Barriers to the care of HIV-infected children in rural Zambia: a cross-sectional analysis

<p>Abstract</p> <p>Background</p> <p>Successful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. The objective of this study was to identify patient characteristics, barriers to care, and treatment responses of HIV-infected children seeking care in rural Zambia.</p> <p>Methods</p> <p>Cross-sectional analysis of HIV-infected children seeking care at Macha Hospital in rural southern Zambia. Information was collected from caretakers and medical records.</p> <p>Results</p> <p>192 HIV-infected children were enrolled from September 2007 through September 2008, 28% of whom were receiving antiretroviral therapy (ART) at enrollment. The median age was 3.3 years for children not receiving ART (IQR 1.8, 6.7) and 4.5 years for children receiving ART (IQR 2.7, 8.6). 91% travelled more than one hour to the clinic and 26% travelled more than 5 hours. Most participants (73%) reported difficulties accessing the clinic, including insufficient money (60%), lack of transportation (54%) and roads in poor condition (32%). The 54 children who were receiving ART at study enrollment had been on ART a median of 8.6 months (IQR: 2.7, 19.5). The median percentage of CD4⁺T cells was 12.4 (IQR: 9.2, 18.6) at the start of ART, and increased to 28.6 (IQR: 23.5, 36.1) at the initial study visit. However, the proportion of children who were underweight decreased only slightly, from 70% at initiation of ART to 61% at the initial study visit.</p> <p>Conclusion</p> <p>HIV-infected children in rural southern Zambia have long travel times to access care and may have poorer weight gain on ART than children in urban areas. Despite these barriers, these children had a substantial rise in CD4⁺T cell counts in the first year of ART although longer follow-up may indicate these gains are not sustained.</p

Critical agency and development: applying Freire and Sen to ICT4D in Zambia and Brazil

This paper draws upon critical theories and the capability approach. It argues for a conceptualization of development as a process designed to enable people to free themselves from structural disadvantage. Amartya Sen has argued that people’s “critical-agency” to question and reject unjust social norms is “pivotal” to human development and important for tackling inequalities of any kind. Freire’s critical pedagogy, and critical feminism, go further by providing disadvantaged people with the practical means to do this; to identify the structural root causes of unjust social norms and the critical-agency to challenge and change them. Two empirical case studies of ICT4D are presented, from Zambia and Brazil, which draw upon these critical approaches but use them in different ways. The paper argues that ICT4D must go beyond addressing people’s immediate practical needs for access to ICT tools and skills, to also address their strategic interest in identifying and tackling the root causes of disadvantage