Search

Objectives: a) To document the prevalence and correlates of frailty among older adults living with HIV (OALWH) and their uninfected peers, and b) Investigate HIV status as an independent predictor of frailty.Methods: This cross-sectional study was conducted between 2020 and 2021 at the Kenyan coast among 440 older adults aged ≥50 years (257 OALWH). Frailty was assessed using the Reported Edmonton Frail Scale. Logistic regression was used to examine the correlates of frailty.Results: The prevalence of frailty was significantly higher among OALWH (24%) than their uninfected peers (13%). HIV seropositivity was not independently associated with frailty. Sleeping difficulties, ageism, higher waist/hip ratio, visiting traditional healers, HIV treatment change/interruption, prolonged illness following HIV diagnosis, and self-reported diabetes were significantly associated with higher odds of frailty. Residing in larger households, having higher income, having friends, being male and light physical activities were significantly associated with reduced odds of frailty.Conclusion: The prevalence of frailty is elevated among OALWH; however, factors other than HIV are predominant, particularly psychosocial factors. Multicomponent interventions are needed to prevent/delay and manage frailty in this setting.

IntroductionGlobally, 1.7 million children are living with HIV, with the majority of them residing in sub-Saharan Africa. Due to reduced rates of vertical transmission of HIV, there is an increasing population of children born to HIV-infected mothers who remain uninfected. There is a growing concern around the development of these children in the antiretroviral therapy era. This study examined the neurocognitive outcomes of children who are HIV-exposed infected (CHEI), HIV-exposed uninfected (CHEU) and HIV-unexposed uninfected (CHUU) and explored the relationship between child neurocognitive outcomes and child's biomedical and caregivers’ psychosocial factors.MethodsCHEI, CHUU and CHEU aged 3–5 years and their caregivers were recruited into the study. Neurocognitive outcomes were assessed using a validated battery of assessments. One-way analysis of variance and covariance (ANOVA and ANCOVA) were used to evaluate differences among the three groups by neurocognitive outcomes. Linear regression models were used to investigate the association between child neurocognitive outcomes and biomedical factors (nutritional status, HIV disease staging) and caregivers’ psychosocial factors [symptoms of common mental disorders (CMDs) and parenting behaviour].ResultsThe study included 153 children and their caregivers: 43 (28.1%) CHEI, 52 (34.0%) CHEU and 58 (39.9%) CHUU. ANOVA and ANCOVA revealed a significant difference in cognitive ability mean scores across the child groups. Post hoc analysis indicated that CHEU children had higher cognitive ability mean scores than the CHUU group. Better nutritional status was significantly associated with higher cognitive ability scores (β = 0.68, 95% CI [0.18–1.18], p = 0.008). Higher scores of CMDs were negatively associated with inhibitory control (β = −0.28, 95% CI [−0.53 to 0.02], p = 0.036). While comparing HIV stages 2 and 3, large effect sizes were seen in working memory (0.96, CI [0.08–1.80]) and cognitive ability scores (0.83 CI [0.01–1.63]), indicating those in stage 3 had poor performance.ConclusionsNeurocognitive outcomes were similar across CHEI, CHEU and CHUU, although subtle differences were seen in cognitive ability scores where CHEU had significantly higher cognitive mean scores than the CHUU. Well-designed longitudinal studies are needed to ascertain these findings. Nonetheless, study findings underscore the need for strategies to promote better child nutrition, mental health, and early antiretroviral therapy initiation.

Objectives: This study explores the perceptions of adults living with HIV aged ≥50 years (recognized as older adults living with HIV—OALWH), primary caregivers and healthcare providers on the health challenges of ageing with HIV at Kilifi, a low literacy setting on the coast of Kenya.Methods: We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi in 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data.Results: Symptoms of common mental disorders, comorbidities, somatic symptoms, financial difficulties, stigma, and discrimination were viewed as common. There was also an overlap of perceived risk factors across the physical, mental, and psychosocial health domains, including family conflicts and poverty.Conclusion: OALWH at the Kenyan coast are perceived to be at risk of multiple physical, mental, and psychosocial challenges. Future research should quantify the burden of these challenges and examine the resources available to these adults.

