The Quality of Learning and Care at Community-Based Early Childhood Development Centers in Malawi

This exploratory study examined the strengths and weaknesses in the quality of early childhood care and learning at selected community-based childcare centers (CBCCs) in Malawi, and aimed to understand underlying challenges and opportunities that may be addressed to improve quality and ultimately children’s outcomes. Classroom environments and interactions were systematically observed at 12 CBCCs. Early childhood caregivers were surveyed, and in-depth interviews were conducted with key informants from the community. Areas of relative strength at the CBCCs included the physical environment, adult child interactions, and inclusiveness. However, the CBCCs struggled substantially with the quality of learning and play opportunities; the availability of play and learning materials; and the quality of instruction for literacy, numeracy, and science. Underlying challenges that emerged from surveys and interviews included the CBCCs’ reliance on unskilled and volunteer caregivers, lack of materials, lack of food for children, and lack of interest from parents in the CBCCs. A fundamental strength was that in almost all the communities, key stakeholders were aware of the challenges, were motivated and committed to improving quality at their CBCCs, and had already taken actions to address specific problems. CBCCs in Malawi hold tremendous potential to provide early childhood services to the most vulnerable children; however, communities need to be supported to improve the quality of learning and care at these centers to maximize the benefits for children’s development and long-term outcomes

Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review

Introduction: Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub-Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA. Methods: We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: “Depression OR Anxiety”, “Young people”, “HIV infections ” and “sub-Saharan Africa”. Results and discussion: Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV-negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV-related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV-positive status, bullying, sexual abuse, HIV-related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms. Conclusions: The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV-negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV-clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth-friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social suppor

A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya

Background: The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap. Methods: From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18–58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. A framework approach was used to analyze the data using NVIVO 11 software. Results: Participants reported experiences of HIV-related stigma in its various forms (anticipated, perceived, internalised, and enacted), as well as its effects on HIV treatment and social and personal spheres. The internalisation of stigma caused by enacted stigma impacted care-seeking behavior resulting in worse overall health. Anxiety and depression characterized by suicidal ideation were the results of internalised stigma. Anticipated stigma prompted HIV medication concealment, care-seeking in remote healthcare facilities, and care avoidance. Fewer social interactions and marital conflicts resulted from perceived stigma. Overall, HIV-related stigma resulted in partial and non-disclosure of HIV seropositivity and medication non-adherence. At a personal level, mental health issues and diminished sexual or marital prospects (for the unmarried) were reported. Conclusion: Despite high awareness of HIV and AIDS among the general population in Kenya, adults living with HIV in rural Kilifi still experience different forms of HIV-related stigma (including self-stigma) that result in a raft of social, personal, and HIV-treatment-related consequences. Our findings underscore the urgent need to reevaluate and adopt more effective strategies for implementing HIV-related anti-stigma programs at the community level. Addressing individual-level stigma will require the design of targeted interventions. To improve the lives of adults living with HIV in Kilifi, the effects of HIV-related stigma, particularly on HIV treatment, must be addressed

Psychosocial and mental health challenges faced by emerging adults living with HIV and support systems aiding their positive coping: a qualitative study from the Kenyan coast

Background: In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV tran- sitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults. Methods: In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18–24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software. Results: Young adults living with HIV from this setting face various challenges at different levels of the social eco- system. At the individual level, key challenges they reported included acceptance of HIV positive status, antiretroviral adherence, economic burden associated with access to healthcare, building an intimate relationship, mental health problems, and HIV status disclosure. At the family level, death of parents, poverty, and being unaccepted were the commonly mentioned challenges. At the community level, socialization difficulties and long waiting time at the HIV clinic were highlighted. HIV stigma and discrimination were frequently reported across the different levels. Economic independence, social support (from families, friends, organizations, healthcare providers and peer meetings), and reli- ance on spirituality aided positive coping among these young adults amidst the challenges of living with HIV. Conclusions: In this rural setting, emerging adults living with HIV face various challenges at the individual, family, and community level, some of which are cross-cutting. Our findings underscore the need for designing multi-level youth-friendly interventions that can address modifiable challenges encountered by emerging adults living with HIV in this and similar settings. Such interventions should incorporate appropriate context-specific support structures that may help these young people smoothly transit into adult life

HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast

Background: In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18–24 years from the Kenyan coast. Methods: Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilif and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defned as plasma viral load≥1000 copies/mL. Results: Among these YLWH with a mean age of 20.7 years (SD=2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confdence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p=0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p=0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p=0.01) were signifcantly associated with higher odds of VNS in YLWH. Conclusions: In this study, high levels of VNS were observed among YLWH and this was signifcantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensifed in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profle HIV drug resistance patterns in youths from the Kenyan coast with confrmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherenc

