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The research study that informed this article’s discussion, critically interrogates an HIV-infected research team’s positionality whilst conducting a mixed-methods’ study on HIV-positive patients’ experiences of the public ART programme at four ARV clinics in KwaZulu-Natal, South Africa. It primarily utilises the principal investigator’s (PI) narrative to explore insider/outsider positionality, reflexivity, bracketing and participatory action research through exposure of feelings, emotions, challenges, engagements, relationships and observations. The fluid positionality of the HIV-positive research team presented both challenges and opportunities. However, the opportunities for more HIV-infected researchers to engage in HIV-related research to assist with destigmatising HIV, close research gaps and the creation of a trustworthy research environment to achieve an ethical and reliable health science study, far outweigh the challenges. Further, such research can improve patients’ support and healthcare, healthcare workers’ perceptions of patients, and provide a guide for policymakers to better understand the recipients of HIV policies. Lastly, the term ‘HIV reflexivity’ is coined as a result

ImportanceThe US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children's Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US. The project was overseen by a steering committee and informed by an advisory committee composed of youth leaders and experts in children's rights, advocacy, health, law, and a range of child-specific issues (eg, youth justice, early childhood development), who provided expert input on strategic considerations for advancing children's rights.ObservationsSeven findings about advancing children's rights in the US are notable, all reflecting current gaps and opportunities for using a whole-child rights framework in the US, even without formal adoption of the CRC. Actionable strategies, tactics, and tools to leverage sustainable change in the multitude of issue areas can advance the current state of children's rights. High-potential strategies for catalyzing advancement of children's rights include youth activism, innovations in governance and accountability, legislative action, impact litigation, place-based initiatives, education and public awareness, alignment with other children's movements, and research. The child rights framework is unifying and adaptive to future unforeseen challenges.Conclusions and relevanceChildren's rights provide a powerful, synergistic framework for child health professionals-in partnership with youth and other leaders-to increase equity and protect the rights and well-being of all children in the US.

A better understanding of the social influences, self-efficacy, and communication with parents, peers, and teachers associated with teenage pregnancy is required owing to the consequences of teenage pregnancy. This article aimed to determine the prevalence of teenage pregnancy and to understand the association between social influences, self-efficacy, and communication about teenage pregnancies, among high school students in KwaZulu-Natal, South Africa. Grade 11 students at 20 randomly selected schools in two districts completed an anonymous questionnaire on sociodemographics, social influences, self-efficacy communication, and teenage pregnancy. Teenage pregnancy was associated with age, being female, and exposure to communication discouraging pregnancy. Students living with both parents, or where family and peers believed that the adolescents should abstain from sex, or who experienced positive social pressure discouraging pregnancy were unlikely to have had a pregnancy. This study identified sociodemographic and sociobehavioral influences associated with teenage pregnancy that can assist school nurses in their work.

While it is well-accepted that mothers play a key role in child health outcomes, the role of the father is less well understood. This study, the first of two investigations of the relationship between the social environment and child health, growth and development, was nested in a child nutrition programme carried out in Kwale County. At present child health services are largely administered through government Mother and Child Health programmes. Previous community consultations have raised the need to include all family members, particularly fathers, in the process of addressing child health and development issues. To provide a background to planning for inclusion of the wider family this study investigated local attitudes and beliefs towards parenting and how these may influence child health outcomes. In this study, we used qualitative in-depth interviews of 61 co-habiting couples with fathers and mothers interviewed separately, analysed using NVivo 10 software, to look for patterns of responses with regards to attitudes and behaviours relevant to child health. The study findings suggested that both mothers and fathers overall valued their status as parents and were willing to be involved in promoting the well-being of their children. Fathers and mothers saw that they carried out a different role, and drew on different influences in their decision making and role definition. The main barrier to direct paternal involvement in the health care of their children was reported to be the cost of attendance at clinics, both in terms of time and money. Innovation in how medical services engage with families is required to increase the supportive role that fathers can provide by using opportunities such as community meetings where men gather to explain child health risks and preventative measures.

