severity and mental health. Self-report data from 122 participants were collected during the intake process at the clinic through a variety of methods including the use of questionnaires and a standardised 90-minute interview with a psychologist. Reported suicidality was high (current suicidal thoughts [28.7%] and plans [6.6%]), yet only one measure of gambling severity (estimated total losses) was found to be inversely associated with suicidality. Indices of poorer mental health were found to have a greater association with suicidality than measures of gambling severity, and a logistic regression analysis identified depressive symptomology and a history of psychiatric disorder in the participants’ family as significant factors associated with suicidality. Overall, within GD populations, factors associated with poorer mental health rather than gambling severity are seemingly a greater risk factor in patients with suicidality.

The impact of the research process on the researcher is an emerging topic of interest. Data collection in most low- and middle-income countries (LMICs) is often the responsibility of community members who are identified and trained specifically for data collection. When research involves data on mental health and social well-being, data collectors may have specific competency needs and the task of data gathering may impact data collectors. This study aims to explore the experiences and needs of data collectors within South Africa using qualitative methods to examine the impact of data collection on data collectors. Nineteen data collectors, involved in face-to-face data collection, completed semi-structured interviews exploring their insights, attitudes and experiences. Thematic analysis revealed barriers and challenges associated with research, complexities regarding boundaries within the participant-data collector relationship and the benefits of being involved with research for the individual and the community. Numerous challenges and opportunities are outlined. Findings expose the beneficial and often overlooked contribution of data collectors and warrants key considerations in the planning and implementation of future research to ensure adequate support and standardization of practice.

Gender is an important factor in child development. Especially in sub-Saharan Africa, girls have often been shown to be less likely to access education compared to boys. The consequence of this has been that that programmes addressing child development are often aimed at girls in order to redress gender imbalances. This study examines the effect of gender on the development of children attending community-based organisations in high HIV-affected areas, and explores whether community-based organisation attendance was associated with any changes in gender differences over time. Baseline data from 989 children and 12–15 month follow from 854 (86% response rate) were used to examine gender differences in children from Malawi and South Africa. At baseline, where there were differences by gender, these tended to disadvantage boys. It was found that boys were significantly more often found to be subjected to violence. Boys showed worse performance at school and more behavioural problems than girls. These gender differences persisted from baseline to follow-up. At follow-up, boys self-reported significantly worse average quality of life than girls. Only harsh discipline differed by gender in progression over time: boys experienced a stronger reduction in harsh physical discipline than girls from baseline to follow-up. Since harsh discipline was associated with boys’ worse educational outcomes and behavioural problems, our data cautiously suggests that gender differences could be reduced over time. In conclusion, our data suggests that, perhaps due to the narrow equity approach focusing on provision for girls, boys may be overlooked. As a result, there are some specific experiences where boys are generally worse off. These differences have distinct ramifications for the educational and emotional development of boys. A broader equity approach to child development might be warranted to ensure that the needs of both girls and boys are considered, and that boys are not overlooked.

Background Parental loss is a major stressful event found to increase risk of mental health problems in childhood. Yet, some children show resilient adaptation in the face of adversity across time. Setting This study explores predictors of mental health resilience among parentally bereaved children in South Africa and Malawi and their cumulative effect. The study also explores whether predictors of resilience differed between orphaned and nonorphaned children. Methods Consecutive attenders of community-based organizations (children; 4-13 years, and their caregivers) were interviewed at baseline and 15- to 18-month follow-up (n = 833). Interviews comprising inventories on demographic information, family data, child mental health, bereavement experience, and community characteristics. Mental health screens were used to operationalize resilience as the absence of symptoms of depression, suicidality, trauma, emotional, and behavioral problems. Results Almost 60% of children experienced parental loss. One-quarter of orphaned children showed no mental health problems at either wave and were classified as resilient. There were equal proportions of children classified as resilient within the orphaned (25%) versus nonorphaned group (22%). Being a quick learner, aiding ill family members, positive caregiving, household employment, higher community support, and lower exposure to domestic violence, physical punishment, or stigma at baseline predicted sustained resilience. There were cumulative influences of resilience predictors among orphaned children. Predictors of resilience did not vary by child age, sex, country of residence or between orphaned and nonorphaned children. Conclusions This study enhances understanding of resilience in younger children and identifies a number of potential environmental and psychosocial factors for bolstering resilience in orphaned children.

