Acceptability of Rectal Artesunate as pre-referral treatment for severe malaria in children under 5 years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda

Background In children below 6 years with suspected severe malaria who are several hours from facilities providing parenteral treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out. Yet to date, there is limited literature on RAS acceptability. This study aimed to determine the acceptability of RAS by health care providers and child caregivers in communities where quality assured RAS was rolled out. Methods This study was nested within the comprehensive multi-country observational research project Community Access to Rectal Artesunate for Malaria (CARAMAL). The CARAMAL project was implemented in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Data from three different sources were analysed to understand RAS acceptability: Interviews with health workers during three healthcare provider surveys, with caregivers of children under 5 years of age during three household surveys, and with caregivers of children who were recently treated with RAS and enrolled in the CARAMAL Patient Surveillance System. Results RAS acceptability was high among all interviewed stakeholders in the three countries. After the roll-out of RAS, 97-100% heath care providers in DRC considered RAS medication as very good or good, as well as 98-100% in Nigeria and 93-100% in Uganda. Majority of caregivers whose children had received rectal artesunate for pre-referral management of severe malaria indicated that they would want to get the medication again, if their child had the same illness (99.8% of caregivers in DRC, 100% in Nigeria and 99.9% in Uganda). Further, using data from three household surveys, 67-80% of caregivers whose children had not received RAS considered the medication as useful. Conclusion RAS was well accepted by health workers and child caregivers in DRC, Nigeria and Uganda. Acceptability is unlikely to be an obstacle to the large-scale roll-out of RAS in the studied settings.

Effects of Relationship Type on Quality of Life in Older Adults with Cognitive Impairment and the Informal Caregivers

Purpose The purpose of this study was to assess whether there was an association between care-recipient relationship type and the QoL of older adults and their informal caregivers, and whether this association pertained to older adults’ cognitive function. Methods This was a secondary data analysis. Older adults (n=1230) and their informal caregivers (n=1871) were identified from participants in the National Health and Aging Trends Study (NHATS) Round 5 and the National Study of Caregiving (NSOC) II. A series of bivariate and multivariable regression models examined the associations among the care-recipient relationship type and QoL in older adults and their informal caregivers, adjusted for socio-demographic variables as well as cognitive functioning. Results Both older adults and caregivers’ QoL outcomes varied by the type of relationship. Recipients cared for by adult-child caregivers or multiple caregivers experienced higher functional limitation than those cared by spousal caregivers (β=.79, CI [.39, 1.19]; β=.50, CI [.17, .82], respectively). “Other” caregivers, such as siblings, friends, etc., had lower odds of experiencing negative emotional burden than spousal caregivers (OR=.26, CI [.13, .52]; OR=.53, CI [.35, .81], respectively). "Other" caregivers were also 51% less likely to experience social strain than spousal caregivers. Lower odds of experiencing negative emotional burdens were also found with multiple caregivers. The association between adult-child caregivers and social strain was explained by the recipients’ cognitive function. Conclusions Care-recipient relationship type impacts the QoL in both recipients and their informal caregivers. This association appears to be affected by care recipients' cognitive function level.

Longitudinal Effects of Cultural and Psychosocial Factors on Biomarkers of Cardiovascular Risk in Caregivers

Dysfunctional thoughts about caregiving (DTAC) and familism (i.e. familistic obligation) were associated with worse caregiver emotional and cardiovascular health in cross-sectional studies. The aim of this study was to longitudinally examine the effects of familism and DTAC on cardiovascular health, considering caregiver kinship adjusting for well-established predictors of cardiovascular health. Study participants were 80 family dementia caregivers. Individual interviews and collection of blood samples were conducted in three yearly assessments. Linear mixed (random effects) regression analysis was performed to examine longitudinal associations of familism, DTAC, and circulating levels of cytokine interleukin (IL)-6, a cytokine and biomarker of cardiovascular disease risk (CVD). Caregiver age, gender, alcohol consumption, body mass index (BMI), hours caring, frequency and reaction of behavioral problems and caregivers’ transitions were used as covariates. Results showed that increases in DTAC, in familism and higher caregiver age were independently and significantly associated with higher levels of IL-6 over time in the group of spousal caregivers. No significant effects were found for any of the other covariates in spousal caregivers. In contrast, increases in BMI and in frequency of behavioral problems were significantly associated with increases in IL-6 over time in adult child caregivers. No significant effects were found for any of the rest of predictors in adult child caregivers. Findings suggest that high level of obligation familism and DTAC may a profile of increased vulnerability for CVD in spousal caregivers. In contrast, problem behaviors of the care recipient may characterize adult child caregivers in terms of an increased CVD risk.

