The relationship between psychosocial factors and poor neurocognitive and socio-emotional development in children perinatally infected with HIV in South Africa.
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Date
2015
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Abstract
Background: Survival among perinatally HIV infected children has increased over the last
few years in South Africa, mainly due to the availability and accessibility of combination
antiretroviral therapy (cARTs). These children, however, remain a vulnerable group with
respect to heightened behavioural and socio-emotional problems as well as neurocognitive
deficits. The majority of HIV-positive children live in an environment of multiple
deprivations; i.e. poverty, parental death or ill health, stress associated with daily living and
poor stimulation in the home environment. Early childhood is known to be a sensitive period
for brain development, especially in forming neural circuits underlying behaviours and higher
cognitive functions. Injury or insult and environmental deprivation (impoverishment,
nutritional deficits and lack of nurturance) have the potential to create vulnerability which
can negatively impact on the life trajectory of the child. With this in mind, the aim of this
study was to investigate the impact of key psychosocial factors, namely, socio-economic
status, caregiver depression, quality of home environment and nutritional status, on the
neurocognitive and socio-emotional functioning of perinatally acquired HIV-positive children
living in semi-rural Eastern Cape, South Africa.
Method: A cross-sectional, convergent mixed method design using non-probability sampling
was employed. Quantitative data was collected on 152 dyads of perinatally infected HIV
positive children on cARTs (mean age = 63.13 months) and their caregivers. The Wechsler
Preschool and Primary Scale of Intelligence-III (WPPSI-III) was administered to assess the
neurocognitive functioning of the children, while the Strengths and Difficulties Questionnaire
(SDQ) (caregiver report version) was administered to assess the children’s socio-emotional
function. Anthropometric data was obtained from the HIV-positive children through the
WHO-anthro-programme to assess nutritional status. The Home Screening Stimulation
Questionnaire (HSQ) was administered to assess the quality of home environment the
children were living in. The Beck Depression Inventory, 2nd edition (BDI-II) was used to
assess caregiver depression among the 152 (mean age = 45 years) caregivers. Qualitative data
was obtained through a series of semi-structured in-depth interviews with a sub-set of 44
caregivers of the HIV-positive children who were conveniently recruited from the
quantitative sample. A series of one-way ANOVAs, independent t-tests, chi-square and
correlation analyses was performed on the quantitative data. The qualitative data was
analysed using interpretive phenomenological analysis.
Results: The converging quantitative and qualitative results in this doctoral study provides
evidence that various psychosocial factors differentially impact neurocognitive and socioemotional
development of perinatally HIV-infected children. Older HIV-positive boys who
lived in suboptimal, poor quality homes and who demonstrated stunting, wasting and /or were
underweight (indicators of nutritional status) were worse off neurocognitively when
compared to younger boys and girls infected with HIV from similar environmental
deprivation context. Socio-emotional adjustment was also generally poor, with caregiver
depression strongly associated with poor socio-emotional functioning among HIV-positive
children. This relationship existed whether or not the child was raised by a biological or nonbiological
caregiver and was greater in younger children. The children’s overall psychosocial
difficulties mean score was 16.9 (SD = 5.05), with indications of the significant presence of
psychological and behavioural symptoms. Hyperactivity problems was reported in 40.1 % (M
= 5.27, SD = 1.72) of the children, emotional problems in 29.6 % (M = 4.31, SD = 2.34),
conduct problems in 41.4 % (M = 3.13, SD = 2.18) and peer related problems in 51.3 % (M =
3.49, SD = 1.46).
The qualitative data indicated, inter alia, that stigma negatively impacts on caregivers’
mental health and deters them from seeking social support. This in turn, exacerbates
caregivers’ poor mental health and capacity to adequately meet the needs of their HIVvii
positive children, ultimately leading to negative child outcomes. This finding highlights the
importance of Bronfenbrenner’s micro- and meso-system variables, such as the importance of
quality parent/child interaction, adequate language stimulation through dialogue, and
availability of tools within the home and school environment that could act as a buffer against
the negative effects of HIV on the infected child’s developing brain. The children’s
neurocognitive, psychological and behavioural development is influenced by their ecological
context.
Conclusion: This is the first study in South Africa investigating the impact of psychosocial
factors associated with poor neurocognitive and socio-emotional functioning in perinatally
HIV-infected children. The findings highlight that it is not enough to just focus attention on
the medical management of paediatric HIV. Despite having access to cART’s, HIV-positive
children are vulnerable to developing neurocognitive deficits and socio-emotional and
behavioural problems. These problems can impact negatively on their ability to learn and
thrive academically, establish pro-social relationships with peers, and importantly, adhere to
their treatment regimes. The need for integrative interventions including the identification
and treatment of caregiver depression as well as nutritional supplementation, early parenting
skills training and psychosocial stimulation to improve overall health and future quality of
life of this population is recommended.
Description
Doctor of Philosophy in Psychology. University of KwaZulu-Natal, Howard College 2015.
Keywords
HIV-positive children -- South Africa -- Psychological aspects., Fetus -- Effect of drugs on -- South Africa., Highly active antiretroviral therapy., HIV-positive children -- Social aspects -- South Africa., Theses -- Psychology.