Browsing by Subject "Africa"

* Designated as an Exemplary Master's Project for 2014-15*

Objectives: To compare measures of health and health quality between Orphans and Vulnerable Children (OVC) in different living arrangements-- institutional and community care; and to correlate different measures of OVC health and health quality using clinical, laboratory and quality of life instruments.

Design: Cross-sectional study.

Setting: Two rural districts (sites) in East Africa, Bungoma in Kenya, and Kilimanjaro in Tanzania.

Participants: 77 male and 45 female OVC aged 16-18 years (N=122). Participants, who had attained a minimum age of 16 at the date of interview, were selected from the larger sample of OVC in the Positive Outcomes for Orphans (POFO) study. POFO, a longitudinal study in five less wealthy countries that started in 2006, obtained its sample through cluster randomization.

Methods: To obtain self-ratings of OVC physical health, OVC responded to an interviewer administered SF-36 questionnaire, a multipurpose generic measure of health status. A neutral examiner then measured OVC physical health using 4 clinical variables: a physical health examination, body mass index, hemoglobin level, and the Harvard physical fitness score.

Main Outcome Measures: SF-36 scores presented as a two component score- the physical health and mental health composite sub-scores. For physical health, normal findings for age were considered as meeting the threshold for good physical health.

Results: Of the 122 OVC, 89 (73%) lived in the community while 33 (27%) lived in institutional settings. For the SF-36, the mean physical composite score for the entire study population was 50.6 (SD=6.2). Mean body mass index (BMI) was 19.3 (SD=2.4). Mean hemoglobin was found to be 13.2g/dl (SD=1.8). The average Harvard physical fitness score was found to be 40.7(SD=16.9). Pearson's correlations between SF-36 Physical Functioning and hemoglobin, BMI, and the Harvard Step-Test fitness score were 0.1, 0.1, and -0.1 respectively. There was no evidence that self-rating of OVC health outcomes differed by living arrangement. Using paired t-tests for continuous variables and chi-square tests for categorical variables, no significant p- values were obtained at the 95% level. Using a threshold of vision 20/20 for normal vision, 91.0% of community OVC and 78.8% of OVC in institutions had normal vision (p=0.07).

Conclusion: Although this study did not detect significant differences in self-reported measures of health among OVC in different living arrangements, physical examination revealed a slightly high incidence of poor vision among those living in institutions. In this sample, the correlations between SF-36 physical functioning sub-score and 3 physical health outcomes of BMI, hemoglobin, and the Harvard Step-test fitness score were weak.

Background

Methods

Conclusions

Background: Youth living with HIV have worse health outcomes compared to adults or children. Few interventions have been developed engaging youth in their care to promote resilience. Peer-led education is one potential way to boost confidence and bolster resilience while also improving HIV knowledge of youth living with HIV (YLHIV). Peer youth leaders (PYL) can be effective educators because they are seen as trustworthy and relatable to their peers. PYL themselves may also benefit from increased resilience and empowerment after taking on leadership position at their monthly adolescent HIV clinic. This study evaluated the acceptability, feasibility, and effectiveness of using PYL to teach an HIV education. Methods: Seven HIV-infected youth were recruited based on their previous enrollment in a mental health intervention for HIV-infected youth. Those who demonstrated confidence, excellent adherence, and upstanding behavior were chosen to become PYL. PYLs were trained by a doctor, social worker, and previously trained group leaders of a mental health intervention to teach an HIV education curriculum adapted from the Baylor International Pediatric AIDS Initiative. Trainings occurred once a week for two to three hours in preparation for teaching at the monthly adolescent HIV clinic. Two PYLs taught one-hour lessons to youth during the monthly adolescent HIV clinic. Approximately 25 clinic attendees were asked to volunteer to complete pre/post knowledge assessments and provided feedback on the PYL model. Acceptability and feasibility of using PYL to deliver an HIV curriculum to YLHIV was evaluated through attendance records, fidelity checklists and feedback notes that were documented by trained group leaders who supervised PYL curriculum delivery. In depth interviews were conducted to evaluate change in fears, motivations, and resilience among PYL before and after assuming the leadership role. PYL resilience was measured using the Connor-Davidson Scale at baseline (prior to starting the teaching role) and 6 months after initiating training. Results: A PYL model of delivering an HIV curriculum was both feasible and acceptable as reported by youth attending monthly adolescent HIV clinic and PYL. Qualitative findings showed peer education created safe discussion spaces, reduced stress of participants, and enhanced beliefs of importance in maintaining good adherence. HIV knowledge was improved as measured by self-report, and improvement did not meet statistical significant (p =0.057). PYL leaders demonstrated trends toward improved resilience as measured by Connor-Davidson Resilience Scale and increased confidence, feelings of self-worth, sense of purpose, social support, and optimism and decreased internal stigma based on in-depth interviews. Conclusions: Results demonstrated the PYL model of teaching an HIV curriculum was feasible and acceptable. PYL had improved resilience as a result of taking on a leadership role at their monthly adolescent HIV clinic. Future evaluation of YLHIV retention in care and health outcomes as a result of participation in the PYL education should be explored.