Caregiving Between Spouse and Adult Child Caregivers of Older Adults with Cognitive Impairment

Prior studies of caregiving characteristics by type of caregivers are inconsistent, particularly those who are spouses and adult children. This study examined caregiving characteristics between spouses and adult children of cognitively impaired older adults. We analyzed phone-screening data from an ongoing trial of a dyadic sleep intervention program for persons with dementia and their caregivers. Data included spouse caregivers (n=52) and adult child caregivers (n=24). Nearly all participants (95%) lived with their care recipients (91% with dementia). Types of caregiving activities were measured by activities of daily living [ADLs] and instrumental ADLs [IADLs] with their levels of intensity (0 [total independent] to 3 [total dependent]). Care recipients’ sleep was measured by the Neuropsychiatric Inventory-Nighttime Behavioral Subscale (8 items). Analyses included Pearson correlations and t-tests. Adult child caregivers helped their care recipients at significantly higher levels as indicated by their measure of dependence in dressing (1.46±1.22 vs. 0.87±1.16, p=0.044), continence (1.22±1.38 vs. 0.54±1.04, p=0.021), laundry (2.87±0.46 vs. 2.13±1.24, p=0.007), and transportation (3.00±0.00 vs. 2.63±0.79, respectively; p=0.031) than spouse caregivers. Adult child caregivers also reported their care recipients having more difficulty falling asleep (56% vs. 19%, respectively; p=0.004) and having more numbers of sleep problems than spouse caregivers (3.54±2.08 vs. 2.48±1.51, respectively; p=0.014). The findings suggest that adult child caregivers may involve higher levels of caregiving responsibilities during daytime and nighttime, compared to spouse caregivers. Further research needs to explore complimentary ways to involve spouse and adult child caregivers in the care of this vulnerable population.

Recruiting Diverse Dementia Family Caregivers: What Works for Which Groups?

The purpose of this presentation is to compare success of recruitment methods by race/ethnicity, age, and kinship of dementia family caregivers. We conducted a cross-sectional study and recruited a convenience sample of dementia family caregivers using community-based and online methods. Recruitment success was tracked through survey questions, direct referrals, and community event sign-ups. Using chi-squared statistics, we examined the success of each method by caregiver race/ethnicity, age, and relationship to person with dementia (kinship). There were significant differences in recruitment source based on race/ethnicity, age, and kinship (P<.001). Specifically, referrals and newspaper advertisements were most successful for recruiting older (54 years+), White, non-Hispanic, and spousal or child caregivers; community events and reputable websites for recruiting older, minority, child caregivers; ResearchMatch for recruiting younger, minority, child/grandchild caregivers; and social media for recruiting younger, White, non-Hispanic, and child caregivers. Findings support the importance of implementing tailored methods to reach diverse dementia caregivers.

Different Experiences of Adult Child and Spousal Caregivers with Family Conflict

Previous research indicates that different types of caregivers report distinct levels of family conflict (Dieker et al., 2019). However, as half (52%) of the participants in the previous study did not report family conflict, the purpose of this study was to examine the relationships among types of caregivers, family conflict, and caregiver burden in those who experience family conflict. Participants (N = 277; aged 19 to 87; M = 52.96) comprised of 197 adult child and 80 spousal caregivers. They completed the Caregiver Reaction Scale (O’Malley & Qualls, 2017) to assess different aspects of the caregiving experience. Hierarchical regressions (block 1: demographics, block 2: family conflict) were computed to predict caregiving burden. For spousal caregivers, the final model explained 2.2% of the variance in caregiving burden, F(7, 69) = 0.22, p = .98. None of the variables were significant. Additionally, family conflict did not uniquely influence caregiving burden beyond demographics, Fchange(2, 69) = 0.03, p = .97. For adult child caregivers, the set of predictors accounted for 20.5% of the variance in caregiving burden, F(7, 183) = 6.75, p < .001. Having more family beliefs and support conflict predicted greater caregiving burden (ps < .01). Family conflict scores also significantly explicated caregiver burden beyond demographics, Fchange(2, 183) = 17.60, p < .001. Results suggest that family conflict is a stronger driver of caregiver burden for adult child than spousal caregivers. Findings imply the need for clinicians to target appropriate interventions for adult child caregivers to reduce caregiver burden.

