Paul Narh Doku

Parental HIV/AIDS status and death, and children's psychological wellbeing

BackgroundGhana has an estimated one million orphans, 250,000 are due to AIDS parental deaths. This is the first study that examined the impact of parental HIV/AIDS status and death on the mental health of children in Ghana.MethodsIn a cross-sectional survey, 4 groups of 200 children (children whose parents died of AIDS, children whose parents died of causes other than AIDS, children living with parents infected with HIV/AIDS, and non-orphaned children whose parents are not known to be infected with HIV/AIDS) aged between 10 and 19 were interviewed on their hyperactivity, emotional, conduct, and peer problems using the Strengths and Difficulties Questionnaire.ResultsChildren whose parents died of AIDS showed very high levels of peer problems [F (3,196) = 7.34, p < .001] whilst both orphaned groups scored similarly high on conduct problems [F (3, 196) = 14.85, p < .001]. Hyperactivity showed no difference and was very low in the entire sample. Emotional problems were very high in all the groups except among the non-orphaned children [F (3, 196) = 5.10, p < .001].ConclusionOrphans and children living with parents infected with HIV/AIDS are at heightened risks for emotional and behavioural disorders and that efforts to address problems in children affected by HIV/AIDS must focus on both groups of children. Parallel to this, researchers should see these findings as generated hypotheses (rather than conclusions) calling for further exploration of specific causal linkages between HIV/AIDS and childrens mental health, using more rigorous research tools and designs.

Cultural adaptation of the Condom Use Self Efficacy Scale (CUSES) in Ghana

BackgroundAccurate assessment of self-reports of sexual behaviours is vital to the evaluation of HIV prevention and family planning interventions. This investigation was to determine the cross-cultural suitability of the Condom Use Self Efficacy Scale (CUSES) originally developed for American adolescents and young adults by examining the structure and psychometric properties.MethodA self-administered cross-sectional survey of a convenient sample of 511 participants from a private university in Ghana with mean age 21.59 years.ResultA Principal Component Analysis with varimax rotation identified a 14 item scale with four reliable factors labelled Appropriation (Cronbach alpha = .85), Assertive (Cronbach alpha = .90), Pleasure and Intoxicant (Cronbach alpha = .83), and STDs (Cronbach alpha = .81) that altogether explained 73.72% of the total variance. The scale correlated well with a measure of condom use at past sexual encounter (r = .73), indicating evidence of construct and discriminatory validity. The factor loadings were similar to the original CUSES scale but not identical suggesting relevant cultural variations.ConclusionThe 14 item scale (CUSES-G) is a reliable and valid instrument for assessing condom use self efficacy. It is culturally appropriate for use among Ghanaian youth to gauge actual condom use and to evaluate interventions meant to increase condom use. Finally, the study cautioned researchers against the use of the original CUSES without validation in African settings and contexts.

Psychosocial adjustment of children affected by HIV/AIDS in Ghana

Objective: The study was conducted to assess the psychosocial adjustment of children affected by HIV/ AIDS in the eastern part of Ghana. Method: Four groups of children (children who lost their parents to AIDS, children who lost their parents through other causes, children living with HIV infected, alive parents and the comparison children who were from the same community but did not have HIV/AIDS-related illness or death in their families) were interviewed on depressive symptoms, prosocial behaviours, hyperactivity, conduct and peer problems using the Strengths and Difficulties Questionnaire (SDQ). Results: Orphans in general and children living with HIV-infected parents consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. Conclusion: The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the wellbeing of these children.

Perceived social support disparities among children affected by HIV/AIDS in Ghana: a cross-sectional survey

BackgroundThe study investigated whether perceived social support varied among children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families (comparison group).MethodThis study employed cross-sectional, quantitative survey that involved 291 children aged 10–18 years in the Lower Manya Krobo District of Ghana and examined their social support disparities.ResultsMultivariate linear regressions indicate that children living with HIV/AIDS-infected caregivers reported significantly lower levels of social support compared with AIDS-orphaned children, other-orphaned children and non-orphaned children independent of socio-demographic covariates. Children who have lost their parents to other causes and other-orphaned children reported similar levels of social support. In terms of sources of support, all children orphans and vulnerable children were more likely to draw support from friends and significant others rather than from the family.ConclusionThe findings indicate a need to develop interventions that can increase levels of social support for orphaned and vulnerable children within the context of HIV/AIDS in Ghana, particularly networks that include the family.

Reactive Attachment Disorder in Orphans and Vulnerable Children (OVC)Affected by HIV/AIDS: Implications for Clinical Practice, Education andHealth Service Delivery

Background: Orphans and vulnerable children (OVC) affected by HIV/AIDS frequently experience placement/ residential changes, inconsistent caregivers, abuse, neglect, disruptions in their lives and several mental health problems. This may lead to a disorder of emotional functioning, reactive attachment disorder (RAD), where the child exhibits wary, watchful, and emotionally withdrawn. Despite its clinical importance, nothing is known about RAD among OVC. This study investigated: (1) whether RAD symptoms can occur in children affected by HIV/AIDS; (2) association between RAD and other psychiatric symptoms; (3) possible aetiological or contextual factors for high RAD symptom; and (4) any interactive, cumulative effects between the aetiological or contextual factors (both risks and protective) for higher RAD symptoms. Method: In a cross-sectional survey, caregivers of 191 OVC and 100 non-OVC completed questionnaires on mental health problems including RAD and contextual variables. Results: The results demonstrated that RAD is present in OVC and that RAD symptoms may be as a result of environmental factors. The study also found high levels of RAD comorbidity with other disorders including depression, conduct problems and hyperactivity. Finally, the results indicate that experiencing more neglect and psychological abuse among OVC increases their likelihood of exhibiting RAD symptoms five-fold. Conclusion: The paper discusses the clinical implications of these findings for service development for this vulnerable group in the community and concluded that among children affected by HIV/AIDS, RAD was not rare.

Multi-informant Perspective on Psychological Distress among Ghanaian Orphans and Vulnerable Children (OVC) within the Context of HIV/AIDS

There is little knowledge about the psychosocial distress of children affected by HIV/AIDS in Ghana, to aid planning of services. This study investigated mental health problems among children affected by HIV/AIDS in Ghana, compared to control groups of children orphaned by other causes, and non-orphans. It employed a cross-sectional survey that interviewed 291 children and their caregivers on their psychosocial wellbeing using standardized scales. The results indicated that controlling for relevant socio-demographic factors both children’s self-reports and caregivers reports indicate that both children living with HIV/AIDS-infected caregivers and children orphaned by AIDS were at heightened risk for mental health problems than both children orphaned by other causes and non-orphans. The findings further indicated that significant proportion of orphaned and vulnerable children (OVC) exhibited symptoms for depression and other psychiatric disorders (approximately 63%) compared with 7% among the non-orphaned group. Caregivers gave higher ratings for children on externalizing problems and lower on internalizing problems, and vice versa when the children’s self-reports were analyzed. These findings suggest that both children and their informants have diverse yet complementary perspectives on psychological outcomes. The study discusses the theoretical and practical implications of these findings andurgently called for necessary intervention programs that targets all children affected by HIV/AIDS to effectively alleviate psychological distress and enhance the mental health of these children.