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

Background: In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. Methods: Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. Results: The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p \u3c 0.01; current illicit drug use, 7% vs. 15%, p \u3c 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p \u3c 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (\u3c 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. Conclusions: At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives

Brief report: Validity and reliability of the Nigerian Autism Screening Questionnaire

Informant-report measures for screening symptoms of autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs) are needed for low-resource settings if early identification is to be prioritized because early developmental concerns are likely to be expressed by parents and other caregivers. This paper describes the initial psychometric evaluation of the Nigeria Autism Screening Questionnaire (NASQ). Parents and other caregivers completed the NASQ on 12,311 children ages 1 to 18 in a Nigerian population sample as part of the World Bank National General Household Survey conducted in the country in 2016. Factor analyses indicated a parsimonious three-factor structure with social communication/interaction, repetitive sensory motor, and insistence on sameness dimensions. Measurement invariance was excellent across age and sex. Reliability of the subscales and total scale was good, and item response theory analyses indicated good measurement precision in the range from below average to high scores, crucial for screening, and tracking ASD symptoms. Studies with gold standard ASD diagnostic instruments and clinical confirmation are needed to evaluate screening and diagnostic accuracy. The NASQ appears to be a reliable instrument with a clear factor structure and potential for use in screening and tracking ASD symptoms in future Nigerian samples

Assessing Executive Function in Adolescence: A scoping review of existing measures and their psychometric robustness

The dataset contains information extracted from 705 studies. The information was used in the conducted scoping review. Objectives were to identify EF measures used with adolescent population, the most preferred measures and their psychometric evidence. </p

Dormancy and Physiological Age of Seed Tubers from a Diverse Set of Potato Cultivars Grown at Different Altitudes and in Different Seasons in Kenya

The study was conducted to determine the dormancy and physiological age characteristics of diverse potato genotypes as influenced by growing altitudes and seasons for future breeding strategies and optimal patterns of use. Dormancy and sprouting characteristics have an impact on tuber production, storability and seed quality for planting and ware for consumption and the market. This study presents the results of dormancy and physiological age measurements conducted on 47 potato genotypes grown at three altitudes with three replications at each location and in two contrasting growing seasons. The seed tubers were evaluated at low altitude under darkness on moist sand storage conditions to assess their dormancy release, number of sprouts, sprout weight, sprout length and percentage tuber weight loss. Results showed significant (p < 0.001) differences among genotypes, locations and seasons, and significant interactions between these factors for days to dormancy release, number of sprouts per tuber at dormancy release and at 45 days after dormancy release, length of longest sprout, weight loss percentage of unsprouted and sprouted tubers at dormancy release and at 45 days after dormancy release, respectively. There was a wide variation in time to dormancy release (54 to 136 days); most genotypes showed medium to long dormancy. Seed tubers grown at low altitude showed longer dormancy than those grown at higher altitudes, while genotypic differences in dormancy were very consistent across environments. Genotypes strongly differed in sprouting characteristics and weight loss. There were highly significant interactions between altitude and season for all variables assessed, except for the number of sprouts 45 days after dormancy release and the weight loss after sprouting. Generally, the genotypic effects were larger than those of altitude, season and the interaction effects for all variables evaluated. This paper will allow variety selection to optimize seed quality at planting and minimize storage losses while providing new targets for breeders

Validation of a Swahili version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to a community sample from Kilifi, Kenya

Background: Depression remains under-investigated in people living with HIV in sub-Saharan Africa due to paucity of adequately validated measures. This study aimed to validate an adapted version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to those from the community in Kilifi, Kenya. Methods: Analysis of data from 450 adults living with HIV and 337 adults from the community was conducted examining the reliability, factorial structure, measurement invariance and discriminant validity of interviewer-administered PHQ-9, Swahili version. Results: Internal consistency of the Swahili PHQ-9 was good overall, in adults living with HIV and those from the community (Macdonald's omega > 0.80). The two-week test-retest reliability was acceptable among adults living with HIV (ICC = 0.64). A one-factor confirmatory factor analysis (CFA) model indicated the Swahili PHQ-9 was unidimensional in the overall sample, in adults living with HIV and those from the community. Multi-group CFA substantiated measurement invariance of this unidimensional scale across participant group (adults living with HIV vs. community), sex (females vs. males) and age category (young, middle-age and elderly adults). The Swahili PHQ-9 exhibited good discriminant validity between the two participant groups. Limitations: No diagnostic interview for mental disorders was administered in the original studies limiting analysis of sensitivity and specificity of the Swahili PHQ-9. Conclusion: The Swahili PHQ-9 is a reliable and valid unidimensional scale. It appears a valuable tool for assessing depressive symptoms that can be generalized across different demographic groups, in primary HIV clinics and the general community within this and similar settings