Early educators' perceptions of play and learning influence whether they adopt responsive roles to facilitate learning in play. While studies have investigated perceptions of play as pedagogical practice and its perceived relevance for learning, few have also interrogated educator learning perceptions, and hence compared these perceptions. This study explored perceptions among South African early educators by contrasting their interview and questionnaire responses. Findings revealed play perceptions encompassing structured, adult-led activities alongside child-managed play. While play was highlighted as active, joyful and chosen, participants emphasised appropriate, real-world play over children's self-directed explorations and make-believe. Learning perceptions presented a span that primarily centred on correctness, followed by children understanding and applying lessons. Surprisingly, less nuance emerged for learning in play: rather than viewing play as a context for practicing and improving, respondents saw play as a 'stage' where children could demonstrate proficiency. Finally, patterns in play and learning perceptions came out more clearly in interviews than the questionnaire. These findings point to a need for alternative at-scale methods when eliciting educator perceptions, and for supporting educators to develop reflected, nuanced notions of play as practice and children's learning in play.

The university period provides a critical developmental transition from adolescence to adulthood. During this period, young people establish patterns of behaviors and make lifestyle choices that affect their current and future health. Using the social constructionist paradigm that examines the development of masculinities as a mutual construct of individual, social, cultural, and historical context, this article explores the interactions between masculinities and sexual behaviors of young men at the University of KwaZulu-Natal, South Africa. The study used a qualitative approach and employed purposive sampling to recruit 36 young Black male students aged between 18 and 30 years. Four focus group discussions consisting of 8 to 10 participants were conducted according to the current year of study of male students. Data were transcribed, coded, and analyzed thematically. Our results show that the freedom and independence acquired from being away from home enabled students to enact their masculinities freely. Our findings further reveal that an individual has multiple masculinities which are often exerted to suit the present discourse they are in at any given point.

Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV-exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4-6-year old CHEU versus children HIV-unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu-Natal, South Africa. Children completed: Grover-Counter Scale of cognitive development, sub-scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross-sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.

Introduction: : Tuberculosis (TB) remains the most common cause of death among people living with HIV Integrating HIV and TB services reduces mortality but is sub-optimally implemented. Quality improvement (QI) methods offer a low-cost and easily implementable approach to strengthening healthcare delivery systems. This trial assessed a QI intervention on key process indicators for delivering integrated HIV-TB care in rural South African primary healthcare (PHC) clinics. Methods: Sixteen nurse supervisors, (each with a cluster of clinics) overseeing 40 PHC clinics, were randomized 1:1 to the intervention or the standard of care (SOC) groups. The QI intervention comprised three key components: clinical and QI skills training, on-site mentorship of nurse supervisors and clinic staff, and data quality improvement activities to enhance accuracy and completeness of routine clinic data. The SOC comprised monthly supervision and data feedback meetings. From 01 December 2016 to 31 December 2018, data were collected monthly by a team of study-appointed data capturers from all study clinics. This study's outcomes were HIV testing services (HTS), TB screening, antiretroviral therapy (ART) initiation, isoniazid preventive therapy (IPT) initiation and viral load (VL) testing. Results: The QI group (eight clusters) comprised 244 clinic staff who attended to 13,347 patients during the trial compared to the SOC group (eight clusters) with 217 clinic staff who attended to 8141 patients. QI mentors completed 85% (510/600) of expected QI mentorship visits to QI clinics. HTS was 19% higher [94.5% vs. 79.6%; relative risk (RR)=1.19; 95% CI: 1.02-1.38; p=0.029] and IPT initiation was 66% higher (61.2 vs. 36.8; RR=1.66; 95% CI: 1.02-2.72; p=0.044), in the QI group compared to SOC group. The percentage of patients screened for TB (83.4% vs. 79.3%; RR=1.05; p=0.448), initiated on ART (91.7 vs. 95.5; RR=0.96; p=0.172) and VL testing (72.2% vs. 72.8%; RR=0.99; p=0.879) was similar in both groups. Conclusions: QI improved HIV testing and IPT initiation compared to SOC. TB screening, ART initiation and VL testing remained similar. Incorporating QI methods into routine supervision and support activities may strengthen integrated HIV-TB service delivery and increase the success of future QI scale-up activities. Keywords: cluster-randomized; collaboratives; HIV-TB services; integration; primary healthcare clinics; quality improvement, 1 | INTRODUCTION In South Africa (SA), the convergence of the HIV and tuberculosis (TB) epidemics created one of the largest HIV-TB co-epidemics in the world [1]. In 2016, an [...]

