Erica L. Pufall
Imperial College London
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Featured researches published by Erica L. Pufall.
Aids Care-psychological and Socio-medical Aspects of Aids\/hiv | 2014
Erica L. Pufall; Constance Nyamukapa; Jeffrey W. Eaton; Catherine Campbell; Morten Skovdal; Shungu Munyati; Laura Robertson; Simon Gregson
Little is known about how HIV impacts directly and indirectly on receiving, or particularly succeeding in, education in sub-Saharan Africa. To address this gap, we used multivariable logistic regression to determine the correlation between education outcomes in youth (aged 15–24) (being in the correct grade-for-age, primary school completion and having at least five “O” level passes) and being HIV-positive; having an HIV-positive parent; being a young carer; or being a maternal, paternal or double orphan, in five rounds (1998–2011) of a general population survey from eastern Zimbabwe. The fifth survey round (2009–2011) included data on children aged 6–17, which were analysed for the impacts of the above risk factors on regular attendance in primary and secondary schools and being in the correct grade-for-age. For data pooled over all rounds, being HIV-positive had no association with primary school completion, “O” level passes, or being in the correct grade-for-age in adolescents aged 16–17 years. Additionally, HIV status had no significant association with any education outcomes in children aged 6–17 surveyed in 2009–2011. In 2009–2011, being a young carer was associated with lower attendance in secondary school (69% vs. 85%, AOR: 0.44; p=0.02), whilst being a maternal (75% vs. 83%, AOR: 0.67; p<0.01), paternal (76% vs. 83%, AOR: 0.67; p=0.02) or double (75% vs. 83%, AOR: 0.68; p=0.02) orphan was associated with decreased odds of being in the correct grade-for-age. All forms of orphanhood also significantly decreased the odds of primary school completion in youths surveyed from 1998 to 2011 (all p<0.01). We found no evidence that HIV status affects education but further evidence that orphans do experience worse education outcomes than other children. Combination approaches that provide incentives for children to attend school and equip schools with tools to support vulnerable children may be most effective in improving education outcomes and should be developed and evaluated.
AIDS | 2014
Erica L. Pufall; Simon Gregson; Jeffrey W. Eaton; Tidings Masoka; Edith Mpandaguta; Louise Andersen; Morten Skovdal; Constance Nyamukapa; Catherine Campbell
Objectives:Schools are often cited as a source of support for orphans and children affected by HIV/AIDS in populations experiencing generalized HIV epidemics and severe poverty. Here we investigate the success of schools at including and supporting the well being of vulnerable children in rural Zimbabwe. Design:Data from a cross-sectional household survey of 4577 children (aged 6–17 years), conducted between 2009 and 2011, were linked to data on the characteristics of 28 primary schools and 18 secondary schools from a parallel monitoring and evaluation facility survey. Methods:We construct two measures of school quality (one general and one HIV-specific) and use multivariable regression to test whether these were associated with improved educational outcomes and well being for vulnerable children. Results:School quality was not associated with primary or secondary school attendance, but was associated with childrens being in the correct grade for age [adjusted odds ratio 2.0, 95% confidence interval (CI) 1.2–3.5, P = 0.01]. General and HIV-specific school quality had significant positive effects on well being in the primary school-age children (coefficient 5.1, 95% CI 2.4–7.7, P < 0.01 and coefficient 3.0, 95% CI 0.4–5.6, P = 0.02, respectively), but not in the secondary school-age children (P > 0.2). There was no evidence that school quality provided an additional benefit to the well being of vulnerable children. Community HIV prevalence was negatively associated with well being in the secondary school-age children (coefficient −0.7, 95% CI −1.3 to −0.1, P = 0.03). Conclusions:General and HIV-specific school quality may enhance the well being of primary school-age children in eastern Zimbabwe. Local community context also plays an important role in child well being.
