Correlates of fatigue among South African adolescents living with HIV and receiving antiretroviral therapy

Fatigue among adolescents living with HIV is poorly understood. In this study, we examined the relationships between fatigue and demographic and psychosocial variables to further the understanding of the symptom experience and associated factors. We recruited consecutive attenders at ART clinics in the Western Cape, South Africa (N = 134, age 11–18 years). Participants completed a battery of questionnaires including measures of fatigue, insomnia and mood disturbance. Just under a quarter (24.6%) of adolescents reported elevated levels of fatigue that affected their functioning. The linear combination of age, depression, and insomnia explained 40.6% of the variance in fatigue. Amongst adolescents with HIV, fatigue seems a problematic symptom associated with poor sleep and mood disturbance. Timely identification and management of these potentially disabling symptoms are needed to attain better health outcomes and retention in care in this group. Interventions aimed at ameliorating these symptoms are needed

Correlates of fatigue among South African adolescents living with HIV and receiving antiretroviral therapy

Fatigue among adolescents living with HIV is poorly understood. In this study, we examined the relationships between fatigue and demographic and psychosocial variables to further the understanding of the symptom experience and associated factors. We recruited consecutive attenders at ART clinics in the Western Cape, South Africa (N = 134, age 11–18 years). Participants completed a battery of questionnaires including measures of fatigue, insomnia and mood disturbance. Just under a quarter (24.6%) of adolescents reported elevated levels of fatigue that affected their functioning. The linear combination of age, depression, and insomnia explained 40.6% of the variance in fatigue. Amongst adolescents with HIV, fatigue seems a problematic symptom associated with poor sleep and mood disturbance. Timely identification and management of these potentially disabling symptoms are needed to attain better health outcomes and retention in care in this group. Interventions aimed at ameliorating these symptoms are needed

Fatigue among South Africa adolescents living with HIV: Is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue

Evidence suggests that HIV-infected adolescents experience elevated levels of fatigue that impacts their functioning at school and other important aspects of their lives. Yet, fatigue has not been measured amongst this population group. In this cross-sectional, mixed-methods study, we explored the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) amongst 134 South African adolescents (11–18 years old) receiving antiretroviral therapy in the Western Cape. Using the Likert scoring method for the CFQ, the mean total score was 14.89 (SD = 3.83) and about a quarter (n = 33, 24.63%) of adolescents scored ≥18, indicating problematic levels of fatigue. The CFQ demonstrated good internal consistency with a Cronbach’s alpha of 0.83 (0.84, with item 11 deleted), which is comparable to other validation studies. On the first iteration of the principal component analysis (PCA) with a Varimax rotation, three factors accounted for 59.15% of the variance. However, the third factor consisted of one item only which we chose to remove from the analysis. On the second iteration of the PCA, a two-factor solution was retained that accounted for 54.24% of the variance. The first factor, ‘Physical fatigue’, represented the first eight items on the scale. The second factor, ‘Mental fatigue’, represented items 9 and 10. The CFQ also demonstrated modest content and construct validity. The CFQ is a short, easy-to-use and cost-effective measure of fatigue, and demonstrates reliability and validity amongst a South African sample of adolescents. Given the high rate of fatigue amongst our participants, we recommend that future interventions be developed to reduce fatigue among HIV-infected adolescents, which may ultimately lead to improvements in school performance and social functioning. Future research may include test–retest reliability of the CFQ in order to show stability over time

‘…But I’m still tired’: The experience of fatigue among South African adolescents receiving antiretroviral therapy.

In adults with HIV, fatigue is a common and disabling symptom associated with suboptimal adherence to antiretroviral therapy (ART), poor health and well-being, reduced economic productivity, and increased health care resource use. Fatigue among adolescents with HIV is relatively unexplored. We recruited 14 adolescents with HIV receiving ART in South Africa whom we interviewed about fatigue. We used thematic analysis to analyse the data. Participants reported difficulties in maintaining concentration at school and resorting to self-care strategies such as napping during school hours. Adolescents also described actively avoiding activities thought to lead to fatigue and spoke of being socially excluded by their peers. The findings demonstrate that adolescents experienced symptoms consistent with a definition of fatigue, which had implications for their academic and social lives

Psychosocial predictors of quality of life among South Africa adolescents receiving antiretroviral therapy

