Developmental outcomes of HIV-exposed infants in a low-income South African context

Background: Effective HIV transmission prevention strategies have led to a growing population of vulnerable HIV- and antiretroviral-exposed infants in sub-Saharan Africa, however uncertainty exists regarding their development. Objective: To determine the developmental outcomes of HIV-exposed (HE) infants in a low-income South African con- text, when compared to HIV-unexposed (HU) counterparts. Methods: In this prospective cross-sectional, group comparison study, the development of 41 HE and 40 HU infants (mean age=8.4 months, SD=2.1 months) from a low-income context was assessed. Caregivers were interviewed using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) to evaluate infants’ development. Results: Most HE participants had age-appropriate overall development (90.2%;n=37). Some HE participants, however, presented with delays in domains of communication (9.8%;n=4), daily living skills (2.4%;n=1), socialisation (19.5%;n=8), and motor development (7.3%;n=3). HU participants also demonstrated some domain-specific delays, thus delays were present in both groups. No statistically significant between-group differences regarding development were found. Conclusion: Findings were reassuring and suggested that HE and HU participants had similar development. Developmen- tal differences may, however, only emerge with age, therefore large-scale longitudinal research is recommended. It is suggest- ed that the entire sample was vulnerable, highlighting the importance of developmental surveillance in low-income contexts, irrespective of HIV and antiretroviral exposure status. Keywords: Developmental outcomes; HIV-exposed infants; low-income context.

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Recognising the barriers to securing affordable housing through the land use planning system in Sub-Saharan Africa: A perspective from Ghana

Urban Studies ◽

10.1177/0042098017724092 ◽

2017 ◽

Vol 55 (12) ◽

pp. 2640-2659 ◽

Cited By ~ 11

Author(s):

Felix SK Agyemang ◽

Nicky Morrison

Keyword(s):

Affordable Housing ◽

Low Income ◽

Land Use Planning ◽

Large Scale ◽

Central Government ◽

Global South ◽

Real Estate Market ◽

Sub Saharan Africa ◽

Planning System ◽

Daunting Task

Housing low-income households is a daunting task for policy makers across the Global South, and especially for those in Africa where past attempts to deliver State-funded affordable housing projects yielded minimal results. Presenting Ghana as a case study, the purpose of this article is to consider the rationale for and barriers to securing affordable housing through the planning system, situated within an African context. The key factors that would inhibit effective policy implementation include, on the one hand, a lack of central government commitment, weak enforcement of planning regulations and low capacity of local planning authorities, and, on the other hand, the dominance of customary land ownership and the informal nature of housing delivery. That notwithstanding, undertaking a mapping exercise of large-scale formal residential developments built across Greater Accra in recent years, the article suggests that there is an opportunity cost in not attempting to extract some form of economic rent from the private sector. By having an already established nationalised development rights system alongside a rising formal real estate market, there is in effect scope for introducing planning obligations in the longer term. Whilst by necessity, it takes time to fully establish and enforce this form of land value capture legislation; nonetheless, if the principles can be established, transferable lessons exist across Africa and the Global South.

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South African community in Auckland

Disaster Prevention and Management An International Journal ◽

10.1108/dpm-02-2019-0052 ◽

2019 ◽

Vol 29 (3) ◽

pp. 390-404

Author(s):

Osamuede Odiase ◽

Suzanne Wilkinson ◽

Andreas Neef

Keyword(s):