Background Parenting quality is important in child development. In the presence of HIV poverty and life stress, parenting may be challenged and child development affected. Methods This study examines cross-sectional associations of situational factors such as poverty, mental health, HIV status, living with a biological parent, and stigma with good parenting and child outcomes (n=989; age=4-13 years) within the Child Community Care study (South Africa and Malawi). A parenting measure was created from 10 variables comprising 6 child and 4 parent ratings. These were highly correlated. Total parenting score was generated on a 10 point continuous scale, with a good parenting cut off then defined as >=8 out of a possible 10. Results Five factors were associated with good parenting. Positively associated with good parenting were being the biological parent of the child, parental mental health and dwelling in households with multiple adults. Poverty and stigma were negatively associated with good parenting. Using multiple mediation analysis, a positive direct effect of good parenting was found on child self-esteem, child behaviour and educational risks with a partial mediation via child depression and trauma. Conclusions These data highlight possible intervention points. Influences on parenting could be seen through being the biological parent, parental mental health, poverty and stigma. In these challenging environments, health, nutrition, mental health, education, and treatment to keep parents alive are all clearly identified as potential pathways to ensure child well-being. 19

Institutions are not necessarily good environments for children. In the face of challenges such as HIV, Ebola, poverty, conflict and disaster the numbers have grown rather than reduced. Some countries have closed institutions down -driven by findings that cognitive developmental delay is associated with institutional care. Yet insight into abuse and violence within institutionalised settings is neglected. Maltreatment -violence and abuse -may be an issue. This systematic review series addresses violence and abuse experiences in institutionalised care, exploring firstly the frequency of abuse/violence in institutions, secondly any interventions to reduce such violence or abuse and thirdly the perpetrators of such violence or abuse. The final systematic review updates the findings on cognitive delay associated with institutionalised care. With a violence lens, cognitive delay may well be considered under the umbrella of neglect. Maltreatment and abuse may be a driver of cognitive delay. The keyword search covered several electronic databases and studies were included for data abstraction if they met adequacy criteria. Eight studies were identified on the prevalence of abuse in institutions and a further three studies reported on interventions. Only one study was identified documenting peer on peer violence in institutions. Sixty-six studies were identified examining cognitive development for institutionalised children. All but two of these record cognitive deficits associated with institutionalisation. Only two asked about violence or abuse which was found to be higher in institutionalised children. Overall the abuse experiences of children in institutions are poorly recorded, and in one study violence was associated with high suicidal attempts. The major intervention pathway for ameliorating cognitive challenge seems to be placement out of the institutions which shows benefits and redresses some cognitive outcomes - yet not a total panacea. The single study providing training and monitoring of harsh punishment and maltreatment showed immediate and decided reductions. This data suggest, despite the paucity of studies, violence and abuse, by commission or omission is prevalent in institutions, has an effect on child well-being and is amenable to intervention. Simple training or more complex structures to place children within conducive alternative environments (or to avoid institutionalised placements in the first place) seem to be the main pathway of intervention.

Nitrification, the microbial oxidation of ammonia to nitrite and nitrate, occurs in a wide variety of environments and plays a central role in the global nitrogen cycle. Catalyzed by the enzyme ammonia monooxygenase, the ability to oxidize ammonia was previously thought to be restricted to a few groups within the β- and γ- Proteobacteria . However, recent metagenomic studies have revealed the existence of unique ammonia monooxygenase α-subunit (amoA) genes derived from uncultivated, nonextremophilic Crenarchaeota. Here, we report molecular evidence for the widespread presence of ammonia-oxidizing archaea (AOA) in marine water columns and sediments. Using PCR primers designed to specifically target archaeal amoA , we find AOA to be pervasive in areas of the ocean that are critical for the global nitrogen cycle, including the base of the euphotic zone, suboxic water columns, and estuarine and coastal sediments. Diverse and distinct AOA communities are associated with each of these habitats, with little overlap between water columns and sediments. Within marine sediments, most AOA sequences are unique to individual sampling locations, whereas a small number of sequences are evidently cosmopolitan in distribution. Considering the abundance of nonextremophilic archaea in the ocean, our results suggest that AOA may play a significant, but previously unrecognized, role in the global nitrogen cycle.

