Effect of Caregiver Training on the Neurodevelopment of HIV-Exposed Uninfected Children and Caregiver Mental Health: A Ugandan Cluster-Randomized Controlled Trial

Overview

Journal J Dev Behav Pediatr

Specialties Pediatrics
Social Sciences

Date 2017 Oct 10

PMID 28991146

Citations 24

Authors

Michael J Boivin

Noeline Nakasujja

Itziar Familiar-Lopez

Sarah M Murray

Alla Sikorskii

Jorem Awadu

Cilly Shohet

Deborah Givon

Horacio Ruisenor-Escudero

Elizabeth E Schut

Robert O Opoka

Judith K Bass

Affiliations

Soon will be listed here.

Abstract

Objective: Early childhood development programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these 2 components in a cluster-randomized controlled trial to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers.

Methods: Two hundred twenty-one HIV-exposed but uninfected child (2-3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either (1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation or (2) Uganda Community Based Association for Child Welfare (UCOBAC) program that delivered health and nutrition training. Children were evaluated at baseline, 6 months, 1 year (training conclusion), and 1-year posttraining with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell Home Observation for the Measurement of the Environment (HOME) was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment.

Results: Mediational Intervention for Sensitizing Caregivers resulted in significantly better quality of caregiving compared with UCOBAC midintervention with an adjusted mean difference (MadjDiff) of 2.34 (95% confidence interval [CI]: 1.54-3.15, p < .01), postintervention (MadjDiff = 2.43, 95% CI: 1.61-3.25, p < .01), and at 1-year follow-up (MadjDiff = 2.07, 95% CI: 1.23-2.90, p < .01). MISC caregivers reported more problems on the BRIEF for their child at 1-year posttraining only (p < .01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance 1-year posttraining for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms.

Conclusion: Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared with health and nutrition training.

Trial Registration: clinicaltrials.gov Identifier: NCT01640561.

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References

Bindt C, Appiah-Poku J, Bonle M, Schoppen S, Feldt T, Barkmann C . Antepartum depression and anxiety associated with disability in African women: cross-sectional results from the CDS study in Ghana and Côte d'Ivoire. PLoS One. 2012; 7(10):e48396. PMC: 3482210. DOI: 10.1371/journal.pone.0048396. View

Grantham-McGregor S . What is the best design for early childhood interventions?. Dev Med Child Neurol. 2015; 58(3):222-3. DOI: 10.1111/dmcn.12951. View

Walker S, Wachs T, Meeks Gardner J, Lozoff B, Wasserman G, Pollitt E . Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007; 369(9556):145-57. DOI: 10.1016/S0140-6736(07)60076-2. View

Grantham-McGregor S, Cheung Y, Cueto S, Glewwe P, Richter L, Strupp B . Developmental potential in the first 5 years for children in developing countries. Lancet. 2007; 369(9555):60-70. PMC: 2270351. DOI: 10.1016/S0140-6736(07)60032-4. View

Shawar Y, Shiffman J . Generation of global political priority for early childhood development: the challenges of framing and governance. Lancet. 2016; 389(10064):119-124. DOI: 10.1016/S0140-6736(16)31574-4. View

Weobong B, ten Asbroek A, Soremekun S, Gram L, Amenga-Etego S, Danso S . Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana. BMJ Open. 2015; 5(8):e006509. PMC: 4554911. DOI: 10.1136/bmjopen-2014-006509. View

Kerr S, Puthanakit T, Vibol U, Aurpibul L, Vonthanak S, Kosalaraksa P . Neurodevelopmental outcomes in HIV-exposed-uninfected children versus those not exposed to HIV. AIDS Care. 2014; 26(11):1327-35. PMC: 4122621. DOI: 10.1080/09540121.2014.920949. View

Lo S, Das P, Horton R . A good start in life will ensure a sustainable future for all. Lancet. 2016; 389(10064):8-9. DOI: 10.1016/S0140-6736(16)31774-3. View

Goldman D, Shapiro E, Nelson C . Measurement of vigilance in 2-year-old children. Dev Neuropsychol. 2004; 25(3):227-50. DOI: 10.1207/s15326942dn2503_1. View

10.

Familiar I, Nakasujja N, Bass J, Sikorskii A, Murray S, Ruisenor-Escudero H . Caregivers' depressive symptoms and parent-report of child executive function among young children in Uganda. Learn Individ Differ. 2016; 46:17-24. PMC: 4860739. DOI: 10.1016/j.lindif.2015.01.012. View

11.

Sirois P, Huo Y, Williams P, Malee K, Garvie P, Kammerer B . Safety of perinatal exposure to antiretroviral medications: developmental outcomes in infants. Pediatr Infect Dis J. 2013; 32(6):648-55. PMC: 3723344. DOI: 10.1097/INF.0b013e318284129a. View

12.

Bass J, Nakasujja N, Familiar-Lopez I, Sikorskii A, Murray S, Opoka R . Association of caregiver quality of care with neurocognitive outcomes in HIV-affected children aged 2-5 years in Uganda. AIDS Care. 2016; 28 Suppl 1:76-83. PMC: 4820354. DOI: 10.1080/09540121.2016.1146215. View

13.

Black M, Walker S, Fernald L, Andersen C, DiGirolamo A, Lu C . Early childhood development coming of age: science through the life course. Lancet. 2016; 389(10064):77-90. PMC: 5884058. DOI: 10.1016/S0140-6736(16)31389-7. View

14.

Familiar I, Ruisenor-Escudero H, Giordani B, Bangirana P, Nakasujja N, Opoka R . Use of the Behavior Rating Inventory of Executive Function and Child Behavior Checklist in Ugandan Children with HIV or a History of Severe Malaria. J Dev Behav Pediatr. 2015; 36(4):277-84. PMC: 4414719. DOI: 10.1097/DBP.0000000000000149. View

15.

Surkan P, Kennedy C, Hurley K, Black M . Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ. 2011; 89(8):608-15. PMC: 3150769. DOI: 10.2471/BLT.11.088187. View

16.

Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty K . Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA. 2007; 298(5):519-27. DOI: 10.1001/jama.298.5.519. View

17.

Beyer T, Postert C, Muller J, Furniss T . Prognosis and continuity of child mental health problems from preschool to primary school: results of a four-year longitudinal study. Child Psychiatry Hum Dev. 2012; 43(4):533-43. DOI: 10.1007/s10578-012-0282-5. View

18.

Yousafzai A, Aboud F . Review of implementation processes for integrated nutrition and psychosocial stimulation interventions. Ann N Y Acad Sci. 2013; 1308:33-45. DOI: 10.1111/nyas.12313. View

19.

Laughton B, Cornell M, Boivin M, Van Rie A . Neurodevelopment in perinatally HIV-infected children: a concern for adolescence. J Int AIDS Soc. 2013; 16:18603. PMC: 3687073. DOI: 10.7448/IAS.16.1.18603. View

20.

Alcock K, Abubakar A, Newton C, Holding P . The effects of prenatal HIV exposure on language functioning in Kenyan children: establishing an evaluative framework. BMC Res Notes. 2016; 9(1):463. PMC: 5062875. DOI: 10.1186/s13104-016-2264-3. View