South African ◽

Affordable Housing ◽

Low Income ◽

Longitudinal Research ◽

Community Resilience ◽

Potential Hazard ◽

The South ◽

Content Type ◽

Secondary Sources ◽

African Community

Purpose The purpose of this paper is to investigate the resilience of the South African community in Auckland to a potential hazard event. Design/methodology/approach The research collected data from both primary and secondary sources. The research used parametric and non-parametric analytical procedures for quantitative data and a general inductive approach to qualitative data analysis and a three-step coding cycle for interviews. A content analytical process of theme formation was used to analyse secondary materials. The research discussed findings in line with related studies on community resilience. Findings The aggregate community resilience index was above average on the scale of 1–5. The highest and lowest contributions to the resilience of the South African community came from communication and information and physical capacities of the community. Although the highest contribution came from the communication domain, there is a need to sensitise the community on the importance of real-time information for resilience. Community ability to respond as a first responder and to access diverse sources was low because of a lack of interest in disaster risk reduction activities and membership of associations. Intervention in the economic domain and affordable housing is needed to assist low-income earners in coping with a potential disaster and enhance future resilience. Research limitations/implications The practical resilience of the community is limited to the time of this research. The state of resilience might change in longitudinal research due to changes in resources and ecosystem. The research did not consider institutional and natural domains because its focus was to predict resilience at the individual level. Practical implications At-risk societies could enhance their resilience through a periodic audit into its resources, identify indicators of low resilience and carry out interventions to address potential vulnerabilities. Besides the importance of resource in resilience, the research illuminates the need to address the question of who is resilient and resources distribution in the community. The issues are imperative in community resilience as they underpinned the personal ability to preparedness, response and recover from a disaster. Originality/value Although the research provides insight into the resilience of the South African community, it constitutes preliminary research towards a further understanding of the resilience of the South African community in Auckland.

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Male Partner Involvement and Development of HIV-exposed Infants in Rural South Africa

AIDS and Behavior ◽

10.1007/s10461-021-03326-5 ◽

2021 ◽

Author(s):

Motlagabo Gladys Matseke ◽

Robert A. C. Ruiter ◽

Violeta J. Rodriguez ◽

Karl Peltzer ◽

Deborah L. Jones ◽

...

Keyword(s):

Cognitive Development ◽

Motor Development ◽

Male Partner ◽

Gross Motor ◽

Hiv Exposed Infants ◽

Male Partner Involvement ◽

Gross Motor Development ◽

Hiv Exposed ◽

Partner Involvement ◽

Rural South Africa

AbstractMale partner involvement (MPI) during the prenatal and postnatal periods has been proven to have a beneficial effect on infant development. Infants born to HIV seropositive mothers with lacking or no prenatal and postnatal male partner support may be at a higher risk for adverse developmental outcomes. This study examined the effect of MPI on cognitive, communicative, fine, and gross motor development in 160 infants born to HIV seropositive mothers attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. Results of the bivariate logistic regression showed that both prenatal (OR 1.13; 95% CI 1.01, 1.26; p < 0.05) and postnatal MPI (at 12 months) (1.19; 1.07, 1.31; p < 0.005) were associated with risk for delayed gross motor development in HIV exposed infants. Decreased postnatal MPI (0.85; 0.75, 0.98; p < 0.05) was significantly associated with risk for delayed cognitive development. Not living together with a male partner (2.01; 1.06, 3.80; p < 0.05) was significantly associated with risk for delayed cognitive development. In the multivariate logistic regression analysis, decreased postnatal MPI (0.85; 0.75, 0.98; p < 0.05) was significantly associated with risk for delayed cognitive development. On the other hand, postnatal MPI (1.30; 1.12, 1.50; p < 0.005) was associated with risk for delayed gross motor development among HIV exposed infants. Increased MPI can have beneficial effects on infants’ cognitive development. Interventions in PMTCT programs should promote increased prenatal and postnatal MPI to improve cognitive development in HIV exposed infants.

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Growth Trajectories of HIV Exposed and HIV Unexposed Infants. A Prospective Study in Gweru, Zimbabwe

Global Pediatric Health ◽

10.1177/2333794x21990338 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199033

Author(s):

Lucy Mabaya ◽

Hilda Tendisa Matarira ◽

Donald Moshen Tanyanyiwa ◽

Cuthbert Musarurwa ◽

Johannes Mukwembi

Keyword(s):

