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Admin Sup FACET: Family Dynamics and Child Neurodevelopment in Botswana

Admin Sup FACET：博茨瓦纳的家庭动态和儿童神经发育

基本信息

批准号：
10766920
负责人：
Jennifer Jao
金额：
$ 28.77万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-03-17 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10766920
关键词：
15 year old 17 year old 2 year old Adolescent Advocate Affect Africa South of the Sahara Age Age Months Assessment tool Birth Botswana Caregiver support Caregivers Caring Categories Child Child Rearing Cohort Studies Country Couples Data Development Enrollment Ensure Environment Familiarity Family Family dynamics Focus Groups Growth HIV HIV Infections Health Healthcare High Prevalence Home Home environment Hospitalization Household Infant Infant Health Intervention Interview Knowledge Learning Life Linear Regressions Maps Marriage Methods Modeling Modification Mothers Newborn Infant Observational Study Outcome Parents Pattern Personal Satisfaction Persons Policies Population Pregnancy Prevalence Principal Investigator Public Health Qualitative Methods Qualitative Research Reporting Research Research Design Risk Role Safety Sampling Social Environment Source Structure Temperament Testing Time UNICEF Woman World Health Organization caregiving cohort design experience family structure family support fetal food insecurity high risk indexing instrument intimate partner violence life-long learning low and middle-income countries member mortality neurodevelopment nutrition peer pregnant primary caregiver programs prospective satisfaction social visual map young mother

项目摘要

In sub-Saharan Africa (SSA) is home to 90% of the nearly 16 million children who are HIV-exposed uninfected (CHEU). This population has been shown to be at increased risk of neurodevelopmental delays compared to their HIV-unexposed peers. The World Health Organization and UNICEF advocate for use of the Nurturing Care Framework, consisting of five facets of care – health, nutrition, responsive caregiving, safety from threats, and opportunities for learning – a framework shown to optimize child neurodevelopment when fully implemented. Given that families and caregivers are the primary source of a child's nurturing care, it is important to explore associations between family structures, home environment, and child neurodevelopment, particularly among families affected by HIV. In Botswana, a high prevalence HIV setting, one in four children under 15 years of age are CHEU, and fewer than 10% of parenting couples are formally married. Given the fact that the Nurturing Care Framework has never been programmatically implemented in Botswana and caregiving structures have not been well described, understand caregiving within this unique context of low marriage rates and high HIV prevalence and associations with developmental outcomes among CHEU is of critical public health importance. The proposed FACET study (Family Dynamics and Child Neurodevelopment in Botswana) will leverage an ongoing birth cohort within the FLOURISH Study (Following Longitudinal Outcomes to Understand, Report, Intervene and Sustain Health of Infants, Children and Adolescents who are HIV-Exposed Uninfected; R33 HD103099; Principal Investigators: Powis, Jao, Makhema) currently enrolling up to 300 pregnant persons, half of which are living with HIV, and their infants to a) (Aim 1) to characterize patterns of household composition and family dynamics for caregiving, and the role of nurturing care in promoting healthy neurodevelopment among children in Botswana using a focus group discussion format; and b) employing a mixed-methods design (Aim 2), assess the associations between child HIV exposure status, caregiver relationship factors, and child neurodevelopment. The Caregiver Reported Early Developmental Index (CREDI), a parent-reported assessment tool that has been validated for use across 26 countries, 17 of which are low-and-middle income countries, including Botswana, will be administered to FACET participating mothers when their child reaches six-months of life. Simultaneously, qualitative data will be collected from up to 30 mothers participating in a second round of focus group discussions exploring how their relationships with their partners, paternal involvement in caregiving, home environment factors (e.g., food insecurity, intimate partner violence), and child temperament may impact their caregiving. Convergent parallel triangulation will be employed to jointly interpret quantitative and qualitative research findings. Research is urgently needed to assess the combined impact of fetal HIV exposure and family structures on child neurodevelopment.

在撒哈拉以南非洲，近1600万未感染艾滋病毒的儿童中有90%居住在撒哈拉以南非洲（CHEU）.这一人群已被证明是在神经发育迟缓的风险增加相比，他们没有感染艾滋病的同龄人。世界卫生组织和联合国儿童基金会倡导使用“养育护理”，框架，包括五个方面的护理-健康，营养，反应迅速，安全的威胁，学习机会--一个框架在全面实施后可优化儿童神经发育。鉴于家庭和照顾者是儿童养育的主要来源，家庭结构，家庭环境和儿童神经发育之间的联系，特别是受艾滋病毒影响的家庭。在博茨瓦纳，艾滋病毒感染率很高，四分之一的15岁以下儿童只有不到10%的父母正式结婚。鉴于养育护理博茨瓦纳从未以方案方式实施框架，很好地描述，理解在低结婚率和高艾滋病毒流行率的独特背景下的婚姻 CHEU与发展结果之间的关系具有关键的公共卫生重要性。的拟议的FACET研究（博茨瓦纳的家庭动力学和儿童神经发育）将利用正在进行的 FLOURISH研究中的出生队列（了解、报告、干预的纵向结局和维持未感染艾滋病毒的婴儿、儿童和青少年的健康; R33 HD 103099; 主要研究者：Powis，Jao，Makhema）目前招募了多达300名孕妇，其中一半是（a）（目标1）确定家庭组成和家庭结构的模式，动力学，以及养育护理在促进儿童健康神经发育中的作用在博茨瓦纳使用焦点小组讨论格式;和B）采用混合方法设计（目标2），评估儿童HIV暴露状况、照顾者关系因素与儿童神经发育之间的关系。照顾者报告的早期发育指数（CREDI），一个父母报告的评估工具，经验证可在26个国家使用，其中17个是中低收入国家，包括博茨瓦纳，在婴儿出生6个月时，对参与FACET的母亲进行给药。与此同时，将从参加第二轮焦点小组讨论的多达30名母亲那里收集定性数据探索他们与伴侣的关系，父亲参与育儿，家庭环境因素（例如，粮食不安全、亲密伴侣暴力）和儿童性格可能影响他们的生育。收敛平行三角测量将被用来共同解释定量和定性研究调查结果。迫切需要研究评估胎儿艾滋病毒暴露和家庭结构的综合影响对儿童神经发育的影响