The hidden harm of Home-Based Care: Pulmonary tuberculosis symptoms among children providing home medical care to HIV/AIDS-affected adults in South Africa
Identifieur interne : 001E01 ( Pmc/Corpus ); précédent : 001E00; suivant : 001E02The hidden harm of Home-Based Care: Pulmonary tuberculosis symptoms among children providing home medical care to HIV/AIDS-affected adults in South Africa
Auteurs : Lucie Cluver ; Mark Orkin ; Mosa Moshabela ; Caroline Kuo ; Mark BoyesSource :
- AIDS care [ 0954-0121 ] ; 2013.
Abstract
Millions of children in sub-Saharan Africa undertake personal and medical care for family members who are unwell with AIDS. To date, no research has investigated whether such care provision places children at heightened risk for pulmonary tuberculosis. This study aimed to address this gap by identifying risk factors for pediatric pulmonary tuberculosis symptomatology. In 2009-2011, 6002 children aged 10-17 were surveyed using door-to-door household sampling of census enumeration areas. These were randomly sampled from six urban and rural sites with over 30% HIV prevalence, within South Africa's three highest tuberculosis burden provinces. Validated scales and clinical tuberculosis symptom checklists were modeled in multivariate logistic regressions, controlling for sociodemographic co-factors. Findings showed that, among children, severe pulmonary tuberculosis symptomatology was predicted by primary caregiver HIV/AIDS-illness (OR1.63 CI1.23-2.15 p<.001), and AIDS-orphanhood (OR1.44 CI1.04-2.00, p<.029). Threefold increases in severe tuberculosis symptoms were predicted by the child's exposure to body fluids through providing personal or medical care to an ill adult (OR3.12 CI1.96-4.95, p<.001). Symptoms were also predicted by socioeconomic factors of food insecurity (OR 1.52 CI1.15-2.02, p<.003) and household overcrowding (OR1.35 CI1.06-1.72, p<.017). Percentage probability of severe tuberculosis symptoms rose from 1.4% amongst least-exposed children, to 18.1% amongst those exposed to all above-stated risk factors, independent of biological relationship of primary caregiver-child and other sociodemographics. Amongst symptomatic children, 75% had never been tested for tuberculosis. These findings identify the risk of tuberculosis among children providing home medical care to their unwell caregivers, and suggest that there are gaps in the health system to screen and detect these cases of pediatric tuberculosis. There is a need for effective interventions to reduce childhood risk, as well as further support for community-based contact-tracing, tuberculosis screening and anti-tuberculosis treatment for children caring for ill adults in contexts with a high burden of HIV and tuberculosis.
Url:
DOI: 10.1080/09540121.2013.772281
PubMed: 23458120
PubMed Central: 3835168
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The hidden harm of Home-Based Care: Pulmonary tuberculosis symptoms among children providing home medical care to HIV/AIDS-affected adults in South Africa</title><author><name sortKey="Cluver, Lucie" sort="Cluver, Lucie" uniqKey="Cluver L" first="Lucie" last="Cluver">Lucie Cluver</name><affiliation><nlm:aff id="A1">Department of Social Policy and Intervention, University of Oxford</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Psychiatry and Mental Health, University of Cape Town</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Health Economics and AIDS Research Division, University of KwaZulu-Natal</nlm:aff></affiliation></author><author><name sortKey="Orkin, Mark" sort="Orkin, Mark" uniqKey="Orkin M" first="Mark" last="Orkin">Mark Orkin</name><affiliation><nlm:aff id="A4">School of Public and Development Management, University of Witwatersrand, Johannesburg</nlm:aff></affiliation></author><author><name sortKey="Moshabela, Mosa" sort="Moshabela, Mosa" uniqKey="Moshabela M" first="Mosa" last="Moshabela">Mosa Moshabela</name><affiliation><nlm:aff id="A5">School of Public Health, University of Witwatersrand, Johannesburg</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Earth Institute, Columbia University, New York</nlm:aff></affiliation></author><author><name sortKey="Kuo, Caroline" sort="Kuo, Caroline" uniqKey="Kuo C" first="Caroline" last="Kuo">Caroline Kuo</name><affiliation><nlm:aff id="A7">Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and Rhode Island Hospital</nlm:aff></affiliation></author><author><name sortKey="Boyes, Mark" sort="Boyes, Mark" uniqKey="Boyes M" first="Mark" last="Boyes">Mark Boyes</name><affiliation><nlm:aff id="A1">Department of Social Policy and Intervention, University of Oxford</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23458120</idno><idno type="pmc">3835168</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835168</idno><idno type="RBID">PMC:3835168</idno><idno