Can the use of a method such as role play help reduce sexual risk behaviour among KwaZulu-Natal learners? A study was undertaken of the use of role plays by Grade 8 learners, at eight urban and rural KwaZulu-Natal high schools, as part of a programme to reduce the prevalence of teenage pregnancy. Within the framework of Bandura's Social Cognitive Theory, learners participated in role plays covering five topics--choice, self-respect and emotional abuse; partner coercion/negotiation about having sex; visiting the clinic for contraception; perceived and purchasing value of the child support grant; and testing for HIV. We report on the organisation, implementation and evaluation of the role plays. Data from facilitators, educators and learners were triangulated and suggest that role play has potential for building self-efficacy among learners with respect to sexual behaviour.

A broad range of initiatives including early intervention programmes have been implemented in Australia to assist disadvantaged and at-risk Indigenous parents and children. This qualitative exemplar case study details the perspectives of caregivers and service providers of one such early learning intervention programme situated within the remote Mowanjum community in Western Australia. Twelve participants were interviewed and their transcript data were analysed thematically. The findings reveal participants maintained that the Mowanjum Early Learning Program provided psychological benefits for both the attending infants and their caregivers. Additionally, that the programme facilitated learning and skill development in the children, which in turn enhanced their preschool readiness. Finally, participants maintained that a further significant benefit of the programme was that it provided caregivers with a supportive and safe respite place in which they could socialize and engage with their child free from the tribulations associated with raising children within a remote community.

Custodial grandparenting (i.e. raising grandchildren on a full-time basis) is a global phenomenon. Despite the hardships associated with 24/7 custodial care, grandparents continue to invest in their grandchildren. Why they do so is a matter of much conjecture. For example, it has been posited that grandparents assume custodial care of their grandchildren for reasons of necessity, altruism, aged-care reciprocity, or cultural continuity. This study examines the often overlooked issue of grandparent enjoyment as a motivating force behind custodial grandparenting caregiving investment. The results of our analysis of 88 completed Grandparent Needs, Wellbeing and Health Surveys determined that custodial grandparents' investiture in their grandchildren is influenced by three types of enjoyment, namely those derived from engagement in the child-centred nurturance of an at-risk grandchild, dyadic engagement in shared activities with their grandchild, and the personal grandparent-centred pleasure benefits to be had from fulfilling a grandcarer role. This study additionally reveals that informal custodial grandparents experience lower levels of closeness to their grandchild/ren, satisfaction with their grandparenting role, and assessment of their state of health than do formal (legal) custodial grandparents. The need to educate custodial grandparents of the potential health benefits to be had from investiture in their grandchildren is discussed.

