7 research outputs found

    AcceptabiliteĀ“ du test VIH proposeĀ“ aux nourrissons dans les services peĀ“ diatriques, en CoĖ† te dā€™Ivoire, Significations pour la couverture du diagnostic peĀ“diatrique

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    Proble`me: Le deĀ“pistage VIH chez les enfants a rarement eĀ“teĀ“ au centre des preĀ“occupations des chercheurs. Quand le deĀ“pistage peĀ“diatrique a retenu lā€™attention, cela a eĀ“teĀ“ pour eĀ“clairer seulement sur les performances diagnostiques en ignorant meĖ†me que le test peĀ“diatrique comme bien dā€™autres peut sā€™accepter ou se refuser. Cet article met au coeur de son analyse les raisons qui peuvent expliquer quā€™on accepte ou quā€™on refuse de faire deĀ“pister son enfant.Objectif: Etudier chez les parents, les me`res, les facteurs explicatifs de lā€™acceptabiliteĀ“ du test VIH desĀ  nourrissons de moins de six mois.MeĀ“thodes: Entretien semi-directif a` passages reĀ“peĀ“teĀ“s avec les parents de nourrissons de moins de six mois dans les formations sanitaires pour la peseĀ“e/vaccination et les consultations peĀ“diatriques avec proposition systeĀ“matique dā€™un test VIH pour leur nourrisson.ReĀ“sultats: Nous retenons que la reĀ“alisation effective du test peĀ“diatrique du VIH chez le nourrisson repose sur trois eĀ“leĀ“ments. Primo, le personnel de santeĀ“ par son discours (qui deĀ“note de ses connaissances etĀ  perceptions meĖ†me sur lā€™infection) orienteĀ“ vers les me`res influence leur acceptation ou non du test. Secundo, la me`re qui par ses connaissances et perceptions meĖ†me sur le VIH, dont le statut particulier, lā€™impression de bien-eĖ†tre chez elle et son enfant influence toute reĀ“alisation du test peĀ“diatrique VIH. Tertio, lā€™environnement conjugal de la me`re, particulie`rement caracteĀ“riseĀ“ par les rapports au sein du couple, sur la faciliteĀ“ de parler du test VIH et sa reĀ“alisation chez les deux parents ou chez la me`re seulement sont autant de facteurs qui influencent la reĀ“alisation effective du deĀ“pistage du VIH chez lā€™enfant. Le principe preĀ“ventif du VIH, et le deĀ“sir de faire tester lā€™enfant ne suffisent pas a` eux seuls pour aboutir a` sa reĀ“alisation effective, selon certaines me`res confronteĀ“es au refus du conjoint. A lā€™opposeĀ“, les autres me`res refusant la reĀ“alisation du testĀ  peĀ“diatrique disent sā€™y opposer ; bien entendu, meĖ†me dans le cas ou` le conjoint lā€™accepterait.Discussion: Les me`res sont les principales mises en cause et craignent les reĀ“primandes et la stigmatisation. Le pe`re, le conjoint peut eĖ†tre un obstacle, quand il sā€™oppose au test VIH du nourrisson, ou devenir le facilitateur de sa reĀ“alisation sā€™il est convaincu. Le positionnement du pe`re demeure donc essentiel dans la question de lā€™acceptabiliteĀ“ du VIH peĀ“diatrique. Les me`res en ont conscience et preĀ“sagent des difficulteĀ“s a` faireĀ  deĀ“pister ou non les enfants sans avis preĀ“alable du conjoint a` la fois pe`re, et chef de famille.Conclusion: La question du deĀ“pistage peĀ“diatrique du VIH, au terme de notre analyse, met en face trois eĀ“leĀ“ments qui exigent une gestion globale pour assurer une couverture effective. Ces trois eĀ“leĀ“ments nā€™existeraient pas sans sā€™influencer, donc ils sont constamment en interaction et empeĖ†chent ou favorisent la reĀ“alisation ou non du test peĀ“diatrique. Aussi, dans une intention dā€™aboutir a` une couverture effective du deĀ“pistage VIH des nourrissons, faut-il tenir compte dā€™une gestion harmonieuse de ces trois eĀ“leĀ“ments: La premie`re, la me`re seule (avec ses connaissances, ses perceptions), son environnement conjugal (deĀ  proposition du test inteĀ“grant 1- lā€™eĀ“poux et / ou pe`re de lā€™enfant avec ses perceptions et connaissances sur lā€™infection 2- la faciliteĀ“ de parler du test et sa reĀ“alisation chez les deux ou un des parents, la me`re) et les connaissances, attitudes et pratiques du personnel de lā€™eĀ“tablissement sanitaire sur lā€™infection du VIH.Recommandations: Nos recommandations proposent une redeĀ“finition de lā€™approche du VIH/sida vers des familles exposeĀ“es au VIH et une inteĀ“gration plus accentueĀ“e du pe`re facilitant leur propre acceptation du test VIH et celle de leur enfant.Mots cleĀ“s: AcceptabiliteĀ“, Test VIH, Enfants, NourrissonsĀ Problem: HIV testing in children had rarely been a central concern for researchers. When pediatric tracking retained the attention, it was more to inform on the diagnosis tools performances rather than the fact the pediatric test can be accepted or refused. This article highlights the parentā€™s reasons which explain why pediatric HIV test is accepted or refused.Objective: To study among parents, the explanatory factors of the acceptability of pediatric HIV testing among infant less than six months.Methods: Semi-structured interview with repeated passages in the parents of infants less than six months attending in health care facilities for the pediatric weighing/vaccination and consultations.Results: We highlight that the parentā€™s acceptance of the pediatric HIV screening is based on three elements.Firstly, the health care workers by his speech (which indicates its own knowledge and perceptions on the infection) directed towards mothersā€™ influences their acceptance or not of the HIV test. Secondly, the mother who by her knowledge and perceptions on HIV, whose particular status, give an impression of her own wellbeing for her and her child influences any acceptance of the pediatric HIV test. Thirdly, the marital environment of the mother, particularly characterized by the ease of communication within the couple, to speak about the HIV test and its realization for the parents or the mother only are many factors which influence the effective realization of the pediatric HIV testing. The preventive principle of HIV transmission and the desire to realize the test in theĀ  newborn are not enough alone to lead to its effective realization, according to certain mothers confronted with the fatherā€™s refusal. On the other hand, the other mothers refusing the realization of the pediatric test told to be opposed to it; of course, even if their partner would accept it.Discussion: The mothers are the principal facing the pediatric HIV question and fear the reprimands and stigma. The father, the partner could be an obstacle, when he is opposed to the infant HIV testing, or also the facilitator with his realization if he is convinced. The father position thus remains essential face to the question of pediatric HIV testing acceptability. The mothers are aware of this and predict the difficulties of achieving their infant to be tested without the preliminary opinion of their partner at the same time father, and head of the family.Conclusion: The issue of pediatric HIV testing, at the end of our analysis, highlights three elements which require a comprehensive management to improve the coverage of pediatric HIV test. These three elements would not exist without being influenced; therefore they are constantly in interaction and prevent or support the realization or not pediatric test. Also, with the aim to improve the pediatric HIV test coverage, it is necessary to take into account the harmonious management of these elements. Firstly, the mother alone (with her knowledge, and perceptions), its marital environment (with the proposal of the HIV test integrating (1) the partner and/or father with his perceptions and knowledge on HIV infection and (2) facility of speaking about the test and its realization at both or one about the parents, the mother) and of the knowledge, attitudes and practices about the infection of health care workers of the sanitary institution.Recommendations: Our recommendations proposed taking into account a redefinition of the HIV/AIDS approach towards the families exposed to HIV and a more accentuated integration of the father facilitating their own HIV test acceptation and that of his child.Keywords: acceptability, HIV testing, children, infantsArticle in French

