The impact of disclosure on health outcomes in HIV-infected Nigerian children

AIM: The study aimed to determine the prevalence, age and main agent of disclosure among Nigerian children on antiretroviral treatment. The study also sought to elicit barriers to, and facilitators of disclosure, and the context and process of disclosure. METHODS: In this cross-sectional, facility-based study, a semi-structured questionnaire was administered to 110 parents/caregivers of children ≥ 6 years, to determine child’s disclosure status. This was followed by a more detailed interview with 15 parent/caregivers of disclosed children. CD4, viral load, opportunistic infections and adherence information were also extracted from medical records for all 110 children. RESULTS: The mean age (SD) of the children in the study was 10.15 (2.97) years, with a median (range) of 9.50 (6 – 18) years. According to parents/caregivers’ accounts 34 (30.9%) children knew they were living with HIV, while 74 (67.3%) did not know. Mean age (SD) at disclosure was 10.47 (2.62) years, with a median (range) of 10.00 (6 - 17) years. Most of the children (79.4%) were disclosed at home by their parent(s)/caregiver. The rest were disclosed at the hospital: five were disclosed by a health care provider, while two were accidental disclosure. The most common reasons for disclosure were related to adherence issues – either to help prepare the children to take their medicines or that the child had refused to take his/her medicines (39.4%). This was followed by the child asking a lot of questions related to his/her health, frequent visits to the hospital, or why s/he was taking a lot of medicines even though s/he did not feel ill (27.3%). Most parents/ caregivers did not disclose because the child was considered too young (84.0%) or will not be able to keep their HIV status a secret (10.7%). Disclosure was mostly unplanned and a one-off event. Children’s reaction to disclosure ranged from no reaction to shock and crying. Multivariate logistic regression showed that only child’s age was a statistically significant predictor of status disclosure (OR 1.69, p=0.002; 95% CI 1.21 – 2.34). The study did not show any association between disclosure and other child and parent/caregiver characteristics. There was no association between disclosure and self-reported adherence (p=0.615).Doctor of Public Healt

Ascorbic Acid Supplementation: Effects on the Growth and Packed Cell Volume of Broiler Chickens

This study was conducted to observe the effect of natural and artificial ascorbic acid supplementation on the growth and packed cell volume using broiler chicks. The chicks were divided into groups A, B, C and D. They were fed with the same quantity of feed but different type of ascorbic acid in a litre of water were also administered to groups B to D. Group A which served as the control group received no ascorbic acid and groups B was given 150 g of natural and 150 g of artificial ascorbic acid per litre of water, C received 300 g of natural and 300 g artificial ascorbic acid while D was given 300 g of artificial ascorbic acid per litre of water. The result of the supplement effects on the birds showed that birds feed with natural ascorbic acid recorded the highest weight gain 1.22 kg followed by those feed with mixture of natural and artificial ascorbic acid 1.09kg. Birds that were feed artificial ascorbic acid recorded a weight gain of 0.89 kg while the control group produced the least weight gain of 0.79 kg. The mixture of natural and artificial ascorbic acid proved to be most effective on PCV 21.23, followed by that of artificial ascorbic acid 18.1. Whereas control group recorded a PCV level of 12.84 natural ascorbic acid recorded the least PCV level of 9.93. The result of the experiment indicated that natural ascorbic acid elevated body weight while mixture of natural and artificial ascorbic acid boosted PCV in broiler when given in the right proportion. Keywords: ascorbic acid; packed cell volume; supplementation; natural; artifici

The Impact of Disclosure on Health and Related Outcomes in Human Immunodeficiency Virus-Infected Children: A Literature Review

This review explores the association between pediatric human immunodeficiency virus (HIV) disclosure and health and related outcomes among children living with HIV. A multi-stage process was used to search for relevant articles on the ISI Web of Knowledge database. Fifteen articles met the inclusion criteria. Five major outcomes emerged from children’s knowledge of their HIV-seropositive status: physical/physiological outcomes; adherence to antiretroviral therapy; psychosocial outcomes; sexual and reproductive health, including HIV prevention outcomes; and disclosure of status by the children. Disclosure of a child’s HIV status to the child has value in terms of positive health outcomes for the child, such as better adherence and slower disease progression—albeit the different studies did not always reach the same conclusions, and some suggest negative health outcomes, such as increased psychiatric hospitalization. Yet, there does not seem to be a systematic or coherent system for child disclosure. One recommendation from this review, therefore, is for government and program policies and guidelines that will promote child HIV disclosure in order to address the current low rates of disclosure in sub-Saharan Africa (SSA). More rigorous and longitudinal studies on the outcomes of disclosure, with larger sample sizes, and in SSA, are also needed

