1
|
Azevedo Da Silva M, Alexander EC, Martins SS, Naidoo S, Gruver RS, Desmond C, Davidson LL. Association between caregiver and household alcohol use and child behavior problems in KwaZulu Natal, South Africa. Child Psychiatry Hum Dev 2023; 54:1438-1445. [PMID: 35380341 PMCID: PMC10304574 DOI: 10.1007/s10578-022-01342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Abstract
We explored the association between household alcohol use and behavior problems among South-African children, using data from the Asenze study, a population-based cohort of South African children and their caregivers. Household alcohol use and child behavior were assessed when children were 6-8 years old. To examine the association, we performed linear regressions. The sample included 1383 children with complete data under the care of 1251 adults. Children living in a household where self-reported caregiver alcohol use was scored as hazardous (4.6%) had higher levels of problem behavior (β = 1.94, 95% CI 0.06-3.82). There were no statistically significant associations between reported hazardous alcohol use by another member of the household (14.5%) and child problem behavior. Hazardous household alcohol use was associated with child problem behavior and this effect appeared to be mainly driven by primary caregiver use.
Collapse
Affiliation(s)
- Marine Azevedo Da Silva
- Institute for Health and Social Policy, McGill University, Charles, House, Room 302, 1130 Pine Avenue West, H3A 1A3, Meredith, Montreal, Quebec, Canada.
| | - Emma C Alexander
- Imperial College Healthcare NHS Trust, London, UK
- Aceso Global Health Consultants Limited, London, UK
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Saloshni Naidoo
- Department of Public Health Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Rachel S Gruver
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu Natal, Durban, South Africa
| | - Leslie L Davidson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Columbia University, New York, NY, USA
| |
Collapse
|
2
|
Nazareth ML, Kvalsvig JD, Mellins CA, Desmond C, Kauchali S, Davidson LL. Adverse childhood experiences (ACEs) and child behaviour problems in KwaZulu-Natal, South Africa. Child Care Health Dev 2022; 48:494-502. [PMID: 34913192 DOI: 10.1111/cch.12950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 10/05/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adverse childhood events (ACEs) are associated with negative health effects in adulthood. Despite knowledge of these later impacts, little is known about the earlier effect of ACEs on later child behaviour in low- and middle-income countries (LMIC). METHODS The population-based Asenze cohort study was implemented in a peri-rural area of KwaZulu-Natal, South Africa, comprising five Zulu tribal areas. Two waves of data were examined: family information and ACEs exposure when children were on average 5 years old and child behaviour problems (Strengths and Difficulties Questionnaire [SDQ]) approximately 2 years later (average age 7 years). Logistic regression analysis was used to examine unadjusted and adjusted relationships between cumulative ACEs experienced and the SDQ total scores (dichotomized as top 10% vs. the rest) as well as selected SDQ subscales. RESULTS A significant relationship between increased ACE exposure and SDQ total score was observed. The same relationship was also seen for the SDQ emotional symptoms and conduct problem subscales, but not for hyperactivity. The results of a sensitivity analysis excluding intimate partner violence from the ACEs measure demonstrated similar results. CONCLUSIONS There is an association between exposure to ACEs and later child behaviour problems within this LMIC population demonstrating an early negative impact for ACEs. While previous research has focused on the effects of ACEs on adult health, this study provided evidence for an earlier relationship between ACEs and child behaviour problems that may be a part of the mechanism through which later health effects arise.