BACKGROUND: Violence during childhood may affect short and long-term educational factors. There is scant literature on younger children from resource poor settings. METHODS: This study assessed child violence experiences (harsh punishment and exposure to domestic or community violence) and school enrolment, progress and attendance in children attending community-based organisations in South Africa and Malawi (n=989) at baseline and at 15 months' follow-up, examining differential experience of HIV positive, HIV affected and HIV unaffected children. RESULTS: Violence exposure was high: 45.4% experienced some form of psychological violence, 47.8% physical violence, 46.7% domestic violence and 41.8% community violence. Primary school enrolment was 96%. Violence was not associated with school enrolment at baseline but, controlling for baseline, children exposed to psychological violence for discipline were more than ten times less likely to be enrolled at follow-up (OR 0.09; 95% CI 0.01 to 0.57). Harsh discipline was associated with poor school progress. For children HIV positive a detrimental effect of harsh physical discipline was found on school performance (OR 0.10; 95% CI 0.02 to 0.61). CONCLUSION: Violence experiences were associated with a number of educational outcomes, which may have long-term consequences. Community-based organisations may be well placed to address such violence, with a particular emphasis on the challenges faced by children who are HIV positive. Language: en

Near-surface waters ranging from the Pacific subarctic (58°N) to the Southern Ocean (66°S) contain the neurotoxin domoic acid (DA), associated with the diatom Pseudo-nitzschia . Of the 35 stations sampled, including ones from historic iron fertilization experiments (SOFeX, IronEx II), we found Pseudo-nitzschia at 34 stations and DA measurable at 14 of the 26 stations analyzed for DA. Toxin ranged from 0.3 fg·cell −1 to 2 pg·cell −1 , comparable with levels found in similar-sized cells from coastal waters. In the western subarctic, descent of intact Pseudo-nitzschia likely delivered significant amounts of toxin (up to 4 μg of DA·m −2 ·d −1 ) to underlying mesopelagic waters (150–500 m). By reexamining phytoplankton samples from SOFeX and IronEx II, we found substantial amounts of DA associated with Pseudo-nitzschia . Indeed, at SOFeX in the Antarctic Pacific, DA reached 220 ng·L −1 , levels at which animal mortalities have occurred on continental shelves. Iron ocean fertilization also occurs naturally and may have promoted blooms of these ubiquitous algae over previous glacial cycles during deposition of iron-rich aerosols. Thus, the neurotoxin DA occurs both in coastal and oceanic waters, and its concentration, associated with changes in Pseudo-nitzschia abundance, likely varies naturally with climate cycles, as well as with artificial iron fertilization. Given that iron fertilization in iron-depleted regions of the sea has been proposed to enhance phytoplankton growth and, thereby, both reduce atmospheric CO 2 and moderate ocean acidification in surface waters, consideration of the potentially serious ecosystem impacts associated with DA is prudent.

Corals are known to harbor diverse microbial communities of Bacteria and Archaea , yet the ecological role of these microorganisms remains largely unknown. Here we report putative ammonia monooxygenase subunit A ( amoA ) genes of archaeal origin associated with corals. Multiple DNA samples drawn from nine coral species and four different reef locations were PCR screened for archaeal and bacterial amoA genes, and archaeal amoA gene sequences were obtained from five different species of coral collected in Bocas del Toro, Panama. The 210 coral-associated archaeal amoA sequences recovered in this study were broadly distributed phylogenetically, with most only distantly related to previously reported sequences from coastal/estuarine sediments and oceanic water columns. In contrast, the bacterial amoA gene could not be amplified from any of these samples. These results offer further evidence for the widespread presence of the archaeal amoA gene in marine ecosystems, including coral reefs.

Chemical profiles of the Black Sea suboxic zone show a distribution of nitrogen species which is traditionally associated with denitrification, i.e. a secondary nitrite maximum associated with nitrate depletion and a N(2) gas peak. To better understand the distribution and diversity of the denitrifier community in the Black Sea suboxic zone, we combined a cultivation approach with cloning and sequencing of PCR-amplified nitrite reductase (nirS and nirK) genes. The Black Sea suboxic zone appears to harbour a homogeneous community of denitrifiers. For nirK, over 94% of the sequences fell into only three distinct phylogenetic clusters, and for nirS, a single closely related sequence type accounted for 91% of the sequences retrieved. Both nirS and nirK genes showed a dramatic shift in community composition at the bottom of the suboxic zone, but overall, nirK-based community composition showed much greater variation across depths compared with the highly uniform distribution of nirS sequences throughout the suboxic zone. The dominant nirK and nirS sequences differed at the amino acid level by at least 17% and 8%, respectively, from their nearest database matches. Denitrifying isolates recovered from the suboxic zone shared 97% 16S rRNA gene sequence similarity with Marinobacter maritimus. Analysis of the recently discovered nirS gene from the anammox bacterium Candidatus'Kuenenia stuttgartiensis' revealed that mismatches with commonly used primers may have prevented the previous detection of this divergent sequence.

While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.

Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children’s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.