International Journal of Educational Development | 2015
Catherine Campbell; Louise Andersen; Alice Mutsikiwa; Erica L. Pufall; Morten Skovdal; Claudius Madanhire; C Nyamukapa; Simon Gregson
We present multi-method case studies of two Zimbabwean primary schools – one rural and one small-town. The rural school scored higher than the small-town school on measures of child well-being and school attendance by HIV-affected children. The small-town school had superior facilities, more teachers with higher morale, more specialist HIV/AIDS activities, and an explicit religious ethos. The relatively impoverished rural school was located in a more cohesive community with a more critically conscious, dynamic and networking headmaster. The current emphasis on HIV/AIDS-related teacher training and specialist school-based activities should be supplemented with greater attention to impacts of school leadership and the nature of the school-community interface on the HIV-competence of schools.
PLOS Medicine | 2016
Annick Borquez; Anne Cori; Erica L. Pufall; Jingo Kasule; Emma Slaymaker; Alison Price; Jocelyn Elmes; Basia Zaba; Amelia C. Crampin; Joseph Kagaayi; Tom Lutalo; Mark Urassa; Simon Gregson; Timothy B. Hallett
Background Programmatic planning in HIV requires estimates of the distribution of new HIV infections according to identifiable characteristics of individuals. In sub-Saharan Africa, robust routine data sources and historical epidemiological observations are available to inform and validate such estimates. Methods and Findings We developed a predictive model, the Incidence Patterns Model (IPM), representing populations according to factors that have been demonstrated to be strongly associated with HIV acquisition risk: gender, marital/sexual activity status, geographic location, “key populations” based on risk behaviours (sex work, injecting drug use, and male-to-male sex), HIV and ART status within married or cohabiting unions, and circumcision status. The IPM estimates the distribution of new infections acquired by group based on these factors within a Bayesian framework accounting for regional prior information on demographic and epidemiological characteristics from trials or observational studies. We validated and trained the model against direct observations of HIV incidence by group in seven rounds of cohort data from four studies (“sites”) conducted in Manicaland, Zimbabwe; Rakai, Uganda; Karonga, Malawi; and Kisesa, Tanzania. The IPM performed well, with the projections’ credible intervals for the proportion of new infections per group overlapping the data’s confidence intervals for all groups in all rounds of data. In terms of geographical distribution, the projections’ credible intervals overlapped the confidence intervals for four out of seven rounds, which were used as proxies for administrative divisions in a country. We assessed model performance after internal training (within one site) and external training (between sites) by comparing mean posterior log-likelihoods and used the best model to estimate the distribution of HIV incidence in six countries (Gabon, Kenya, Malawi, Rwanda, Swaziland, and Zambia) in the region. We subsequently inferred the potential contribution of each group to transmission using a simple model that builds on the results from the IPM and makes further assumptions about sexual mixing patterns and transmission rates. In all countries except Swaziland, individuals in unions were the single group contributing to the largest proportion of new infections acquired (39%–77%), followed by never married women and men. Female sex workers accounted for a large proportion of new infections (5%–16%) compared to their population size. Individuals in unions were also the single largest contributor to the proportion of infections transmitted (35%–62%), followed by key populations and previously married men and women. Swaziland exhibited different incidence patterns, with never married men and women accounting for over 65% of new infections acquired and also contributing to a large proportion of infections transmitted (up to 56%). Between- and within-country variations indicated different incidence patterns in specific settings. Conclusions It is possible to reliably predict the distribution of new HIV infections acquired using data routinely available in many countries in the sub-Saharan African region with a single relatively simple mathematical model. This tool would complement more specific analyses to guide resource allocation, data collection, and programme planning.