Collapse
Affiliation(s)
- Meaghan L Nazareth
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jane D Kvalsvig
- School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Chris Desmond
- School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Shuaib Kauchali
- Department of Pediatrics, Nelson Mandela University, Port Elizabeth, South Africa
| | - Leslie L Davidson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.,Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York, USA
| |
Collapse
|
3
|
Desmond C, Norwitz GA, Kvalsvig JD, Gruver RS, Kauchali S, Watt KG, Myeza NP, Munsami A, Davidson LL. The Asenze Cohort Study in KwaZulu-Natal, South Africa: protocol and cohort profile. Epidemiol Health 2022; 44:e2022037. [PMID: 35413165 PMCID: PMC9684003 DOI: 10.4178/epih.e2022037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/05/2022] [Indexed: 10/22/2023] Open
Abstract
The Asenze cohort is set in South Africa, a middle-income country impacted by one of the highest global rates of people living with HIV/AIDS and high levels of socioeconomic inequality. This longitudinal population-based cohort of children and their primary caregivers assesses household and caregiver functioning, child health, social well-being, and neuro-development from childhood through adolescence. Almost 1,600 children born at the peak of the human immunodeficiency virus epidemic (2003-2005) were followed (with their primary caregivers) in 3 waves, between 2008 and 2021, at average ages of 5, 7, and 16. Wave 3 is currently underway, having assessed over 1,100 of the original wave 1 children. Wave 4 begins in 2022. The study, with a dyadic structure, uses a broad range of measures, validated in South Africa or recommended for global use, that address physical, social and neuro-development in childhood and adolescence, and the social, health, and psychological status of children's primary caregivers. The Asenze study deepens our understanding of childhood physical, cognitive, and social abilities and/or disabilities, including risk-taking behaviors, and biological, environmental, and social determinants of health. We anticipate the findings will contribute to the development of community-informed interventions to promote well-being in this South African population and elsewhere.
Collapse
Affiliation(s)
- Chris Desmond
- Center for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Gabriella A. Norwitz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jane D. Kvalsvig
- Department of Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rachel S. Gruver
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shuaib Kauchali
- Maternal, Adolescent, and Child Health Institute NPC (MatCH), Durban, South Africa
| | - Kathryn G. Watt
- Center for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Adele Munsami
- Center for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Leslie L. Davidson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Columbia College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
4
|
Prevalence of children witnessed violence in a pediatric emergency department. Eur J Pediatr 2022; 181:2695-2703. [PMID: 35441247 PMCID: PMC9018099 DOI: 10.1007/s00431-022-04474-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/03/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Witnessed violence is a form of child abuse with detrimental effects on child wellbeing and development, whose recognition relies on the assessment of their mother exposure to intimate partner violence (IPV). The aim of this study was to assess the frequency of witnessed violence in a population of children attending a pediatric emergency department (ED) in Italy, by searching for IPV in their mother, and to define the characteristics of the mother-child dyads. An observational cross-sectional study was conducted from February 2020 to January 2021. Participating mothers were provided a questionnaire, which included the Woman Abuse Screening Tool (WAST) and additional questions about their baseline data and health. Descriptive analysis was reported as frequency and percentage for the categorical variables and median and interquartile range (IQR) for quantitative variables. Mothers and children screened positive and negative for IPV and witnessed violence, respectively, were compared by the chi-square test or the exact Fisher test for categorical variables, and by the Wilcoxon-Mann-Whitney test for continuous variables. Out of 212 participating mothers, ninety-three (43.9%) displayed a positive WAST. Mothers tested positive were mainly Italian (71%, p 0.003), had a lower level of education (median age at school dropout 19, p 0.0002), and a higher frequency of unemployment (p 0.001) and poor personal health status (8.6%, p 0.001). The children of mothers tested positive showed a higher occurrence of abnormal psychological-emotional state (38.7%, p 0.002) and sleep disturbances (26.9%, p 0.04). CONCLUSION IPV was common in a population of mothers seeking care for their children in a pediatric ED. WHAT IS KNOWN • Witnessed violence is a form of child abuse, usually inferred by their mothers' exposure to IPV. The latter is suffered by one in three women worldwide. WHAT IS NEW • This study shows a 43.9% prevalence of IPV among mothers attending an Italian pediatric ED. • Positive mother-child dyads displayed a higher frequency of poor mothers' health status and children's abnormal emotional state and sleep disturbances.
