Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata

As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline.METHODS/PRINCIPAL FINDINGS: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households. Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets.CONCLUSIONS/SIGNIFICANCE: In this population, since HIV infection among adults was initially more common among the less poor, childhood mortality patterns have changed. The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest

Employing culturally responsive pedagogy to foster literacy learning in schools

 In recent years it has become increasingly obvious that, to enable students in schools from an increasingly diverse range of cultural backgrounds to acquire literacy to a standard that will support them to achieve academically, it is important to adopt pedagogy that is responsive to, and respectful of, them as culturally situated. What largely has been omitted from the literature, however, is discussion of a relevant model of learning to underpin this approach. For this reason this paper adopts a socio-cultural lens (Vygotsky, 1978) through which to view such pedagogy and refers to a number of seminal texts to justify of its relevance. Use of this lens is seen as having a particular rationale. It forces a focus on the agency of the teacher as a mediator of learning who needs to acknowledge the learner’s cultural situatedness (Kozulin, 2003) if school literacy learning for all students is to be as successful as it might be. It also focuses attention on the predominant value systems and social practices that characterize the school settings in which students’ literacy learning is acquired. The paper discusses implications for policy and practice at whole-school, classroom and individual student levels of culturally-responsive pedagogy that is based on a socio-cultural model of learning. In doing so it draws on illustrations from the work of a number of researchers, including that of the author

Antenatal Glucocorticoid Treatment is Associated with Diurnal Cortisol Regulation in Term-Born Children

Due to the rapid developmental changes that occur during the fetal period, prenatal influences can affect the developing central nervous system with lifelong consequences for physical and mental health. Glucocorticoids are one of the proposed mechanisms by which fetal programing occurs. Glucocorticoids pass through the blood-brain barrier and target receptors throughout the central nervous system. Unlike endogenous glucocorticoids, synthetic glucocorticoids readily pass through the placental barrier to reach the developing fetus. The synthetic glucocorticoid, betamethasone, is routinely given prenatally to mothers at risk for preterm delivery. Over 25% of the fetuses exposed to betamethasone will be born at term. Few studies have examined the lasting consequences of antenatal treatment of betamethasone on the regulation of the hypothalamic-pituitary-adrenal (HPA) axis. The purpose of this study is to examine whether antenatal exposure to betamethasone alters circadian cortisol regulation in children who were born full term. School-aged children prenatally treated with betamethasone and born at term (n=19, mean (SD) = 8.1 (1.2) years old) were compared to children not treated with antenatal glucocorticoids (n=61, mean (SD) = 8.2 (1.4) years old). To measure the circadian release of cortisol, saliva samples were collected at awakening; 30, 45, and 60 minutes after awakening; and in the evening. Comparison children showed a typical diurnal cortisol pattern that peaked in the morning (the cortisol awakening response) and gradually decreased throughout the day. In contrast, children exposed to antenatal betamethasone lacked a cortisol awakening response and had a flatter diurnal slope (p’

What happens to ART-eligible patients who do not start ART? Drop out between screening and ART initiation: a cohort study in Karonga, Malawi

BACKGROUND: Routine ART programme statistics generally only provide information about individuals who start treatment. We aimed to investigate the outcome of those who are eligible but do not start ART in the Malawi programme, factors associated with this dropout, and reasons for not starting treatment, in a prospective cohort study.METHODS: Individuals having a first screening visit at the ART clinic at Karonga District Hospital, northern Malawi, between September 2005 and July 2006 were interviewed. Study follow-up to identify treatment outcomes was conducted at the clinic and in the community. Logistic regression models were used to identify factors associated with dropout before ART initiation among participants identified as clinically eligible for ART.RESULTS: 88 participants eligible for ART at their first screening visit (out of 633, 13.9%) defaulted before starting ART. Participants with less education, difficulties in dressing, a more delayed ART initiation appointment, and mid-upper arm circumference (MUAC) < 22 cm were significantly less likely to have visited the clinic subsequently. Thirty-five (58%) of the 60 participants who defaulted and were tracked at home had died, 21 before their ART initiation appointment.CONCLUSIONS: MUAC and reported difficulties in dressing may provide useful screening indicators to identify sicker ART-eligible individuals at high risk of dropping out of the programme who might benefit from being brought back quickly or admitted to hospital for observation. Individuals with less education may need adapted health information at screening. Deaths of ART-eligible individuals occurring prior to ART initiation are not included in routine programme statistics. Considering all those who are eligible for ART as a denominator for programme indicators would help to highlight this vulnerable group, in order to identify new opportunities for further improving ART programmes