The present research studied the symptomatologic overlap of AD/HD behaviours and retention of four primitive reflexes (Moro, Tonic Labyrinthine Reflex [TLR], Asymmetrical Tonic Neck Reflex [ATNR], Symmetrical Tonic Neck Reflex [STNR]) in 109 boys aged 7-10 years. Of these, 54 were diagnosed with AD/HD, 34 manifested sub-syndromal coordination, learning, emotional and/or behavioural symptoms of AD/HD, and 21 had no (or near to no) symptoms of AD/HD. Measures of AD/HD symptomatology and of the boys' academic performance were also obtained using the Conners' rating scale and the WRAT-3, respectively. Results indicated that, in general, boys diagnosed with AD/HD had significantly higher levels of reflex retention than non-diagnosed boys. Results also indicated both direct and indirect relationships between retention of the Moro, ATNR, STNR and TLR reflexes with AD/HD symptomatology and mathematics achievement. The pattern of relationships between these variables was also consistent with the notion of the Moro acting as a gateway for the inhibition of the other three reflexes. (Contains 8 tables and 1 figure.)

Background: Stunting continues to affect young children as a global nutritional disorder. The aim of our study was to assess the prevalence, associated risk factors and spatial clustering for stunting in a disadvantaged South African District. Methods: A community-based cross-sectional weighted survey of households was conducted in the iLembe district, KwaZulu-Natal in 2014. Children aged 0-59 months were included in the study sample. Height for age Z scores were calculated for the children and the spatial clustering was assessed. Results: Of the 572 children included in the weighted analyses, 21.1% (95% confidence intervals (CI) 18.0-24.5) were classified as stunted and of these 7.5% (95% CI 5.3-10.4) were severely stunted. Conclusion: Stunting is a major public health burden in SA that requires intervention at a community level. A multi-sectoral approach is required to reduce stunting prevalence, focusing on child growth and development monitoring, nutrition education and household food security.

Background: Bullying behavior in schools can lead to psychosocial problems. School-based interventions are important in raising student awareness, developing their skills and in planning to reduce bullying behavior. Methods: A randomized controlled trial, using a school-based educational intervention to reduce verbal bullying, was conducted among grade 10 students in 16 urban and rural schools in KwaZulu-Natal, South Africa in 2013. Baseline and postintervention questionnaires, developed using the Integrated Model for Behavior Change theoretical model, were used to assess changes in verbal bullying. Results: Postintervention there were reduced verbal bullying experiences. Improved social norms and awareness of verbal bullying were associated with reduced verbal bullying experiences and behavior. Although less likely to bully others verbally, girls were more likely to experience verbal bullying. Students with no living father were more likely to bully others verbally. Conclusions: The study findings indicate that a school-based intervention can positively impact on verbal bullying experiences and behavior.

The Model of Human Occupation (MOHO) is an evidenced-based model of practice that occupational therapists employ to discuss and reflect on the occupational needs of clients. Custodial grandparents are one cohort of potential clients who experience considerable difficulty in adapting to the occupational challenges of their grandchild-rearing role, particularly in relation to schooling. Hence, this study aims to broaden current understanding of the volition, habituation, and performance processes that custodial grandparents work through in their daily drive to meet their grandchildren's educational needs. Thematic analysis was conducted on 49 custodial grandparent interviews. Critical intervention points exist during the custodial care-giving role, at which juncture grandcarers experience feelings of stress overload and self-doubt. It is at these junctures that custodial grandparents would benefit from occupational therapy (OT), but such OT intervention is difficult to initiate among the hard-to-reach grandcarer age-cohort. To reach grandcarers and meet their occupational needs it is recommended that OTs conduct a family unit strengths, resources, and needs assessment for each student referred to them for age-inappropriate behavioral issues. In conducting a detailed family background assessment, grandcarers by extension can be reached and their occupational needs can be met.

The esteem historically attributed to the teaching profession in Japan is eroding, and some Japanese teachers who identify with the ideal of being a "life educator" are becoming disillusioned with teaching. While the stress and anxiety associated with teacher disillusionment have been researched from a Western perspective, little is known about the work-related stress and anxiety experiences of Japanese teachers. Thus, this grounded theory qualitatively details the teaching experiences of 14 Japanese high school teachers. The findings reveal that whereas only two teachers within the present study had actually achieved a "space in their heart" where they were able to create a balance between the negative and positive forces operating within their teaching careers and home lives, this was a position that many other teachers strove toward.