type="doi">10.1080/09540121.2013.772281</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">001E01</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001E01</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The hidden harm of Home-Based Care: Pulmonary tuberculosis symptoms among children providing home medical care to HIV/AIDS-affected adults in South Africa</title><author><name sortKey="Cluver, Lucie" sort="Cluver, Lucie" uniqKey="Cluver L" first="Lucie" last="Cluver">Lucie Cluver</name><affiliation><nlm:aff id="A1">Department of Social Policy and Intervention, University of Oxford</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Psychiatry and Mental Health, University of Cape Town</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Health Economics and AIDS Research Division, University of KwaZulu-Natal</nlm:aff></affiliation></author><author><name sortKey="Orkin, Mark" sort="Orkin, Mark" uniqKey="Orkin M" first="Mark" last="Orkin">Mark Orkin</name><affiliation><nlm:aff id="A4">School of Public and Development Management, University of Witwatersrand, Johannesburg</nlm:aff></affiliation></author><author><name sortKey="Moshabela, Mosa" sort="Moshabela, Mosa" uniqKey="Moshabela M" first="Mosa" last="Moshabela">Mosa Moshabela</name><affiliation><nlm:aff id="A5">School of Public Health, University of Witwatersrand, Johannesburg</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Earth Institute, Columbia University, New York</nlm:aff></affiliation></author><author><name sortKey="Kuo, Caroline" sort="Kuo, Caroline" uniqKey="Kuo C" first="Caroline" last="Kuo">Caroline Kuo</name><affiliation><nlm:aff id="A7">Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and Rhode Island Hospital</nlm:aff></affiliation></author><author><name sortKey="Boyes, Mark" sort="Boyes, Mark" uniqKey="Boyes M" first="Mark" last="Boyes">Mark Boyes</name><affiliation><nlm:aff id="A1">Department of Social Policy and Intervention, University of Oxford</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS care</title><idno type="ISSN">0954-0121</idno><idno type="eISSN">1360-0451</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="P1">Millions of children in sub-Saharan Africa undertake personal and medical care for family members who are unwell with AIDS. To date, no research has investigated whether such care provision places children at heightened risk for pulmonary tuberculosis. This study aimed to address this gap by identifying risk factors for pediatric pulmonary tuberculosis symptomatology. In 2009-2011, 6002 children aged 10-17 were surveyed using door-to-door household sampling of census enumeration areas. These were randomly sampled from six urban and rural sites with over 30% HIV prevalence, within South Africa's three highest tuberculosis burden provinces. Validated scales and clinical tuberculosis symptom checklists were modeled in multivariate logistic regressions, controlling for sociodemographic co-factors. Findings showed that, among children, severe pulmonary tuberculosis symptomatology was predicted by primary caregiver HIV/AIDS-illness (OR1.63 CI1.23-2.15 p<.001), and AIDS-orphanhood (OR1.44 CI1.04-2.00, p<.029). Threefold increases in severe tuberculosis symptoms were predicted by the child's exposure to body fluids through providing personal or medical care to an ill adult (OR3.12 CI1.96-4.95, p<.001). Symptoms were also predicted by socioeconomic factors of food insecurity (OR 1.52 CI1.15-2.02, p<.003) and household overcrowding (OR1.35 CI1.06-1.72, p<.017). Percentage probability of severe tuberculosis symptoms rose from 1.4% amongst least-exposed children, to 18.1% amongst those exposed to all above-stated risk factors, independent of biological relationship of primary caregiver-child and other sociodemographics. Amongst symptomatic children, 75% had never been tested for tuberculosis. These findings identify the risk of tuberculosis among children providing home medical care to their unwell caregivers, and suggest that there are gaps in the health system to screen and detect these cases of pediatric tuberculosis. There is a need for effective interventions to reduce childhood risk, as well as further support for community-based contact-tracing, tuberculosis screening and anti-tuberculosis treatment for children caring for ill adults in contexts with a high burden of HIV and tuberculosis.