    Undernutrition among HIV-positive children in Dar es Salaam, Tanzania: antiretroviral therapy alone is not enough

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    BackgroundThe prevalence of HIV/AIDS has exacerbated the impact of childhood undernutrition in many developing countries, including Tanzania. Even with the provision of antiretroviral therapy, undernutrition among HIV-positive children remains a serious problem. Most studies to examine risk factors for undernutrition have been limited to the general population and ART-naive HIV-positive children, making it difficult to generalize findings to ART-treated HIV-positive children. The objectives of this study were thus to compare the proportions of undernutrition among ART-treated HIV-positive and HIV-negative children and to examine factors associated with undernutrition among ART-treated HIV-positive children in Dar es Salaam, Tanzania.MethodsFrom September to October 2010, we conducted a cross-sectional survey among 213 ART-treated HIV-positive and 202 HIV-negative children in Dar es Salaam, Tanzania. We measured the children\u27s anthropometrics, socio-demographic factors, food security, dietary habits, diarrhea episodes, economic status, and HIV clinical stage. Data were analyzed using both univariate and multivariate methods.ResultsART-treated HIV-positive children had higher rates of undernutrition than their HIV-negative counterparts. Among the ART-treated HIV-positive children, 78 (36.6%) were stunted, 47 (22.1%) were underweight, and 29 (13.6%) were wasted. Households of ART-treated HIV-positive children exhibited lower economic status, lower levels of education, and higher percentages of unmarried caregivers with higher unemployment rates. Food insecurity was prevalent in over half of ART-treated HIV-positive children\u27s households. Furthermore, ART-treated HIV-positive children were more likely to be orphaned, to be fed less frequently, and to have lower body weight at birth compared to HIV-negative children.In the multivariate analysis, child\u27s HIV-positive status was associated with being underweight (AOR = 4.61, 95% CI 1.38-15.36 P = 0.013) and wasting (AOR = 9.62, 95% CI 1.72-54.02, P = 0.010) but not with stunting (AOR = 0.68, 95% CI 0.26-1.77, P = 0.428). Important factors associated with underweight status among ART-treated HIV-positive children included hunger (AOR = 9.90, P = 0.022), feeding frequency (AOR = 0.02, p \u3c 0.001), and low birth weight (AOR = 5.13, P = 0.039). Factors associated with wasting among ART-treated HIV-positive children were diarrhea (AOR = 22.49, P = 0.001) and feeding frequency (AOR = 0.03, p \u3c 0.001).ConclusionHIV/AIDS is associated with an increased burden of child underweight status and wasting, even among ART-treated children, in Dar es Salaam, Tanzania. In addition to increasing coverage of ART among HIV-positive children, interventions to ameliorate poor nutrition status may be necessary in this and similar settings. Such interventions should aim at promoting adequate feeding patterns, as well as preventing and treating diarrhea

    Poor Clinical Outcomes for HIV Infected Children on Antiretroviral Therapy in Rural Mozambique: Need for Program Quality Improvement and Community Engagement

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