Modeling the Distress of Adult-Child Caregivers of People with Dementia: The Mediating Role of Self-Efficacy

Background: The increased tasks and responsibilities involved in supporting a parent with dementia (PWD) can induce distress in adult-child caregivers. Previous studies have shown that distress can be influenced by PWD and caregiver determinants, but few studies have considered the associations between these variables. Objective: This study tested a complex model of adult-child caregiver distress in which PWD and caregiver determinants and their associations are considered. Methods: 159 adult-child caregivers participated in this online study. PWD and caregiver determinants were assessed using questionnaires and their associations were investigated using the partial least squares path method. Results: The model showed a significant partial mediation through self-efficacy (confidence in one’s ability to organize and manage caregiving situations) between poor self-rated health and distress. Self-efficacy was a significant mediator of the relationship between informal social support and distress, and between preparedness and distress. The direct path between parental overprotection and distress was significant. The association between care and distress was significantly stronger for adult-child caregivers not living with their PWD. Conclusion: The model revealed the important mediating role of self-efficacy. Clinical interventions should improve the preparedness of adult-child caregivers and the quality of social support. The positive perception of their self-rated health may thus be promoted.

Associated indicator factors among inappropriate malfunctions’ development for the 9-month-old-baby

To investigate the associated an inappropriate development of the 9-month-old-baby with the Matched Case-Control Study on five categories and three factors including predisposing, contributing, and complementary through the babies’ malfunction development with the Analysis Research Method was analyzed. The babies’ developing crisis was enhanced as the guidelines for promoting healthy babies’ development via the DSPM in the future of Thailand. Creative the Interview Factor Questionnaire analyzed the 130-child caregivers’ parenting matching 65-pairs-case-control group into 5 parts: the Predisposing Factor Questionnaire, the Positive Interview Form; the Baby-Self-Efficacy Form; the Inappropriate Contributing Interview Form; the Inappropriate Development Interview Form for assessing the motor skills, self-efficacy, predisposing, contributing, and complementary factors of the 9-month-old-baby, respectively. Highest, Middle, and Lowest means levels are indicated. The child caregivers’ are presenting responses, overall on the Predisposing Factor Questionnaire on five categories’ motor skills, and the Inappropriate Development Interview Form showed off at the Middle Levels. The Positive Interview Form, the Baby-Self-Efficacy Form, and the Inappropriate Contributing Interview Form comprised at the Highest Levels for the predisposing, self-efficacy, and contributing factors for developing the 9-month-old-baby, respectively. To help professionals assess the factors affecting a child’s development into environmental factors, biological factors, interpersonal relationships, and early environments and experiences that identified in contributing to growth, brain, emotional, social developments at early childhood are the GM, FM, RL, EL, and PS motor skills practices with the DSPM for Thai’s children are also more likely to have health problems all child ages with the knowledge and skills.

Adult-Child Caregivers’ Motivations when Caring for Home-Dwelling Parents with Dementia