PurposeMinimal research has been conducted to understand how fatigue influences quality of life (QOL) among adolescents living with HIV. The purpose of the study was to examine the relationship between fatigue, sleep disturbance, depression, anxiety, pain and QOL among adolescents receiving antiretroviral therapy (ART).MethodsUsing a cross-sectional survey design, we studied 134 South African adolescents receiving an ART at community clinics.ResultsParticipants in general reported low levels of fatigue, insomnia, distress and pain and non-problematic levels of QOL. In the regression model, the linear combination of these variables explained 49% of the variance in QOL, a large effect size. Insomnia, anxiety, and depression significantly predicted QOL but surprisingly fatigue and pain did not.ConclusionsMany members of the sample experienced non-clinical levels of sleep disturbance, fatigue and psychosocial distress. Similarly, QOL was within the normal range. These findings are surprising as the commonly held assumption is that adolescents living with HIV, especially those of poorer socio-economic backgrounds, would experience lower QOL than the norm. Even though scores on the instruments measuring these variables fell in the non-clinical range, they were still robustly predictive of poor QOL. Future research may address the relationship between self-reported adherence and QOL, possibly by examining the role of viral load as a mediating variable. Further research may also focus on non-adherent adolescents to understand the ways in which fatigue and other factors such as school functioning and social interaction influence QOL

Protocol for the OCAY study: a cohort study of orphanhood and caregiver loss in the COVID-19 era to explore the impact on children and adolescents

INTRODUCTION: Globally, no person has been untouched by the COVID-19 pandemic. Yet, little attention has been given to children and adolescents in policy, provision and services. Moreover, there is a dearth of knowledge regarding the impact of COVID-19-associated orphanhood and caregiver loss on children. This study aims to provide early insights into the mental health and well-being of children and adolescents experiencing orphanhood or caregiver loss in South Africa. METHODS AND ANALYSIS: Data will be drawn from a quantitative longitudinal study in Cape Town, South Africa. A sample of children and adolescents between the ages of 9 and 18 years, experiencing parental or caregiver loss from COVID-19, will be recruited together with a comparison group of children in similar environments who did not experience loss. The study aims to recruit 500 children in both groups. Mental health and well-being among children will be explored through the use of validated and study-specific measures. Participants will be interviewed at two time points, with follow-up data being collected 12-18 months after baseline. A combination of analytical techniques (including descriptive statistics, regression modelling and structural equation modelling) will be used to understand the experience and inform future policy and service provision. ETHICS AND DISSEMINATION: This study received ethical approval from the Health Research Ethics Committee at Stellenbosch University (N 22/04/040). Results will be disseminated via academic and policy publications, as well as national and international presentations including high-level meetings with technical experts. Findings will also be disseminated at a community level via various platforms

Understanding accelerators to improve SDG-related outcomes for adolescents:An investigation into the nature and quantum of additive effects of protective factors to guide policy making

Recent evidence has shown support for the United Nations Development Programme (UNDP) accelerator concept, which highlights the need to identify interventions or programmatic areas that can affect multiple sustainable development goals (SDGs) at once to boost their achievement. These data have also clearly shown enhanced effects when interventions are used in combination, above and beyond the effect of single interventions. However, detailed knowledge is now required on optimum combinations and relative gain in order to derive policy guidance. Which accelerators work for which outcomes, what combinations are optimum, and how many combinations are needed to maximise effect? The current study utilised pooled data from the Young Carers (n = 1402) and Child Community Care (n = 446) studies. Data were collected at baseline (n = 1848) and at a 1 to 1.5- year follow-up (n = 1740) from children and young adolescents aged 9-13 years, living in South Africa. Measures in common between the two databases were used to generate five accelerators (caregiver praise, caregiver monitoring, food security, living in a safe community, and access to community-based organizations) and to investigate their additive effects on 14 SDG-related outcomes. Predicted probabilities and predicted probability differences were calculated for each SDG outcome under the presence of none to five accelerators to determine optimal combinations. Results show that various accelerator combinations are effective, though different combinations are needed for different outcomes. Some accelerators ramified across multiple outcomes. Overall, the presence of up to three accelerators was associated with marked improvements over multiple outcomes. The benefit of targeting access to additional accelerators, with additional costs, needs to be weighed against the relative gains to be achieved with high quality but focused interventions. In conclusion, the current data show the detailed impact of various protective factors and provides implementation guidance for policy makers in targeting and distributing interventions to maximise effect and expenditure. Future work should investigate multiplicative effects and synergistic interactions between accelerators

Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity

Maternal prenatal stress places a substantial burden on mother’s mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites

Structural brain differences and motor functioning in prenatally Methamphetamine exposed children in Cape Town