Objective: Sexual risk behavior during adolescence is an important public health problem. Self-esteem and hopefulness are potentially important psychological factors that may play a role in the behavioral regulation mechanisms of adolescents. These factors are inadequately explored in sub-Saharan Africa. This study aimed at exploring patterns and associated factors for sexual risk behavior (SRB), self-esteem, and hopefulness among adolescents from a resource-poor setting in Kenya.Method: A cross-sectional study conducted in 2019 among 296 adolescents (12–17 years old) from rural Kilifi (n = 133) and urban informal settings of Nairobi (n = 163) in Kenya. Participants completed the Kilifi Health Risk Behavior Questionnaire, Rosenberg self-esteem questionnaire, and Hope scale administered via computerized tablets. A binary outcome variable based on the experience of adolescents of at least one of the five forms of SRB: transactional sex, sexual violence, intergenerational sex, early sexual debut, and condom non-use was generated. Bi-variate analysis was conducted to summarize various social-demographic and psychosocial factors. A multivariable logistic regression model was fitted to investigate factors associated with the occurrence of SRB, self-esteem, and hopefulness among adolescents.Results: About 13% of the participants had experienced a form of SRB, and among these, 36% reported co-occurrence of multiple forms of SRB. Adolescent SRB was largely characterized by having experienced sexual violence, as well as intergenerational and transactional sex. Higher scores of hopefulness were reported among adolescents who never experienced SRB (P = 0.03) at bivariate analysis level. However, both self-esteem and hopefulness were not significantly associated with the occurrence of SRB in the adjusted logistic regression analysis. Having depressive symptoms (Adj. OR = 3.8, 95% CI: 1.39–10.4), feeling unsafe in the neighborhood (Adj. OR = 3.4, 95% CI: 1.6–7.2), and being in higher compared with lower primary education level (Adj. OR = 0.3, 95% CI: 0.1–0.8) were statistically significantly associated with the occurrence of SRB.Conclusion: Targeted reproductive health interventions, designed with the cognizance of structural and social drivers of adolescent SRB, are needed to concurrently tackle multiple forms of SRB. It is important to integrate mental health promotion within these interventions. More research is needed to understand the mechanisms and implications of self-esteem and hopefulness for adolescent sexual and reproductive health.

Globally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by Onchocerca volvulus may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders—Onchocerca associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for Onchocerca volvulus (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1–4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.

Background: Neurological impairment (NI) and disability are associated with reduced life expectancy, but the risk and magnitude of premature mortality in children vary considerably across study settings. We conducted a systematic review to estimate the magnitude of premature mortality following childhood-onset NI worldwide and to summarize known risk factors and causes of death.Methods: We searched various databases for published studies from their inception up to 31st October 2020. We included all cohort studies that assessed the overall risk of mortality in individuals with childhood-onset epilepsy, intellectual disability (ID), and deficits in hearing, vision and motor functions. Comparative measures of mortality such as the standardized mortality ratio (SMR), risk factors and causes were synthesized quantitatively under each domain of impairment. This review is registered on the PROSPERO database (registration number CRD42019119239).Results: The search identified 2,159 studies, of which 24 studies were included in the final synthesis. Twenty-two (91.7%) studies originated from high-income countries (HICs). The median SMR was higher for epilepsy compared with ID (7.1 [range 3.1–22.4] vs. 2.9 [range 2.0–11.6]). In epilepsy, mortality was highest among younger age groups, comorbid neurological disorders, generalized seizures (at univariable levels), untreatable epilepsy, soon after diagnosis and among cases with structural/metabolic types, but there were no differences by sex. Most deaths (87.5%) were caused by non-epilepsy-related causes. For ID, mortality was highest in younger age groups and girls had a higher risk compared to the general population. Important risk factors for premature mortality were severe-to-profound severity, congenital disorders e.g., Down Syndrome, comorbid neurological disorders and adverse pregnancy and perinatal events. Respiratory infections and comorbid neurological disorders were the leading causes of death in ID. Mortality is infrequently examined in impairments of vision, hearing and motor functions.Summary: The risk of premature mortality is elevated in individuals with childhood-onset NI, particularly in epilepsy and lower in ID, with a need for more studies for vision, hearing, and motor impairments. Survival in NI could be improved through interventions targeting modifiable risk factors and underlying causes.

