Bullying in schools is associated with an extensive public health burden. Bullying is intentional and goal oriented aggressive behavior in which the perpetrator exploits an imbalance of power to ...repeatedly dominate the victim. To differentiate bullying from aggressive behavior, assessment must include a valid measure of power imbalance as perceived by the victim. And yet, to date, there remains no agreement as to how to most accurately measure power imbalance among preadolescent children. This qualitative study explored children's (age 9 to 11) understanding of power imbalance through thematic analysis of focus group discussions. Subthemes that emerged as influencing power imbalance include: age of victim, peer valued characteristics, and group membership and position. Subthemes of empathy and peer valued characteristics emerged as protecting against the negative impact of power imbalance.
The World Health Organisation (WHO) recommends that children living with HIV should be informed about their HIV status within the ages of 6 to 12 years using age-appropriate resources. The aim of ...this study was to assess the socio-demographic, clinical and psychosocial factors associated with primary caregivers' decisions to disclose HIV to children living with HIV aged 6 to 12 years in Malawi. A cross-sectional study of 429 primary caregivers of children living with HIV were systematically recruited from all regions of the country. Information on HIV disclosure, family and child socio-demographic characteristics, child clinical characteristics, and child and family psychosocial characteristics was collected using validated instruments. Logistic regression was used to analyse data. The prevalence of non-disclosure of HIV status to children was 64 per cent. Concerns about the child's inability to cope with the news (29%), a lack of knowledge on how to disclose HIV status (19%), and fear of stigma and discrimination (17%) were the main reasons for non-disclosure. On multivariate analysis, the odds of non-disclosure were higher among primary caregivers who were farmers (aOR 3.0; 95% CI: 1.1-8.4), in younger children (6-8 years) (aOR 4.1; 95% CI: 2.3-7.4), in children who were in WHO HIV clinical stage one (aOR 3.8; 95% CI: 1.4-10.2), and in children who were not asking why they were taking ARVs (aOR 2.9; 95% CI: 1.8-4.8). On the other hand, nondisclosure of HIV status was less likely in underweight children (aOR 0.6; 95% CI: 0.3-0.9). Many children living with HIV in Malawi are unaware of their HIV status. Non-disclosure is associated with a number of clinical and demographic characteristics. The findings highlight the need to provide guidance and support to primary caregivers to help them to effectively disclose HIV status to their children.
Approximately 84,000 children under the age of 15 years are living with HIV in Malawi. Although the survival rate of children living with HIV in Malawi has improved due to the increased availability ...of antiretroviral medications, these children continue to experience numerous challenges negatively impacting on their mental health. The aim of this study was to investigate the prevalence of, and factors associated with, emotional and behavioural difficulties in children aged between 6 and 12 years living with HIV in Malawi.
A random sample of 429 primary caregivers of children living with HIV drawn from the three main administrative regions of Malawi was recruited in a cross-sectional study. They completed a questionnaire about family socio-demographic characteristics, HIV disclosure, and child demographic and clinical characteristics, as well as the Strengths and Difficulties Questionnaire, Life Stress Scale, Support Function Scale, and Impact on Family Scale which were pre-tested and translated into the local Chichewa language. Data were analysed using descriptive statistics and logistic regression.
Using the newer band categorisations of the Strengths and Difficulties Questionnaire, parent version, 31% of primary caregivers reported that their child had a slightly raised to very high level of total difficulties. Factors that were associated with difficulties were: primary caregivers' young age (adjusted odds ratio aOR 3.6; 95% confidence interval CI: 1.4-9.5); low level of education (aOR 2.6; 95% CI: 1.2-5.7); lack of employment (aOR 2.7; 95% CI: 1.2-5.9); the report of a substantial impact of the child's illness on the family (3.1; 95% CI: 1.5-6.5); and a low level of family functional support (aOR 2.0; 95% CI: 1.1-4.1). Neither non-disclosure of HIV status nor any of the child demographic or clinical factors were significant in multivariate analysis (p > .0.05).
Close to one-third of children living with HIV in this study had high scores indicative of emotional and behavioural difficulties. Emotional and behavioural difficulties in children living with HIV were associated with family demographic and psychosocial factors, but not HIV disclosure. Effective policies and programs that promote the mental wellbeing of children living with HIV in Malawi are indicated.
This review aimed to identify and evaluate interventions that have the potential to foster engaged fathering to enhance children's health and development. Relevant articles published in the last 20 ...years were searched in Medline, CINAHL, PsycINFO, Cochrane Database of Systematic Reviews and Web of Science databases. The quality of studies was assessed independently by two reviewers using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Thirty out of 3968 articles met the inclusion criteria and were subsequently reviewed. Studies were conducted in six countries (USA, Australia, Canada, Germany, Vietnam and Taiwan). Twenty‐one studies were targeted interventions while nine were universal interventions. The interventions involved parenting education, physical activity, nutrition, father–child socialization, father delivered infant massage and father–infant skin‐to‐skin contact. Authors of the studies reported that the interventions led to significant improvements in positive parenting behaviours and fathers' engagement with their children and better physical health and developmental outcomes among children. Notwithstanding the reported benefits of the interventions, all 30 studies had one or more methodological problems that call in question the generalizability of the findings. Future, well‐designed, RCT studies with larger sample sizes and clear measures of fidelity are warranted to replicate and strengthen findings reported in this review.
Using data on 2868 children born in the Western Australian Pregnancy Cohort (Raine) Study, we examined the association between changes in family socioeconomic status and childhood asthma.
We ...determined the likelihood (odds ratio) of a child having asthma at ages 6 and 14 years for 4 family-income trajectories (chronic low, increasing, decreasing, and never low) over the child's lifetime. The trajectories were created from longitudinal latent-class models.