HIV status disclosure to male partners among rural Nigerian women along the prevention of mother-to-child transmission of HIV cascade: a mixed methods study

Abstract Background HIV status disclosure to male partners is important for optimal outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Depending on timing of HIV diagnosis or pregnancy status, readiness to disclose and disclosure rates may differ among HIV-positive women. We sought to determine rates, patterns, and experiences of disclosure among Nigerian women along the PMTCT cascade. Methods HIV-positive women in rural North-Central Nigeria were purposively recruited according to their PMTCT cascade status: pregnant-newly HIV-diagnosed, pregnant-in care, postpartum, and lost-to-follow-up (LTFU). Participants were surveyed to determine rates of disclosure to male partners and others; in-depth interviews evaluated disclosure patterns and experiences. Tests of association were applied to quantitative data. Qualitative data were manually analysed by theme and content using the constant comparative method in a Grounded Theory approach. Results We interviewed 100 women; 69% were 21–30 years old, and 86% were married. There were 25, 26, 28 and 21 women in the newly-diagnosed, in-care, postpartum, and LTFU groups, respectively. Approximately 81% of all participants reported disclosing to anyone; however, family members were typically disclosed to first. Ultimately, more women had disclosed to male partners (85%) than to family members (55%). Rates of disclosure to anyone varied between groups: newly-diagnosed and LTFU women had the lowest (56%) and highest (100%) rates, respectively (p = 0.001). However, family (p = 0.402) and male partner (p = 0.218) disclosure rates were similar between cascade groups. Across all cascade groups, fear of divorce and intimate partner violence deterred women from disclosing to male partners. However, participants reported that with assistance from healthcare workers, disclosure and post-disclosure experiences were mostly positive. Conclusion In our study cohort, although disclosure to male partners was overall higher, family members appeared more approachable for initial disclosure. Across cascade groups, male partners were ultimately disclosed to at rates > 75%, with no significant inter-group differences. Fear appears to be a major reason for non-disclosure or delayed disclosure by women to male partners. Augmentation of healthcare workers’ skills and involvement can mediate gender power differentials, minimize fear and shorten time to male partner disclosure among women living with HIV, regardless of their PMTCT cascade status. Trial registration Clinicaltrials.gov registration number NCT 01936753, September 3, 2013 (retrospectively registered)

“They do not see us as one of them”: a qualitative exploration of mentor mothers’ working relationships with healthcare workers in rural North-Central Nigeria

Abstract Background In HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). Nigeria has significant PMTCT program gaps, and in this resource-constrained setting, lay health workers such as MMs serve as task shifting resources for formal healthcare workers and facility-community liaisons for their clients. However, challenging work conditions including tenuous working relationships with healthcare workers can reduce MMs’ impact on PMTCT outcomes. This study explores the experiences and opinions of MMs with respect to their work conditions and relationships with healthcare workers. Methods This study was nested in the prospective two-arm Mother Mentor (MoMent) study, which evaluated structured peer support in PMTCT. Thirty-six out of the 38 MMs who were ever engaged in the MoMent study were interviewed in seven focus group discussions, which focused on MM workload and stipends, scope of work, and relationships with healthcare workers. English and English-translated Hausa-language transcripts were manually analyzed by theme and content in a grounded theory approach. Results Both intervention and control-arm MMs reported positive and negative relationships with healthcare workers, modulated by individual healthcare worker and structural factors. Issues with facility-level scope of work, workplace hierarchy, exclusivism and stigma/discrimination from healthcare workers were discussed. MMs identified clarification, formalization, and health system integration of their roles and services as potential mitigations to tenuous relationships with healthcare workers and challenging working conditions. Conclusions MMs function in multiple roles, as task shifting resources, lay community health workers, and peer counselors. MMs need a more formalized, well-defined niche that is fully integrated into the health system and is responsive to their needs. Additionally, the definition and formalization of MM roles have to take healthcare worker orientation, sensitization, and acceptability into consideration. Trial registration Clinicaltrials.gov number NCT01936753, registered September 3, 2013