Population-level effect of HSV-2 therapy on the incidence of HIV in sub-Saharan Africa.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection increases acquisition and transmission of HIV, but the results of trials measuring the impact of HSV-2 therapy on HIV genital shedding and HIV acquisition are mixed, and the potential impact of HSV-2 therapy on the incidence of HIV at the population level is unknown. METHODS: The effects of episodic and suppressive HSV-2 therapy were simulated using the individual-level model STDSIM fitted to data from Cotonou, Benin (relatively low HIV prevalence) and Kisumu, Kenya (high HIV prevalence). Clinician- and patient-initiated episodic therapy, started when symptomatic, were assumed to reduce ulcer duration. Suppressive therapy, given regardless of symptoms, was also assumed to reduce ulcer frequency and HSV-2 infectiousness. RESULTS: Clinician-initiated episodic therapy in the general population had almost no effect on the incidence of HIV. The impact of patient-initiated therapy was higher because of earlier treatment initiation, but still low (20% in the long term. Impact was increased in both cities by also treating a proportion of their clients. Long-term suppressive therapy with high coverage in the general population could reduce HIV incidence by more than 30%. CONCLUSIONS: These results show that HSV-2 therapy could potentially have a population-level impact on the incidence of HIV, especially in more concentrated epidemics. However, a substantial impact requires high coverage and long duration therapy, or very high symptom recognition and treatment-seeking behaviour

Perceived Neighborhood Cohesion Buffers COVID-19 Impacts on Mental Health in a United States Sample

Objective This study examined whether perceived neighborhood cohesion (the extent to which neighbors trust and count on one another) buffers against the mental health effects of the 2020 COVID-19 pandemic. Methods The XXX University National COVID-19 and Mental Health Study surveyed US adults (N = 3965; M age = 39 years), measuring depressive symptoms, staying home more during than before the 2020 pandemic, and perceived neighborhood cohesion. Results A series of linear regressions indicated that perceiving one\u27s neighborhood as more cohesive was not only associated with fewer depressive symptoms, but also attenuated the relationship between spending more time at home during the pandemic and depressive symptoms. These relationships persisted even after taking into account several individual-level sociodemographic characteristics as well as multiple contextual features, i.e., median household income, population density, and racial/ethnic diversity of the zip codes in which participants resided. Conclusions Neighborhood cohesion may be leveraged to mitigate pandemic impacts on depressive symptoms

Pathwise Sensitivity Analysis in Transient Regimes

The instantaneous relative entropy (IRE) and the corresponding instanta- neous Fisher information matrix (IFIM) for transient stochastic processes are pre- sented in this paper. These novel tools for sensitivity analysis of stochastic models serve as an extension of the well known relative entropy rate (RER) and the corre- sponding Fisher information matrix (FIM) that apply to stationary processes. Three cases are studied here, discrete-time Markov chains, continuous-time Markov chains and stochastic differential equations. A biological reaction network is presented as a demonstration numerical example

Unpredictable Maternal Behavior Is Associated with a Blunted Infant Cortisol Response

Background Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with poor physical and mental health. Early-life adversity may dysregulate cortisol response to subsequent stress. This study examines the association between patterns of maternal behavior and infant stress response to a challenge. Specifically, we test whether infant exposure to unpredictable maternal sensory signals is related to the cortisol response to a painful stressor. Method Participants were 102 mothers and their children enrolled in a longitudinal study. Patterns of maternal sensory signals were evaluated at 6 and 12 months during a 10-min mother–infant play episode. Entropy rate was calculated as a quantitative measure of the degree of unpredictability of maternal sensory signals (visual, auditory, and tactile) exhibited during the play episode. Infant saliva samples were collected for cortisol analysis before and after inoculation at 12 months. Results Unpredictable patterns of maternal sensory signals were associated with a blunted infant cortisol response to a painful stressor. This relation persisted after evaluation of covariates including maternal sensitivity and maternal psychological distress. Conclusions This study provides evidence that unpredictable patterns of maternal sensory signals are one process through which caregiving affects the function of infant stress response systems

Bereavement and the role of religious and cultural factors.

yesThe aim of this article is to give an overview of some of the key dimensions of variation in cultural and religious rituals during the immediate period after a death and in the longer term, in order to inform service delivery in multi-cultural societies. For each area we give examples of different customs, and consider their functions and possible impact. Dimensions considered in the immediate period after bereavement are: The time and space given to formal rituals, expression of feelings, assertion of status and disposal of the body. In the longer term, we look at variations in remembering the deceased and in continuing bonds. Throughout we consider the interplay between individual responses and the person¿s cultural and religious context. Our objective is to provide an accessible introduction for practitioners new to working with bereavement and provide a succinct reference point for more experienced bereavement workers.Full text made available 1st May 2014 at the end of the publisher's embargo period