PLOS ONE | 2014
Erica L. Pufall; Constance Nyamukapa; Jeffrey W. Eaton; Reggie Mutsindiri; Godwin Chawira; Shungu Munyati; Laura Dingle Robertson; Simon Gregson
Background There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source of infection is presumed to be perinatal mother-to-child transmission, but general population data about paediatric HIV are sparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence, possible source of infection, and effects of paediatric HIV in a southern African population. Methods From 2009 to 2011, we conducted a household-based survey of 3389 children (aged 2–14 years) in Manicaland, eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV, risk factors for infection, and effects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-child transmission, child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort. Results HIV prevalence was (2.2%, 95% CI: 1.6–2.8%) and did not differ significantly by sex, socio-economic status, location, religion, or child age. Infected children were more likely to be underweight (19.6% versus 10.0%, p = 0.03) or stunted (39.1% versus 30.6%, p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available, reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infection were not associated with child HIV infection, including blood transfusion, vaccinations, caring for a sick relative, and sexual abuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatal mother-to-child transmission, although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positive children (26.0%) were diagnosed, but, of these, 17 were on antiretroviral therapy. Conclusions Childhood HIV infection likely arises predominantly from mother-to-child transmission and is associated with poorer physical development. Overall antiretroviral therapy uptake was low, with the primary barrier to treatment appearing to be lack of diagnosis.
International Journal of Educational Development | 2016
Erica L. Pufall; Jeffrey W. Eaton; Constance Nyamukapa; Nadine Schur; Albert Takaruza; Simon Gregson
Highlights • We model education trends during the economic turmoil in Zimbabwe.• During the economic collapse, female education decreased more than male’s.• Children with more educated parents continued to have better outcomes.• Despite the collapse, parental and child education has increased over time.• Increasing proportions of educated parents may have helped maintain education.
Vulnerable Children and Youth Studies | 2015
Erica L. Pufall; Constance Nyamukapa; Laura Robertson; Paradzai George Mushore; Albert Takaruza; Simon Gregson
Orphans and other children made vulnerable by HIV in sub-Saharan Africa are at increased risk of moving household and of dropping out of school. However, the relationship between child migration and school enrolment has not been established. Multivariable regression models and prospective data from a cohort of children in Manicaland, Zimbabwe, were used to investigate the effect of migration on school enrolment. Children who had moved household were at increased risk of dropping out of school after adjusting for orphan status, relationship to primary caregiver, and household wealth. Interventions are needed to ensure that children who migrate are re-enrolled in school.
Vulnerable Children and Youth Studies | 2017
Erica L. Pufall; Jeffrey W. Eaton; Laura Robertson; Phyllis Mushati; C Nyamukapa; Simon Gregson
ABSTRACT There is a growing interest in education as a means to reduce HIV infection in vulnerable children in sub-Saharan Africa; however, the mechanisms by which education reduces HIV infection remain uncertain. Substance use has been associated with high-risk sexual behaviour and could lie on the causal pathway between education and HIV risk. Therefore, we used multivariable regression to measure associations between: (i) orphanhood and substance use (alcohol, recreational drugs, and smoking), (ii) substance use and sexual risk behaviours, and (iii) school enrolment and substance use, in adolescents aged 15–19 years, in Eastern Zimbabwe. We found substance use to be low overall (6.4%, 3.2%, and 0.9% of males reported alcohol, drug, and cigarette use; <1% of females reported any substance use), but was more common in male maternal and double orphans than non-orphans. Substance use was positively associated with early sexual debut, number of sexual partners, and engaging in transactional sex, while school enrolment was associated with lower substance use in males. We conclude that education may reduce sexual risk behaviours and HIV infection rates among male adolescents in sub-Saharan Africa, in part, by reducing substance abuse.
Sexually Transmitted Infections | 2013
Erica L. Pufall; C Nyamukapa; Jeffrey W. Eaton; R Mutsindiri; G Chawira; S Munyati; Laura Robertson; Simon Gregson
Sexually Transmitted Infections | 2015
Annick Borquez; Anne Cori; Erica L. Pufall; J Kasule; Emma Slaymaker; Alison Price; Jocelyn Elmes; Simon Gregson; M Crampin; Mark Urassa; J Kagaayi; Tom Lutalo; Timothy B. Hallett