Background It is often seen as demanding to be an informal caregiver of a home-dwelling relative or friend with a long-term illness. Adult-child caregivers are important resources for both their ill parents and their community healthcare services. Dementia is one of the most severe chronic long-term illnesses and represents comprehensive challenges for public health in Norway as in the rest of the world. Research within the caregiver field has generally focused on primary caregivers, the burden of taking on the caregiver role, and interventions to improve health outcomes. Less research has been devoted to understanding how secondary caregivers, such as adult children, remain motivated and how they experience community healthcare services, applying recent theoretical approaches such as self-determination theory and relationship-centred care. Therefore, the overall aim of this thesis was to gain a deeper understanding of adult children’s motivations to remain in the caregiver role when parents with dementia live at home. Methodology The current PhD project applies a qualitative multi-method design including the following three methods: 1) an integrative literature review of the previous research literature concerning the motivation of caregivers of persons with long-term illnesses, 2) individual face-to-face semi-structured interviews with 21 adult-child caregivers who had home-dwelling parents with dementia, and 3) focus group interviews with 15 of the adult-child caregivers who had been individually interviewed. Analyses were conducted using narrative analysis and systematic text condensation. Findings There is consistency between caregivers of persons with long-term illnesses and persons with dementia, describing their quality of motivations and how they experienced being caregivers. High-quality motivation depends on the satisfaction of the caregivers’ three basic psychological needs for competence (understanding of diagnosis, management of symptoms, problem solving, communication skills, knowledge of appropriate healthcare services), autonomy, (available options, planning, freedom of choice regarding tasks), and relatedness, (interacting with parent with dementia and others, being part of the care team, mutual respect, acknowledgement, dialogue, belonging, meaning something to others). Thwarting those psychological needs could lead to amotivation. The main issues thwarting caregivers’ motivations include parents being resistant or refusing to receive community healthcare services, challenges in getting access to timely healthcare services, and not being appropriately involved in their services. Still, caregivers of persons with dementia often prioritised their parents’ needs over their own. The literature review found the three needs of competence, autonomy, and relatedness to be equally important in predicting the quality of caregivers’ motivations and thereby their well- being, as according to the self-determination theory. From the perspective of adult-child caregivers, these basic needs were confirmed as motivational drivers when caring for a home-dwelling parent with dementia. Yet, they reported relatedness as their main motivational driver, including relations with their parents with dementia, with persons in their social network, and with their parents’ community healthcare services. Caregivers wanted to be acknowledged as competent partners in the care team who utilise significant efforts to improve the home-dwelling period for their parents. These findings imply that healthcare professionals should value the importance of relatedness when interacting with caregivers of persons with dementia. Conclusion By applying self-determination theory combined with a relationship-centred care approach, this thesis offers a deeper understanding of caregivers’ motivations in the long-term illness context and, in particular, in caring for persons with dementia. A caregiver’s motivation is described along a continuum representing different qualities of motivation. Addressing caregivers’ motivations is necessary, as the quality of their motivations for caregiving has consequences for their health and well-being. Caregivers’ motivations to remain in this type of role are closely related to satisfaction or thwarting of their basic needs for competence, autonomy, and relatedness. To remain motivated throughout a parent’s trajectory of dementia, support to fulfil the three needs is required. Dyadic improvement efforts addressing both caregivers’ and patients’ needs are recommended.

Utilization of Integrated Community Case Management and Its Factors in Southern Ethiopia: Facility Based-Cross-Sectional Study

Background. An integrated community case management (ICCM) program fosters child health care seeking and access to appropriate treatment for illnesses in children at the community level in Ethiopia. There is paucity of evidence to the utilization of ICCM services by mothers/child caregivers in rural Sothern Ethiopia. Hence, the aim of this study was to determine the utilization of integrated community case management (ICCM) and its factors among mothers/child caregivers in rural Southern Ethiopia. Methods. A multistage sampling technique was used to select study participants in health care facilities offering child health care services. An exit interview was conducted on 574 mothers/child caregivers in randomly selected public health centres. Data were entered using Epi Info and transported to SPSS version 20 for analysis. Results. Only less than a quarter of participants visited health posts for ICCM services during the study period. Those study participants who have not heard about ICCM service before the survey were about 6.53 times more likely not to use the services as compared to those who have heard about the service. Participants who were not members of the women’s development team were about 2.23 times more likely not to utilize ICCM services when compared to their counterparts. Conclusion. The study shows low utilization of ICCM service by children less than five years. Prior information about ICCM services and membership in the health development army was significantly associated with ICCM use. Therefore, our finding may suggest the need for advocacy to increase participation in the health development army and information education to increase the level of awareness and formal education efforts.