Health & Psychosocial Need: Children with Developmental Disorder in a Time of HIV

说明(申请人提供)：这项研究的长期目标是采取干预措施，促进南非儿童更好的身体和心理社会功能，这项研究将确定患有神经发育障碍的儿童的认知和社会功能如何受到与健康相关的(艾滋病毒、贫血、其他感染)、背景因素(社会经济和环境、获得护理和治疗干预的机会)和心理社会因素(照料者的特征，包括精神健康和药物使用、家庭功能)的影响。来自艾滋病毒流行地区的大约2000名5岁和6岁儿童将接受残疾筛查，然后在入学前进行评估。他们将在入学后24个月后接受重新评估。这项研究将为儿童和照顾者提供艾滋病毒检测，并对所有已确定的疾病进行转诊治疗。这些儿童中的许多人与患病或死于艾滋病的父母住在一起。贫穷、获得保健和教育的机会不足等其他挑战也很常见；儿童健康和福祉面临的许多其他风险，包括营养不足、感染和创伤以及照料者抑郁和药物使用影响着许多儿童。因此，许多儿童的功能没有达到最佳水平，并面临发展障碍的风险。这项研究将首先横向和纵向调查神经发育障碍与上述危险因素之间的关系，包括AS结局、儿童认知和心理社会功能以及纵向目标中的学校功能。研究将同时处理横向和纵向关系，评估转介、治疗和获得计划的影响。社区人种学研究将与流行病学研究的结果相联系，以确定文化上适当的干预措施。我们将确定可供干预的已知影响儿童风险和复原力的因素，并与社区领导人合作，以参与式方式制定有效的社区干预措施。此外，研究方法的培训和提高研究能力将是本研究的主要目标之一。这将包括在实地和课堂教学和培训方面培训公共卫生专业学生、人种学学生、儿科登记员、专职卫生专业人员和社区卫生工作者。这将在哥伦比亚大学调查人员的协助下，与UKZN Fogarty计划、山谷信托基金、康复股和UKZN医学院合作进行管理

DESCRIPTION (provided by applicant): With the long term goal of intervening to promote better physical and psychosocial functioning of children in South Africa, this study will determine how the ability of children with neurodevelopmental disorders to function cognitively and socially is influenced by both health-related (HIV, anemia, other infection), contextual (socio-economic and environmental, access to care and therapeutic intervention) and psychosocial factors (caregiver characteristics including mental health and substance use, family functioning). Approximately 2000 5 and 6 year old children from a HIV prevalent area will be screened for disability and then assessed before school entry. They will be reassessed 24 months later after school entry. The study will offer HIV testing to children and caregivers and referral for treatment for all conditions identified. Many of these children live with parents who are ill or have parents who have died from AIDS. Additional challenges such as poverty, inadequate access to health care and to education are common; many other risks to child health and well-being, including inadequate nutrition, infection and trauma as well as caregiver depression and substance use affect many children. As a result, many children do not function at optimal levels, and are at risk for developmental disabilities. The study will investigate first cross sectionally and then longitudinally the relationships among neurodevelopmental disorders and the above mentioned risk factors including as outcomes, child cognitive and psychosocial functioning and in the longitudinal aim, school functioning .The study will address both cross sectional and longitudinal relationships, assessing the impact of referral, treatment and access to programs over time. Community ethnographic studies will be linked to the findings of the epidemiologic study to identify culturally appropriate interventions. We will identify factors open to intervention which are known to affect child risk and resilience and work with community leaders in a participatory approach to develop an effective community based intervention. In addition, training in research methods and enhancing research capacity will be one of the key aims of this research. This will involve training public health students, ethnography students, pediatric registrars, allied health professionals and community health workers in both field and classroom teaching and training. This will be managed in collaboration with the UKZN Fogarty Program, the Valley Trust, the Rehabilitation Unit and the Medical School at UKZN with assistance from the Columbia investigators