Transmission Rate ◽

Growth Patterns ◽

Sub Saharan Africa ◽

Childbearing Age ◽

Hiv Exposed Infants ◽

Vertical Transmission Rate ◽

Sub Saharan ◽

Hiv Exposed ◽

Nutritional Monitoring ◽

A Prospective Study

Background: With the increasing HIV seroprevalence among women of childbearing age in sub-Saharan Africa, limited data on growth outcomes of HIV exposed infants under current policies of universal maternal antiretroviral therapy exist. Methods: The longitudinal growth patterns of 114 HIV exposed and unexposed infants were assessed and compared. The prevalence and factors associated with malnutrition were established. Infants under prevention of mother to child transmission care were recruited at 6 weeks post-delivery as were their HIV unexposed counterparts. Weight and length measurements were recorded at birth, 6 and 16 weeks postpartum. Results: HIV vertical transmission rate was 8.8%. HIV exposed infants had significantly lower mean birth weights compared to HIV unexposed infants (2.9 ± 0.3; 3.2 ± 0.5; P < .001) respectively. Mean weight/length-for-age z-scores for HIV exposed, uninfected (HEU) infants were significantly below those of the HIV unexposed infants during follow up. By 6 weeks of age, 28.5% of HEU infants were malnourished while no malnutrition was evident in HIV unexposed infants. A gestational age <37 weeks (OR: 3.83; 95% CI: 1.03-14.30; P = .045) and HIV exposure (OR: 1.62; 95% CI: 0.17-15.73; P = .017) substantially increased the risk of stunting. Conclusion: Growth deficits were witnessed in HIV exposed infants compared to HIV unexposed infants. There is need for early nutritional monitoring and support among HIV exposed infants.

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6: T cell activation in south african HIV-exposed infants linked to ochratoxin exposure

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.09.007 ◽

2016 ◽

Vol 215 (6) ◽

pp. S817 ◽

Cited By ~ 1

Author(s):

Lianna F. Wood ◽

Heather Jaspan ◽

Don Sodora

Keyword(s):

T Cell ◽

South African ◽

T Cell Activation ◽

Cell Activation ◽

Hiv Exposed Infants ◽

Hiv Exposed

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Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants

Clinical and Vaccine Immunology ◽

10.1128/cvi.00183-13 ◽

2013 ◽

Vol 20 (8) ◽

pp. 1123-1132 ◽

Cited By ~ 2

Author(s):

Christopher R. Sudfeld ◽

Christopher Duggan ◽

Alex Histed ◽

Karim P. Manji ◽

Simin N. Meydani ◽

...

Keyword(s):

T Cell ◽

Cell Count ◽

Sub Saharan Africa ◽

Cd4 T Cell ◽

Measles Vaccine ◽

Multivitamin Supplementation ◽

Hiv Exposed Infants ◽

Vaccine Responses ◽

Hiv Exposed ◽

Cd4 T Cell Count

ABSTRACTImmunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P> 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P= 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P= 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P= 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P= 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P= 0.047), as were lower infant height-for-age z-scores (P= 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered atClinicalTrials.govunder registration no. NCT00197730.)

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Delivering infectious disease interventions to women and children in conflict settings: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-001967 ◽

2020 ◽

Vol 5 (Suppl 1) ◽

pp. e001967

Author(s):

Sarah Meteke ◽

Marianne Stefopulos ◽

Daina Als ◽

Michelle F Gaffey ◽

Mahdis Kamali ◽

...

Keyword(s):

Infectious Disease ◽

Systematic Review ◽

Low Income ◽

Large Scale ◽

Malaria Treatment ◽

Sub Saharan Africa ◽

Intervention Coverage ◽

Middle Income ◽

Intervention Delivery ◽

Increased Risk

BackgroundConflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.MethodsWe searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery site and personnel involved, as well as barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.ResultsA majority of the 194 eligible publications reported on intervention delivery in sub-Saharan Africa. Vaccines for measles and polio were the most commonly reported interventions, followed by malaria treatment. Over two-thirds of reported interventions were delivered in camp settings for displaced families. The use of clinics as a delivery site was reported across all intervention types, but outreach and community-based delivery were also reported for many interventions. Key barriers to service delivery included restricted access to target populations; conversely, adopting social mobilisation strategies and collaborating with community figures were reported as facilitating intervention delivery. Few publications reported on intervention coverage, mostly reporting variable coverage for vaccines, and fewer reported on intervention effectiveness, mostly for malaria treatment regimens.ConclusionsDespite an increased focus on health outcomes in humanitarian crises, our review highlights important gaps in the literature on intervention delivery among specific subpopulations and geographies. This indicates a need for more rigorous research and reporting on effective strategies for delivering infectious disease interventions in different conflict contexts.PROSPERO registration numberCRD42019125221.

