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 (SSA)，近 1600 万感染艾滋病毒的儿童中有 90% 未感染 (CHEU). 与其他人群相比，该人群出现神经发育迟缓的风险更高。世界卫生组织和联合国儿童基金会提倡使用培育护理。框架，由护理的五个方面组成——健康、营养、响应性护理、免受威胁的安全以及学习机会——该框架在充分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照护的主要来源，探索家庭结构、家庭环境和儿童神经发育之间的关联，特别是儿童神经发育之间的关联在艾滋病毒高发地区博茨瓦纳，有四分之一的儿童在 15 岁以下。是 CHEU，考虑到养育护理，只有不到 10% 的育儿夫妇正式结婚。该框架从未在博茨瓦纳有计划地实施，护理结构也尚未建立描述清楚，了解在低结婚率和高艾滋病毒感染率的独特背景下的护理 CHEU 与发展成果的关联具有至关重要的公共卫生重要性。拟议的 FACET 研究（博茨瓦纳的家庭动态和儿童神经发育）将利用正在进行的一项研究 FLOURISH 研究中的出生队列（根据纵向结果来理解、报告、干预维持未感染艾滋病毒的婴儿、儿童和青少年的健康；R33 HD103099；主要研究者：Powis、Jao、Makhema）目前招募了多达 300 名孕妇，其中一半是艾滋病毒感染者及其婴儿 a)（目标 1）描述家庭组成和家庭模式护理动态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，采用焦点小组讨论形式；和 b) 采用混合方法设计（目标 2），评估儿童艾滋病毒暴露状况、照顾者关系因素和儿童神经发育之间的关联。看护者报告的早期发育指数 (CREDI) 是一种家长报告的评估工具，已被经验证可在 26 个国家使用，其中 17 个是中低收入国家，包括博茨瓦纳参与 FACET 的母亲在孩子满六个月时同时服用该药物，将从参加第二轮焦点小组讨论的最多 30 名母亲收集定性数据探索他们与伴侣的关系、父亲对照顾的参与、家庭环境因素（例如粮食不安全、亲密伴侣暴力）和儿童气质可能会影响他们的照顾。将采用收敛并行三角测量来共同解释定量和定性研究迫切需要研究来评估胎儿艾滋病毒暴露和家庭结构的综合影响。关于儿童神经发育。