Vulnerable children in Ukraine : impact of institutional care and HIV on the development of preschoolers

Although institutional care jeopardizes children’s development, some studies suggest that well-functioning child-care institutions may offer children a better environment than their own dysfunctional families. For the growing number of HIV-infected children who often live in underprivileged families or institutions, comparative studies on their care arrangements are crucial. In her dissertation Natasha Dobrova-Krol examined the impact of institutional care and HIV-infection on several developmental domains of more than 60 Ukrainian preschoolers. Physical growth, stress regulation, cognitive and social development, as well as organization of attachment and children’s indiscriminately friendly behavior were addressed in this study. Developmental outcomes of HIV-infected children reared in disadvantaged families were compared with the outcomes of children reared in institutions providing adequate medical and physical care. In search for possible risk and protective factors in the development of the children individual characteristics and various aspects of the rearing environment were explored. The findings of this study demonstrated that institutional rearing impeded the development of children in all domains. Both for children with and without HIV family care, even of compromised quality, was better than institutional care, even of good quality. HIV-infection was found to be associated with less favorable outcomes in physical growth and cognitive development. The negative impact of institutional care, however, was larger than the presence of HIV. In three out of six developmental domains that were examined, HIV-infected children reared in disadvantaged families showed significantly better results than both HIV-infected and uninfected children reared in institutions, and no difference was found in the other domains. The quality of the child-caregiver relationship had a larger impact on children’s physical growth and cognitive performance than either HIV-infection or the quality of the physical environment and thus represents an important intervention target. The study has important implications for intervention efforts in child-care institutions.LEI Universiteit LeidenSpinoza scholarshipFSW - Gezinsopvoeding - Ou

The motor development of orphaned children with and without HIV: Pilot exploration of foster care and residential placement

<p>Abstract</p> <p>Background</p> <p>The AIDS epidemic has lead to an increase in orphaned children who need residential care. It is known that HIV leads to delayed motor development. However, the impact of place of residence on motor function has not been investigated in the South African context. The aim of the study was therefore to establish if children in institutionalised settings performed better or worse in terms of gross motor function than their counterparts in foster care. A secondary objective was to compare the performance of children with HIV in these two settings with those of children who were HIV negative.</p> <p>Methods</p> <p>Forty-four children both with and without HIV, were recruited from institutions and foster care families in Cape Town. The Peabody Development Motor Scale (PDMS II) was used to calculate the total motor quotient (TMQ) at baseline and six months later. Comparisons of TMQ were made between residential settings and between children with and without HIV.</p> <p>Results</p> <p>Twenty-one children were infected with HIV and were significantly delayed compared to their healthy counterparts. Antiretroviral therapy was well managed among the group but did not appear to result in restoration of TMQ to normal over the study period. HIV status and place of residence emerged as a predictor of TMQ with children in residential care performing better than their counterparts in foster care. All children showed improvement over the six months of study.</p> <p>Conclusions</p> <p>Foster parents were well supported administratively in the community by social welfare services but their children might have lacked stimulation in comparison to those in institutional settings. This could have been due to a lack of resources and knowledge regarding child development. The assumption that foster homes provide a better alternative to institutions may not be correct in a resource poor community and needs to be examined further.</p

Vigilância do desenvolvimento neuropsicomotor de crianças de um programa DST/AIDS

A terapia anti-retroviral de alta potência (TARV) é uma forma eficaz de prevenção da transmissão do vírus HIV de mãe para filho. No entanto, os estudos ainda investigam os efeitos da exposição intraútero à TARV, dentre eles o atraso no desenvolvimento neuropsicomotor (DNPM). O presente estudo apresenta o relato de um projeto de extensão, cujos objetivos foram verificar o DNPM de crianças de um programa DST/AIDS, orientar as famílias considerando seu contexto socioeconômico e realizar encaminhamentos para serviços de saúde específicos. A vigilância do DNPM foi feita em três etapas: (1) avaliação em ambulatório; (2) avaliação e orientações em domicílio; (3) elaboração de relatórios aos gestores de saúde. Foram utilizados os testes DENVER II e o PEDI, além de um questionário socioeconômico. Participam do programa DST/AIDS 15 crianças, sendo 12 soro-revertidas, 1 soropositiva e 2 indefinidas. Doze crianças foram avaliadas, e os domínios mais comprometidos foram linguagem, pessoal-social e motor fino, respectivamente. Quanto ao nível econômico, 73,3% pertenciam ao nível E, e 58,3% das mães eram analfabetas ou cursaram apenas o primário. Crianças filhas de mães HIV positivo, além de fatores biológicos, geralmente estão expostas a fatores de risco ambientais que contribuem para alterações do DNPM. Desta forma, o acompanhamento por uma equipe de profissionais de saúde, em parceria com a família da criança, torna-se uma importante ferramenta para a identificação e intervenção precoce.Highly active antiretroviral therapy (HAART) is an effective way of preventing mother-to-child transmission of HIV. However, further studies investigate the effects of short and long term exposure to HAART in-utero and its consequence on child neuropsychomotor development (NPMD). The paper presents a report and discussion of results of an extension project whose objectives were to verify the NPMD of children participating of the STD/AIDS program, to orientate families according to their socioeconomic context and make referrals to specific health services. The NPMD surveillance was divided into three parts: (1) ambulatory evaluation; (2) home evaluation and orientations; (3) reporting health managers. DENVER II and PEDI tests were used and also a socioeconomic questionnaire. Fifteen children were on the program of which 12 uninfected, 1 HIV+ and 2 indeterminate. Twelve children were evaluated and the most impaired domain were language, personal-social and fine motor, respectively. Regarding to socioeconomic status, 73,3% were E level and 58,3% of mothers were analphabet or had primary school. Children born of infected mothers, besides the biological risks, usually are exposed to environment/social risks that can affect the NPMD. Thus, monitoring by a team of health professionals, in partnership with the child's family, becomes an important tool for identification and early intervention

Vulnerable children in Ukraine : impact of institutional care and HIV on the development of preschoolers

Although institutional care jeopardizes children’s development, some studies suggest that well-functioning child-care institutions may offer children a better environment than their own dysfunctional families. For the growing number of HIV-infected children who often live in underprivileged families or institutions, comparative studies on their care arrangements are crucial. In her dissertation Natasha Dobrova-Krol examined the impact of institutional care and HIV-infection on several developmental domains of more than 60 Ukrainian preschoolers. Physical growth, stress regulation, cognitive and social development, as well as organization of attachment and children’s indiscriminately friendly behavior were addressed in this study. Developmental outcomes of HIV-infected children reared in disadvantaged families were compared with the outcomes of children reared in institutions providing adequate medical and physical care. In search for possible risk and protective factors in the development of the children individual characteristics and various aspects of the rearing environment were explored. The findings of this study demonstrated that institutional rearing impeded the development of children in all domains. Both for children with and without HIV family care, even of compromised quality, was better than institutional care, even of good quality. HIV-infection was found to be associated with less favorable outcomes in physical growth and cognitive development. The negative impact of institutional care, however, was larger than the presence of HIV. In three out of six developmental domains that were examined, HIV-infected children reared in disadvantaged families showed significantly better results than both HIV-infected and uninfected children reared in institutions, and no difference was found in the other domains. The quality of the child-caregiver relationship had a larger impact on children’s physical growth and cognitive performance than either HIV-infection or the quality of the physical environment and thus represents an important intervention target. The study has important implications for intervention efforts in child-care institutions.</p