Collapse
|
5
|
A Systematic Review of Household and Family Alcohol Use and Childhood Neurodevelopmental Outcomes in Low- and Middle-Income Countries. Child Psychiatry Hum Dev 2021; 52:1194-1217. [PMID: 33369706 PMCID: PMC8528783 DOI: 10.1007/s10578-020-01112-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
Childhood exposure to alcohol misuse by household adults has been related to childhood developmental delay, cognitive impacts, mental illness, and problem behaviours. Most evidence comes from high income countries. This systematic review only included studies from low- and middle-income countries (LMICs). Five databases were searched from 1990-2020. Twenty-eight studies of children 0-12 years were included, with 42,599 participants from 11 LMICs. The most common outcome was behavioural problems/disorders (19 studies). Despite varying study designs, this review found that alcohol misuse by household members in LMICs is associated with adverse child neurodevelopmental outcomes, although casual inferences cannot be drawn in the absence of well conducted prospective studies. Statistically significant correlations were described between parental alcohol misuse and child emotional and behavioural difficulties, cognitive delay, and risky behaviours. In future, prospective cohort studies are recommended, with adjustment for confounders.
Collapse
|
6
|
Jeong J, Adhia A, Bhatia A, McCoy DC, Yousafzai AK. Intimate Partner Violence, Maternal and Paternal Parenting, and Early Child Development. Pediatrics 2020; 145:peds.2019-2955. [PMID: 32424076 DOI: 10.1542/peds.2019-2955] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research has demonstrated associations between maternal experience of intimate partner violence (IPV) and a range of adverse outcomes among women and their young children. However, few studies have examined the associations between maternal experience of IPV and early child development (ECD) outcomes in low- and middle-income countries (LMIC). Our objectives in this study were to examine the association between IPV victimization and ECD and assess whether the association was mediated by maternal and paternal stimulation. METHODS We combined cross-sectional data from the Demographic and Health Surveys for 15 202 households representing mothers and fathers of children aged 36 to 59 months in 11 LMIC. We used multivariable linear regression models to estimate the association between IPV victimization in the year preceding the survey and ECD, which we measured using the Early Child Development Index. We used path analysis to determine if the association between IPV victimization and ECD was mediated through maternal and paternal stimulation. RESULTS After adjusting for sociodemographic variables, IPV victimization was negatively associated with ECD (β = -.11; 95% confidence interval = -.15 to -.07). Path analysis indicated that the direct association between IPV victimization and ECD was partially and independently mediated through maternal and paternal stimulation. CONCLUSIONS Interventions that include components to prevent IPV may be effective for improving ECD in LMIC.
Collapse
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts;
| | - Avanti Adhia
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Dana Charles McCoy
- Graduate School of Education, Harvard University, Cambridge, Massachusetts
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| |
Collapse
|
7
|
Davidson LL, Gruver RS. Understanding the Role of Intimate Partner Violence on Child Development in LMICs. Pediatrics 2020; 145:peds.2020-0823. [PMID: 32424078 PMCID: PMC7263046 DOI: 10.1542/peds.2020-0823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leslie L. Davidson
- Department of Epidemiology, Mailman School of Public Health and,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | |
Collapse
|
8
|
Laurenzi CA, Skeen S, Sundin P, Hunt X, Weiss RE, Rotheram-Borus MJ, Tomlinson M. Associations between young children's exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample. Glob Public Health 2019; 15:173-184. [PMID: 31426702 DOI: 10.1080/17441692.2019.1656274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.
Collapse
Affiliation(s)
- Christina A Laurenzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Sarah Skeen
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Phillip Sundin
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Xanthe Hunt
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Robert E Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mary Jane Rotheram-Borus
- Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Mark Tomlinson
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| |
Collapse
|
9
|
Silva EP, Ludermir AB, Lima MDC, Eickmann SH, Emond A. Mental health of children exposed to intimate partner violence against their mother: A longitudinal study from Brazil. CHILD ABUSE & NEGLECT 2019; 92:1-11. [PMID: 30901613 DOI: 10.1016/j.chiabu.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Exposure to intimate partner violence (IPV) is an important adverse childhood experience, but there are few longitudinal studies in low and middle-income countries. OBJECTIVE To investigate the consequences of exposure to IPV for a child's mental health. PARTICIPANTS AND SETTING 614 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. METHODS Women were interviewed in pregnancy, postpartum and six to nine years after delivery, and asked about their experience of IPV, and the exposure of their child to violence. The Strengths and Difficulties Questionnaire (SDQ) was completed by child's mother and teacher. Ten types of child experience of IPV and the age of onset of exposure were compared with the child's behavioral profile at school age. RESULTS The mothers reported that 372/614 (60.6%) children had been exposed to IPV. The commonest types of child exposure to IPV were "prenatally", "overheard", "eyewitnessed", and 10.0% of children were physically or verbally involved in the IPV. Mothers reported high SDQ Total Difficulties scores in 71.7% of all children exposed to IPV and teachers in 59.8%. Multivariate logistic regression analysis demonstrated the strongest association with behavioral difficulties was with exposure to IPV in the age group 1-2 years (OR 2.5 [95% CI: 1.3-4.8]). CONCLUSION Young children are sensitive to the age of first exposure to IPV and to the type of IPV. Interventions to reduce IPV should be targeted on vulnerable women from poor urban communities during their pregnancies and in the first two years of their child's life.
