Time-homogeneous Markov process for HIV/AIDS progression under a combination treatment therapy: cohort study, South Africa

This article focuses on working with children affected by HIV/AIDS in South Arica. In the early years of the AIDS epidemic, relief organizations focused their efforts on the material needs of children, but their psychological and emotional needs are no less important. Recognizing this, the Sinomlando Centre for Oral History and Memory Work in Africa, a research and community development center located at the University of KwaZulu-Natal, in Pietermaritzburg South Africa, has pioneered a model of psychosocial intervention for children in grief—particularly but not exclusively in the context of HIV/AIDS. This model uses the methodology of oral history in a novel manner, combined with other techniques such as life story work and narrative therapy. During the early years of the project, the model followed for the family visits was the oral history interview. A discussion on caregiver as the narrator and skills required in memory work especially in these cases concludes this article.

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Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

BMC Public Health ◽

10.1186/s12889-020-10147-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yulia Shenderovich ◽

Mark Boyes ◽

Michelle Degli Esposti ◽

Marisa Casale ◽

Elona Toska ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Cohort Study ◽

Mental Health Problems ◽

Health Problems ◽

Sub Saharan Africa ◽

Depression Symptoms ◽

Sub Saharan ◽

Positive Caregiving ◽

Living With Hiv

Abstract 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, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. 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.

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Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000918 ◽

2021 ◽

Vol 5 (1) ◽

pp. e000918

Author(s):

Isabel A Michaelis ◽

Ingeborg Krägeloh-Mann ◽

Ncomeka Manyisane ◽

Mikateko C Mazinu ◽

Esme R Jordaan

Keyword(s):

South Africa ◽

Cohort Study ◽

Birth Weight ◽

Mortality Rate ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Low Birthweight ◽

Eastern Cape Province ◽

Eastern Cape ◽

Overall Mortality

BackgroundNeonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed.MethodsThis is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality.Results173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years.ConclusionThis prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these.

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