We found a 2-fold increased risk of asthma at age 14 years among children who had lived in a low-income family since birth, especially for girls. Asthma was less likely to occur in children born to single parents; income rose over time in many of these families. Compared with children in chronic low-income families, children in households with increasing incomes had a 60% lower risk of asthma. Single-point measures of low income were not found to be associated with asthma.
Chronic exposure to a low-income environment from birth was associated with the development of persistent asthma. There was also a protective effect against asthma among those children whose families had moved out of poverty.
In 2011 the World Health Organisation recommended that children with a diagnosis of HIV be gradually informed about their HIV status between the ages of 6 and 12 years. However, to date, literature ...has focused mainly on primary caregiver and child experiences with HIV disclosure, little is known about healthcare workers' perspectives and practices of HIV status disclosure to children. The aim of this study was to assess healthcare workers' perspectives and practices regarding the disclosure of HIV status to children aged between 6 and 12 years in Malawi.
A cross-sectional survey was used to collect data from 168 healthcare providers working in antiretroviral clinics in all government District and Tertiary Hospitals in Malawi. Participants were asked questions regarding their knowledge, practice, and barriers to HIV disclosure. Data were analysed using binary logistic regression.
Almost all healthcare workers (98%) reported that it was important to disclose HIV status to children. A significant proportion (37%) reported that they had never disclosed HIV status to a child and about half estimated that the rate of HIV disclosure at their facility was 25% or less. The main barriers to disclosure were lack of training on disclosure (85%) and lack of a standard tool for disclosure (84%). Female healthcare workers (aOR) 2.4; 95% CI: 1.1-5.5) and lack of training on disclosure (aOR 7.7; 95% CI: 3.4-10.7) were independently associated with never having disclosed HIV status to a child.
This study highlights the need for providing appropriate training in HIV disclosure for healthcare workers and the provision of standardised disclosure materials.
Objectives To determine whether there was an independent effect of breastfeeding on child and adolescent mental health. Study design The Western Australian Pregnancy Cohort (Raine) Study recruited ...2900 pregnant women and followed the live births for 14 years. Mental health status was assessed by the Child Behaviour Checklist (CBCL) at 2, 6, 8, 10, and 14 years. Maternal pregnancy, postnatal, and infant factors were tested in multivariable random effects models and generalized estimating equations to examine the effects of breastfeeding duration on mental health morbidity. Results Breastfeeding for less than 6 months compared with 6 months or longer was an independent predictor of mental health problems through childhood and into adolescence. This relationship was supported by the random effects models (increase in total CBCL score: 1.45; 95% confidence interval 0.59, 2.30) and generalized estimating equation models (odds ratio for CBCL morbidity: 1.33; 95% confidence interval 1.09, 1.62) showing increased behavioral problems with shorter breastfeeding duration. Conclusion A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.
While power imbalance is now recognized as a key component of bullying, reliable and valid measurement instruments have yet to be developed. This research aimed to develop a self-report instrument ...that measures power imbalance as perceived by the victim of frequent aggressive behavior.
A mixed methods approach was used (468 participants, Grade 4 to 6). This paper describes the exploratory (n = 111) and confirmatory factor analysis of the new instrument (n = 337), and assessment of reliablity and construct validity.
A 2-factor model represented physical and social aspects of power imbalance (n = 127: normed chi-square = 1.2, RMSEA = .04, CF1 = .993). The social factor included constructs of group and peer valued characteristics.
This research will enhance health and education professionals understanding of power imbalance in bullying and will inform the design and evaluation of interventions to address bullying in children.
The World Health Organisation has recommended that healthcare workers, teachers and community leaders work with parents to support children living with HIV. The aim of this study was to assess the ...perceptions and experiences of primary caregivers and other care providers such as healthcare workers, teachers, and community leaders regarding their involvement, practice and challenges of HIV disclosure to children aged between 6 and 12 years living with HIV in Malawi.
Twelve focus group discussions and 19 one-on-one interviews involving a total of 106 participants were conducted in all three administrative regions of Malawi. The interviews and focus group discussions explored perceptions and experiences regarding involvement, practice and challenges of disclosure of HIV status to children. Data were analysed using thematic analysis.
Primary caregivers, healthcare workers, teachers, and community leaders all reported that the disclosure of HIV status to children was not well coordinated because each of the groups of participants was working in isolation instead of working as a team. A "working together" model emerged from the data analysis where participants expressed the need for them to work as a team in order to promote safe and effective HIV status disclosure through talking about HIV, sharing responsibility and open communication. Participants reported that by working together, the team members would ensure that the prevalence of HIV disclosure to young children increases and that there would be a reduction in any negative impact of disclosure.
Global resources are required to better support children living with HIV and their families. Healthcare workers and teachers would benefit greatly from training in working together with families living with HIV and, specifically, training in the disclosure process. Resources, in the form of books and other educational materials, would help them explain HIV and its effective management to children and families.
There is a high prevalence of mental health problems amongst adolescents. In addition there is a high prevalence of spinal pain in this population. Evidence suggests that these conditions are ...related. This study sought to extend earlier findings by examining the relationship between mental health problems as measured by the Child Behaviour Check List (CBCL) and the experience of back and neck pain in adolescents.
One thousand five hundred and eighty participants (mean age 14.1 years) from the Western Australian Pregnancy (Raine) Study provided cross-sectional spinal pain and CBCL data.
As predicted, there was a high prevalence of back and neck pain in this cohort. On the whole, females reported more mental health difficulties than males. There were strong relationships between the majority of symptom scales of the CBCL and back and neck pain. Scores on the CBCL were associated with higher odds of comorbid back and neck pain.
These findings strongly support the need to consider both psychological and pain symptoms when providing assessments and treatment for adolescents. Further research is required to inform causal models.
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