Parental HIV serodiscordance: implications for the care of the HIV seropositive child in a resource-poor setting

Experiences of Inner-City Fathers of Children With Chronic Illness

We aim to explore the experiences of fathers from inner-city families caring for children affected by chronic health conditions or disabilities. A systematic scoping review was conducted using the Arskey and O'Malley framework. Fourteen of the 5114 articles were included in the full review and were qualitatively evaluated in terms of stressors, resources, perception, coping, and adaptation according to the Double ABCX model. Stressors included financial strain and health care access barriers. Resources ranging from immediate to extended family members depended on ethnicity. Fathers' perceptions of their primary caregiver roles depended on ethnicity in the context of cultural gender norms. While inner-city fathers desired information about their children's health, some were uncomfortable asking physicians. They had a higher risk for coping difficulties and maladaptation, including depression. We highlight a need for pediatricians to advocate for additional resources to provide comprehensive care for inner-city fathers caring for their children with chronic health conditions or disabilities.

Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia

Background

It has been estimated that 430,000 children under 15 years of age were newly infected with HIV in 2008, and more than 71% are living in sub-Saharan Africa. In the absence of intervention to prevent mother-to-child transmission, 30-45% of infants born to HIV-positive mothers in developing countries become infected during pregnancy, delivery and breastfeeding. The aim of this study was to assess infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics of Northwest Ethiopia.

Methods

Institution based cross sectional study was conducted from January to May 2011 among all HIV positive mothers with less than two years old child attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions. A structured pre-tested questionnaire using interview technique was used for data collection. The data was entered and analyzed using SPSS version 16 statistical package.

Results

A total of 209 HIV positive mothers were included in the study. Of these, 187 (89.5%) had followed the recommended way of infant feeding practice while significant percentage (10.5%) had practiced mixed breast feeding. In multivariate analysis, disclosure of HIV status with their spouse, insufficient breast milk and occupational status were found to be independently associated (p-value of < 0.05) with recommended infant feeding practice. Lack of resource, stigma of HIV/AIDS, and husband opposition were also obtained as factors that influenced choice of infant feeding options by respondents.

Conclusions

Higher proportion of respondents used the recommended way of infant feeding practice by WHO as well as by Ethiopian Ministry of Health. However, mixed feeding in the first 6 months of age, an undesirable practice in infant feeding, were reported in this study. Infant feeding education that is aligned to national policy should be strengthened in primary health care, particularly in situations where prevention of mother to child transmission of HIV is prioritized.

Interventions for improving the psychosocial well-being of children affected by HIV and AIDS

BACKGROUND

As a result of HIV-related mortalities more than 13 million children under the age of 15 have lost a parent due to HIV and AIDS. There are also many children who have HIV-positive parents or primary caregivers; these children are affected by HIV and AIDS and are potentially vulnerable to HIV transmission. Children affected by HIV and AIDS are more vulnerable and face greater challenges to their psychosocial well-being compared to other children of the same age. Interventions have been adopted with the aim of improving the psychosocial well-being of children affected by HIV and AIDS.

OBJECTIVES

The primary objective of this review was to assess the effectiveness of interventions that aim to improve the psychosocial well-being of children directly affected by HIV and AIDS.

SEARCH STRATEGY

Electronic databases were systematically searched using pre-defined search terms. Internet searches of relevant organizations involved in HIV and AIDS work were conducted and experts in the field and were contacted directly. Searches were conducted between January and September 2008.

SELECTION CRITERIA

Randomised controlled trials, crossover trials, cluster-randomised trials and factorial trials were eligible for inclusion. If no controlled trials were found, data from well-designed non-randomised intervention studies (such as before and after studies), cohort, and case-control observational studies were considered for inclusion. Studies which included male and female children under the age of 18 years of age, either orphaned due to AIDS (one or more parents died of HIV related-illness or AIDS), or vulnerable children (one or more parents living with HIV or AIDS) were eligible for review.Interventions that aim to improve the psychosocial well-being of children affected by HIV and AIDS were included in the review. This included psychological therapy, psychosocial support and/or care, medical interventions and social interventions. Psychosocial outcomes were defined as any intervention that measures psychological and/or social factors.

DATA COLLECTION AND ANALYSIS

Two of the authors independently screened the results of the search. The full text of all potentially relevant studies were obtained and were independently assessed by the two reviewers using pre-determined criteria.

MAIN RESULTS

No studies of interventions for improving the psychosocial well-being of children affected by HIV and AIDS were identified.

AUTHORS' CONCLUSIONS

Current practice is based on anecdotal knowledge, descriptive studies and situational analyses. Such studies do not provide a strong evidence base for the effectiveness of these interventions.

IMPLICATIONS FOR RESEARCH

This systematic review has identified the need for high quality intervention studies. In order to increase the quality and quantity of such studies there is a need for greater partnerships between program implementers and researchers.

IMPLICATIONS FOR PRACTICE

In the absence of rigorous intervention studies, the body of knowledge available consists of "lessons learned," child psychological theory and other related research in the adult population. However, such knowledge should not replace the urgent need for rigorous monitoring and evaluation of existing programs and intervention studies to ensure evidence-based practice and policy, and prevent subjecting children to interventions which show no benefit or interventions that could unintentionally lead to harm.

Infant feeding intentions and practices of HIV-positive mothers in southwestern Nigeria

It has been shown that infant feeding pattern affects mother-to-child transmission of HIV. This study reports the infant feeding practices of HIV-positive mothers in southwestern Nigeria.