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8915313</journal-id><journal-id journal-id-type="pubmed-jr-id">1056</journal-id><journal-id journal-id-type="nlm-ta">AIDS Care</journal-id><journal-id journal-id-type="iso-abbrev">AIDS Care</journal-id><journal-title-group><journal-title>AIDS care</journal-title></journal-title-group><issn pub-type="ppub">0954-0121</issn><issn pub-type="epub">1360-0451</issn></journal-meta><article-meta><article-id pub-id-type="pmid">23458120</article-id><article-id pub-id-type="pmc">3835168</article-id><article-id pub-id-type="doi">10.1080/09540121.2013.772281</article-id><article-id pub-id-type="manuscript">NIHMS525917</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The hidden harm of Home-Based Care: Pulmonary tuberculosis symptoms among children providing home medical care to HIV/AIDS-affected adults in South Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Cluver</surname><given-names>Lucie</given-names></name><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Orkin</surname><given-names>Mark</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Moshabela</surname><given-names>Mosa</given-names></name><xref ref-type="aff" rid="A5">5</xref><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Kuo</surname><given-names>Caroline</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Boyes</surname><given-names>Mark</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Social Policy and Intervention, University of Oxford</aff><aff id="A2"><label>2</label>Department of Psychiatry and Mental Health, University of Cape Town</aff><aff id="A3"><label>3</label>Health Economics and AIDS Research Division, University of KwaZulu-Natal</aff><aff id="A4"><label>4</label>School of Public and Development Management, University of Witwatersrand, Johannesburg</aff><aff id="A5"><label>5</label>School of Public Health, University of Witwatersrand, Johannesburg</aff><aff id="A6"><label>6</label>Earth Institute, Columbia University, New York</aff><aff id="A7"><label>7</label>Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and Rhode Island Hospital</aff><author-notes><corresp id="FN1">Corresponding author: Dr Lucie Cluver, Department of Social Policy and Intervention, Oxford University, 32 Wellington Square, Oxford OX1 2ER, England, Tel: 01865 280 370 Fax: 01865 270 324, <email>lucie.cluver@spi.ox.ac.uk</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>12</day><month>11</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>04</day><month>3</month><year>2013</year></pub-date><pub-date pub-type="ppub"><year>2013</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>11</month><year>2013</year></pub-date><volume>25</volume><issue>6</issue><elocation-id>10.1080/09540121.2013.772281</elocation-id><abstract><p id="P1">Millions of children in sub-Saharan Africa undertake personal and medical care for family members who are unwell with AIDS. To date, no research has investigated whether such care provision places children at heightened risk for pulmonary tuberculosis. This study aimed to address this gap by identifying risk factors for pediatric pulmonary tuberculosis symptomatology. In 2009-2011, 6002 children aged 10-17 were surveyed using door-to-door household sampling of census enumeration areas. These were randomly sampled from six urban and rural sites with over 30% HIV prevalence, within South Africa's three highest tuberculosis burden provinces. Validated scales and clinical tuberculosis symptom checklists were modeled in multivariate logistic regressions, controlling for sociodemographic co-factors. Findings showed that, among children, severe pulmonary tuberculosis symptomatology was predicted by primary caregiver HIV/AIDS-illness (OR1.63 CI1.23-2.15 p<.001), and AIDS-orphanhood (OR1.44 CI1.04-2.00, p<.029). Threefold increases in severe tuberculosis symptoms were predicted by the child's exposure to body fluids through providing personal or medical care to an ill adult (OR3.12 CI1.96-4.95, p<.001). Symptoms were also predicted by socioeconomic factors of food insecurity (OR 1.52 CI1.15-2.02, p<.003) and household overcrowding (OR1.35 CI1.06-1.72, p<.017). Percentage probability of severe tuberculosis symptoms rose from 1.4% amongst least-exposed children, to 18.1% amongst those exposed to all above-stated risk factors, independent of biological relationship of primary caregiver-child and other sociodemographics. Amongst symptomatic children, 75% had never been tested for tuberculosis. These findings identify the risk of tuberculosis among children providing home medical care to their unwell caregivers, and suggest that there are gaps in the health system to screen and detect these cases of pediatric tuberculosis. There is a need for effective interventions to reduce childhood risk, as well as further support for community-based contact-tracing, tuberculosis screening and anti-tuberculosis treatment for children caring for ill adults in contexts with a high burden of HIV and tuberculosis.</p></abstract><kwd-group><kwd>Pulmonary Tuberculosis</kwd><kwd>HIV</kwd><kwd>Acquired Human Immunodeficiency Syndrome</kwd><kwd>Child</kwd><kwd>South Africa</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Mental Health : NIMH</funding-source><award-id>L30 MH098313 || MH</award-id></award-group><award-group><funding-source country="United States">National Institute of Mental Health : NIMH</funding-source><award-id>K01 MH096646 || MH</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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