Thesis (MA)--Stellenbosch University, 2017.ENGLISH SUMMARY: Rates of methamphetamine use amongst pregnant women in South Africa is alarmingly high, rendering a large number of infants and children at risk for the adverse consequences of prenatal methamphetamine exposure (PME). Indeed, little is known about the effect of PME on brain and cognitive development in exposed children, especially in lowand middle-income settings like South Africa. The aim of the study was to contribute to the small, but growing, body of research that focuses on the brain development and motor performance of prenatally MA exposed children. The objectives were: (1) to examine the effect of PME on motor development in exposed children at the age of 8 years, compared to unexposed children of the same age; (2) to examine the effect of PME on structural brain volumes and cortical thicknesses of the brain in exposed children at the age of 8 years, compared to unexposed children; and (3) to investigate whether a correlation exists between altered brain development and motor function. Participants were 8 year old PME children (n = 17), and unexposed children (n=16) recruited from a local school and day care centre in the northern suburbs of Cape Town. PME children and unexposed controls completed two neurocognitive assessments (Beery Visual Motor Integration (VMI) test and Grooved Pegboard Test), assessing various aspects of motor function. Both groups also underwent magnetic resonance imaging (MRI). Independent sample t-tests showed that PME children scored significantly lower on measures of visual-motor integration, visual-motor coordination and fine motor development, when compared to unexposed children. Hierarchical regression analysis considering potential confounding anthropometric and socio-demographic variables and group effects, confirmed that poorer motor scores observed amongst PME children was as a result of PME. Analysis of variance (ANOVA) by group revealed that PME children had reduced cortical thickness in several brain areas that were associated with motor function.Overall, the findings of this study contribute to the growing body of literature available on the effect of PME on brain and motor development, especially in the South African context.AFRIKAANS OPSOMMING: Die gebruik van metamfetamien onder swanger vroue in Suid Afrika is skrikwekkend hoog, wat ‘n hoë hoeveelheid babas en kinders blootstel aan die negatiewe gevolge van prenatale metamfetamien blootstelling (PMB). Min kennis is beskikbaar oor die uitwerking van PMB op brein en kognitiewe ontwikkeling in blootgestelde kinders, veral in lae- en middel-inkomste areas soos Suid Afrika. Die hoof doel was om toe te voeg tot die groeiende literatuur rakende brein ontwikkeling en motoriese funksie in kinders met PMB. Die doelstelling was: (1) om die effek van PMB op motoriese ontwikkeling in blootgestelde kinders te ondersoek op die ouderdom van 8 jaar; (2) om die effek van PMB op strukturele brein volumes en kortikale dikte te ondersoek in blootgestelde kinders op die ouderdom van 8 jaar; (3) om te ondersoek of daar ‘n korrelasie bestaan tussen veranderinge in brein ontwikkeling en motoriese funksie. Deelnemers was 8 jarige PMB kinders (n = 17), en nieblootgestelde kinders (n = 16) wat gewerf was vanaf ‘n plaaslike skool en dagsorg sentrum in die noordelike voorstede van Kaapstad. Beide PMB kinders en nie-blootgestelde kinders het twee neuro-kognitiewe toetse voltooi (Beery VMI toets en die Grooved Pegboard toets), wat verskeie aspekte van motoriese funksie evalueer. Beide groepe het ook magnetiese resonansbeelding ondergaan. ‘n Onafhanklike t-toets het gewys dat PMB kinders aansienlik laer presteer, vergelyking met nie-blootgestelde kinders, in toetse van visuele-motoriese integrasie, visuele-motoriese koordinasie en fyn motoriese ontwikkeling. Hiërargiese regressie-analise, wat die moontlike impak van antropometriese en sosio-demografiese veranderlikes en groep effek oorweeg het, het vasgestel dat laer motoriese tellings, onder PMB kinders, die oorsaak van PMB is. Ontleding van variansie onder groepe het gevind dat PMB kinders laer kortikale diktes in verskeie brein areas het wat verband hou met motoriese funksie. Algeheel, die bevindinge van die studie dra by tot die groeiende liggaam van literatuur beskikbaar op die effek van PMB op brein en motoriese ontwikkeling, veral in die Suid Afrikaanse konteks

Fatigue among South Africa adolescents living with HIV: Is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue

Evidence suggests that HIV-infected adolescents experience elevated levels of fatigue that impacts their functioning at school and other important aspects of their lives. Yet, fatigue has not been measured amongst this population group. In this cross-sectional, mixed-methods study, we explored the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) amongst 134 South African adolescents (11–18 years old) receiving antiretroviral therapy in the Western Cape. Using the Likert scoring method for the CFQ, the mean total score was 14.89 (SD = 3.83) and about a quarter (n = 33, 24.63%) of adolescents scored ≥18, indicating problematic levels of fatigue. The CFQ demonstrated good internal consistency with a Cronbach’s alpha of 0.83 (0.84, with item 11 deleted), which is comparable to other validation studies. On the first iteration of the principal component analysis (PCA) with a Varimax rotation, three factors accounted for 59.15% of the variance. However, the third factor consisted of one item only which we chose to remove from the analysis. On the second iteration of the PCA, a two-factor solution was retained that accounted for 54.24% of the variance. The first factor, ‘Physical fatigue’, represented the first eight items on the scale. The second factor, ‘Mental fatigue’, represented items 9 and 10. The CFQ also demonstrated modest content and construct validity. The CFQ is a short, easy-to-use and cost-effective measure of fatigue, and demonstrates reliability and validity amongst a South African sample of adolescents. Given the high rate of fatigue amongst our participants, we recommend that future interventions be developed to reduce fatigue among HIV-infected adolescents, which may ultimately lead to improvements in school performance and social functioning. Future research may include test–retest reliability of the CFQ in order to show stability over time