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966. Pregnancy Outcomes and Engagement in HIV Care for Pregnant Women Living with HIV in Rhode Island 2012-2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1152 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S513-S513

Author(s):

Katrina M Byrd ◽

Esther Henebeng ◽

Meghan L McCarthy ◽

Fizza S Gillani ◽

Erica Hardy ◽

...

Keyword(s):

Pregnant Women ◽

Rhode Island ◽

Sub Saharan Africa ◽

Hiv Care ◽

Initial Visit ◽

Hiv Exposed Infants ◽

Women Living With Hiv ◽

Hiv Exposed ◽

Engagement In Hiv Care ◽

Living With Hiv

Abstract Background Prevention of mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) requires a comprehensive approach and understanding the cultural backgrounds of pregnant women living with HIV (PWLH). In Rhode Island (RI), 70% of women newly diagnosed with HIV are foreign-born (FB) despite only representing 14% of RI’s population. Understanding the similarities and differences of pregnancy characteristics and engagement in postpartum HIV care between United States born (USB) and FB women is needed to ensure PWLH remain engaged in care and that appropriate resources are provided to all women with HIV in our state to maintain successful PMTCT of HIV. Methods A retrospective review of pregnant women living with HIV and their HIV-exposed infants evaluated in our hospital system were analyzed from 2012-2019. Clinical data were derived from medical records. Association between country of origin and sociodemographic, clinical, or lab variables were evaluated using chi-square test. Results A total of 72 pregnancies in 64 PWLH were included. Median # of pregnancies were 9 per year, median age at delivery 33 years, 54% of PWLH Black or African American, 33% Hispanic; 67.1% FB, most (56%) from Sub-Saharan Africa. Sixty-one % (n=42) with detectable (> 20 copies/mL) viral load (VL) during pregnancy, 23% (n=15) at delivery, only 1 VL > 200 at delivery. Pregnancy complications seen in 51%; 60% delivered vaginally; most (74%) at term. Engagement in postpartum HIV care declined from 71% at 6 months to 37% at 24 months. There was also decline in engagement in HIV care for the HIV exposed infants- 89% presented to the initial visit their children, from 89% attending the initial visit to 69% attending their last. DCYF involvement was more likely to occur in USB women compared to FB (P < 0.05). Other comparisons between FB & USB women including adherence to care were insignificant. Conclusion USB PWLH are at higher risk of DCYF involvement compared to FB women. Investigation into this disparity is warranted, given the cultural and language differences between groups. Additional research to determine barriers to long-term postpartum follow up for women and their infants is urgently needed. Disclosures All Authors: No reported disclosures

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Measurement of Cognition for the National Children's Study

Frontiers in Pediatrics ◽

10.3389/fped.2021.603126 ◽

2021 ◽

Vol 9 ◽

Author(s):

Philip David Zelazo ◽

Stella F. Lourenco ◽

Michael C. Frank ◽

Jed T. Elison ◽

Robert K. Heaton ◽

...

Keyword(s):

Executive Function ◽

Processing Speed ◽

Cognitive Skills ◽

Large Scale ◽

Longitudinal Research ◽

Early Adulthood ◽

Developmental Outcomes ◽

Behavioral Measures ◽

Cognitive Health ◽

Simultaneous Assessment

The National Children's Study Cognitive Health Domain Team developed detailed plans for assessing cognition longitudinally from infancy to early adulthood. These plans identify high-priority aspects of cognition that can be measured efficiently and effectively, and we believe they can serve as a model for future large-scale longitudinal research. For infancy and toddlerhood, we proposed several paradigms that collectively allowed us to assess six broad cognitive constructs: (1) executive function skills, (2) episodic memory, (3) language, (4) processing speed, (5) spatial and numerical processing, and (6) social cognition. In some cases, different trial sequences within a paradigm allow for the simultaneous assessment of multiple cognitive skills (e.g., executive function skills and processing speed). We define each construct, summarize its significance for understanding developmental outcomes, discuss the feasibility of its assessment throughout development, and present our plan for measuring specific skills at different ages. Given the need for well-validated, direct behavioral measures of cognition that can be used in large-scale longitudinal studies, especially from birth to age 3 years, we also initiated three projects focused on the development of new measures.

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