Browsing by Author "Baumgartner, Joy Noel"

Adolescent girls are a vulnerable population disproportionately affected by HIV in high-prevalence settings such as sub-Saharan Africa. Despite the development of HIV prevention products and subsequent biomedical clinical trials to examine the efficacy and safety of the products, adolescent girls largely have been excluded from the clinical trials, thus delaying their potential access to these products. To further examine the challenges and opportunities for adolescent trial participation, this qualitative study explored and compared adolescents’ (15-17 years old) and young women’s (18-21 years old) perceptions of HIV risk, their perspectives on clinical trial participation, and their understanding of research trial concepts. Multiple in-depth interviews were conducted with 10 adolescent girls (age 15-17) and 11 young women (age 18-21) who were currently sexually active in Dar es Salaam, Tanzania. With similar socio-demographic characteristics and relationship patterns, adolescent girls were less certain about their own HIV risk compared to the young women who more readily recognized their risk. Regarding trial participation, participants in both groups largely did not have logistical concerns, rather they recognized benefits from trial participation, although they had a concern about the recommended condom use. In terms of research concepts, both the adolescent girls and the young women had a hard time understanding them, particularly the concept of placebos. More broadly, the adolescent girls believed they should be included in clinical trials and that they are able to provide informed consent without parental consent. Compared to the young women, adolescent girls had lower perceived HIV risk, similar understandings of research concepts, and higher acceptability of adolescent trial participation without parent consent (although they supported parental/guardian involvement). Even though adolescent girls seem to have potential acceptability and readiness to participate in clinical trials, meaningful modification may be required for the adolescent inclusion in such trials in order to enhance understanding of research concepts, minimize preventive misconceptions and improve the informed consent process to include parental inclusion if not consent.

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Background: Global research on early childhood development is growing; however, there is still an evidence gap regarding how caregiver characteristics can affect a child’s development. Early childhood development begins at conception and family environment can influence the development of a child in utero. This study focused on the maternal-fetal relationship during pregnancy and how it is influenced by caregiver characteristics, specifically intimate partner communication. The aim of this study was to describe the maternal-fetal relationship through a series of bonding activities called early stimulation behaviors and to examine the relationship between early stimulation behaviors during pregnancy and intimate partner communication.

Methods: Study data are from a pre-intervention survey of a cluster randomized trial in two districts of Northern Ghana. A total of 376 pregnant women were enrolled at baseline with informed consent. Intimate partner communication was assessed using the Constructive Communication Subscale, derived from the Relationship Quality Index. Early stimulation behaviors were the primary outcome and was evaluated using four maternal-fetal bonding activities. A generalized linear mixed model with random effects was used for bivariate and multivariable analyses.

Results: Touching and talking was the most frequently performed early stimulation behavior by expectant mothers. Experiences of higher levels of intimate partner communication, physical intimate partner violence, and moderate to severe depression were positively correlated with an increase in stimulation behaviors performed by the expectant mother. Exploratory analysis showed that higher levels of emotional intimate partner violence and more frequently performed early stimulation behaviors had a positive association with intimate partner communication, while higher levels of Hope Score has a negative association. Development and evaluation of strategies to promote early stimulation behaviors during pregnancy are important for ensuring that all children research their developmental potential.

Background: Deinstitutionalization of persons with schizophrenia has led to families providing the majority of care and carrying the bulk of burden. There is a need to identify factors that influence caregiver burden in order to properly address the needs of caregivers. This is particularly important in low-resource settings, where psychiatric services are scarce and interventions for schizophrenia could be most effective if targeted to the affected individual and their caregiver. This study seeks to examine the association between family functioning and perceived burden in informal caregivers of individuals with schizophrenia in Tanzania and identify socio-demographic and illness-related factors that may be associated with caregiver burden in the study population.Methods: This study analyzed cross-sectional data from 65 dyads of individuals with schizophrenia and their informal caregivers in Dar es Salaam and Mbeya, Tanzania. Caregiver burden was measured using the Burden Assessment Scale (BAS). Univariable and multivariable regression analyses were performed to determine the relationship between perceived caregiver burden and family functioning and explore correlates of burden among caregivers. Results: Sixty-three percent of caregivers in our study reported experiencing high burden as a result of caring for a relative with schizophrenia. Multivariable regression analyses revealed that poor family functioning was a significant correlate of high caregiver burden (OR = 4.79; 95% CI = 1.19, 19.32). Additionally, caregiver having worked in the past 3 months was associated with high caregiver burden (OR = 4.80; 95% CI = 1.14, 20.23), while higher levels of hope in the caregiver were associated with low caregiver burden (OR = 0.82; 95% CI = 0.70, 0.95). Although not included in the multivariable regression model, another factor that was linked to high caregiver burden was caring for a woman with schizophrenia (OR = 3.91; 95% CI = 1.13, 13.50). Conclusions: We found that poor family functioning, caregiver having worked in the past 3 months, lower levels of hope in the caregiver, and caring for a woman with schizophrenia were correlates of high caregiver burden. Future interventions aiming to reduce caregiver burden may benefit from improving family functioning and nurturing hope among caregivers of individuals living with schizophrenia. We must pay special attention to the needs of caregivers that work in addition to providing care for a relative with schizophrenia in order to better support them.

Background: While adolescent nutrition has not historically garnered attention in public health programming, assessing adolescent nutrition is necessary in addressing cycles of chronic disease, intergenerational malnutrition, and poor developmental trajectory. Mid-upper arm circumference (MUAC), while mostly used as a tool to screen for undernutrition in children under 5, has the potential to offer a simple, low-resource alternative or supplement to BMI in assessing nutrition in adolescent populations. This study seeks to generate more data on adolescent nutrition in Tanzania, to understand the relationship between BMI and MUAC among adolescents, and to consider current age-specific cutoffs for adolescents.

Methods: This study analyzed anthropometric data from a sample of adolescents in primary school in Bagamoyo, Tanzania. A Spearman’s correlation coefficient was used to determine the relationship between BMI and MUAC and bivariate analysis was used to explore whether anthropometric categories of height, BMI, and MUAC vary according to pubertal and food security status. Additional post-hoc analysis was conducted to explore stunting among this population.

Results: The majority of adolescents in this population were of normal nutritional status. Thirty-eight percent of males compared to 3% of females were stunted. BMI and MUAC were significantly correlated (r=0.6530, p=0.000), with a

stronger correlation among females (r= 0.7736, p=0.000) than males (r=0.5878, p=0.000) and a stronger correlation among non-stunted (r=0.7797, p=0.000) when stunted individuals were removed from the sample. There was no correlation between BMI and MUAC among individuals categorized at overweight according to BMI (r=0.088, p=0.868). There were no significant differences in age-specific anthropometric categories according to self-reported pubertal status or food-insecurity status.

Conclusion: MUAC is a promising measure to be used for determining undernutrition when BMI calculation is not possible. More research is needed on a more nutritionally diverse population to better understand the relationship between BMI and MUAC in under and overnourished individuals and between stunted and non-stunted individuals. More country level data collection on adolescent nutrition including BMI and MUAC is needed to inform programmatic and policy decisions.