Over 80% of people with epilepsy live in low- to middle-income countries where epilepsy is often undiagnosed and untreated due to limited resources and poor infrastructure. In Africa, the burden of epilepsy is exacerbated by increased risk factors such as central nervous system infections, perinatal insults, and traumatic brain injury. Despite the high incidence of these etiologies, the cause of epilepsy in over 60% of African children is unknown, suggesting a possible genetic origin. Large-scale genetic and genomic research in Europe and North America has revealed new genes and variants underlying disease in a range of epilepsy phenotypes. The relevance of this knowledge to patient care is especially evident among infants with early-onset epilepsies, where early genetic testing can confirm the diagnosis and direct treatment, potentially improving prognosis and quality of life. In Africa, however, genetic epilepsies are among the most under-investigated neurological disorders, and little knowledge currently exists on the genetics of epilepsy among African patients. The increased diversity on the continent may yield unique, important epilepsy-associated genotypes, currently absent from the North American or European diagnostic testing protocols. In this review, we propose that there is strong justification for developing the capacity to offer genetic testing for children with epilepsy in Africa, informed mostly by the existing counseling and interventional needs. Initial simple protocols involving well-recognized epilepsy genes will not only help patients but will give rise to further clinically relevant research, thus increasing knowledge and capacity.

Unhealthy diet and physical inactivity are among the key modifiable risk factors for non-communicable diseases, such as diabetes and cardiovascular disease. Although such diseases often only appear in adulthood, these behaviors are typically initiated or reinforced already during adolescence. However, knowledge on underlying factors for adolescents’ unhealthy dieting and physical inactivity in sub-Saharan Africa (SSA) is poor. We conducted in-depth interviews and focus group discussions to explore the perceptions of a diverse group of 78 young people of 10–19 years of age, which also included some adolescents living with HIV, as this is an emerging group in the HIV/AIDS epidemic in many parts of SSA. In addition, 10 stakeholders, such as teachers, clinicians, and staff from organizations at the Kenyan coast and seven young adult community representatives informed us on: (a) adolescents’ unhealthy food choices and their forms of sedentary behavior; (b) predisposing factors; and (c) protective factors against unhealthy food choices and sedentary behavior of adolescents living in Kilifi County. The findings reveal that adolescents occasionally access nutritious foods, such as fruits, vegetables, and animal protein. However, there is a growing tendency to consume unbalanced diets with high intake of carbohydrates, oily foods, and consumption of sugar dense processed foods and drinks. Sports and domestic chores were found to be major sources of physical activity. Sedentary lifestyles characterized by a long-time sitting and chatting, watching sports games and movies were described. Adolescents living with HIV did not indicate any divergent perceptions from those of other adolescents relating to diet and physical activity, but mentioned health-related conditions, such as medication, asthma, and low body weight, as a risk factors for sedentary lifestyle. Using a Socio-Ecological model, our findings suggest that risk factors are numerous and interrelated, especially at intrapersonal, interpersonal, and community level. The negative influences at an intrapersonal level were as follows: body image concerns, attitudes and misconceptions, substance use behavior, and taste for unhealthy foods. In the interpersonal domain, household poverty and parenting practices that condone unhealthy habits were identified risk factors. Availability of affordable unhealthy foods, high prices for nutritious food, farming practices, gambling, and influx of transportation alternatives in the community were interrelated but also had relationships with intrapersonal and interpersonal risk factors. Modernization and poor implementation of policies were discussed as enabling factors especially by stakeholders from a societal perspective. Seasonality and farming practices, school attendance, community-based services, and regulations mitigating adolescents’ engagement in gambling were identified as potential protective factors. Our findings provide a unique qualitative insight of the factors underlying adolescents’ dietary and sedentary lifestyle and highlight the need for ecological intervention approaches to address these forms of health risk behavior in a rural African setting.