Collapse
Affiliation(s)
- Elisabete Pereira Silva
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Hospital das Clínicas, 2(o) Andar, Av. Prof. Moraes Rêgo, s/n, Cidade Universitária, Recife, CEP: 50.670-420, Brazil.
| | - Ana Bernarda Ludermir
- Departamento de Medicina Social, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Av. da Engenharia, s/n, Bloco "D" - 1º Andar, Cidade Universitária, CEP: 50.740-600, Recife, PE, Brazil
| | - Marília de Carvalho Lima
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Hospital das Clínicas, 2(o) Andar, Av. Prof. Moraes Rêgo, s/n, Cidade Universitária, Recife, CEP: 50.670-420, Brazil
| | - Sophie Helena Eickmann
- Departamento Materno Infantil, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Hospital das Clínicas, 2(o) Andar, Av. Prof. Moraes Rêgo, s/n, Cidade Universitária, Recife, CEP: 50.670-420, Brazil
| | - Alan Emond
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, 1-5 Whiteladies Road Clifton, Bristol, BS8 1NU, United Kingdom
| |
Collapse
|
10
|
Donald KA, Hoogenhout M, du Plooy CP, Wedderburn CJ, Nhapi RT, Barnett W, Hoffman N, Malcolm-Smith S, Zar HJ, Stein DJ. Drakenstein Child Health Study (DCHS): investigating determinants of early child development and cognition. BMJ Paediatr Open 2018; 2:e000282. [PMID: 29942867 PMCID: PMC6014194 DOI: 10.1136/bmjpo-2018-000282] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is growing awareness that psychosocial risk and resilience factors in early life play a key role in influencing later health. Most work has been done in high-income settings, rather than low-income and middle-income countries (LMICs), where the majority of the global childhood population resides. The few studies with well-defined cohorts in LMICs have employed various methods and measures, making comparisons across studies challenging. This presentation describes the methodology for infant and child developmental measures used in the Drakenstein Child Health Study (DCHS), a multidisciplinary longitudinal birth cohort study in South Africa. METHODS AND ANALYSIS We outline a multilevel approach combining a range of measures including parental reports, behaviour observations, clinician-administered scales and brain imaging. Using this approach, we aim at a longitudinal perspective of developmental, cognitive, socioemotional and neurophysiological outcomes in a birth cohort of children in an LMIC. ETHICS AND DISSEMINATION The study was approved by the faculty of Health Sciences, Human Research Ethics Committee, University of Cape Town (401/2009), Stellenbosch University (N12/02/0002) and the Western Cape Provincial Health Research committee (2011RP45). DISCUSSION Children in the DCHS develop in a context typical of many communities in South Africa and other LMICs. There is a critical need for research in LMICs to elucidate underlying factors that inform risk for, and resilience to, poor developmental outcomes in infants born into high-risk communities. Such work may inform effective intervention strategies appropriate to this context.
Collapse
Affiliation(s)
- Kirsten A Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Michelle Hoogenhout
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Christopher P du Plooy
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Catherine J Wedderburn
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Raymond T Nhapi
- Unit on Child and Adolescent Health, South African Medical Research Council, Cape Town, South Africa
| | - Whitney Barnett
- Unit on Child and Adolescent Health, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Susan Malcolm-Smith
- Applied Cognitive Science and Experimental Neuropsychology Team, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Unit on Child and Adolescent Health, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
| |
Collapse
|