Effect of COVID-19 on older adults 50 years and above living with HIV in a less-developed country

Introduction: Globally, control measures have been communicated to reverse the COVID-19 pandemic. In Uganda, as soon as the first case of COVID-19 was identified, strict lockdown measures were enforced, including a ban on all public and private transport, night curfew, closure of schools, and suspension of religious and social gatherings and closure of non-essential shops and markets. These measures affected access to health services, which could have been worse for older people living with HIV (PLHIV). In this study, we explored how COVID-19 affected the health and social life of older PLHIV. Methods: We conducted a qualitative study in HIV clinics of two hospitals in Uganda. We completed 40 in-depth interviews with adults above 50 years who had lived with HIV for more than 10 years. The interviews explored the effect of COVID-19 on their health and social life during the lockdown. We analysed data thematically. Results: The overarching themes regarding the effects of COVID-19 on older adults living with HIV were fear and anxiety during the lockdown, lack of access to health care leading to missing HIV clinic appointments and not taking their ART medicines, financial burden, loss of loved ones, and effect on children's education. Some patients overcame health-related challenges by sending motorcycles to their health facilities with their identifying documents to get the medicines refilled. Some health care providers took the ART medicines to their patients' homes. Conclusion: The COVID-19 lockdown negatively affected the health and social well-being of older PLHIV. This calls for strategies to improve HIV care and treatment access during the lockdown to sustain the HIV program gains in this vulnerable population.

Functional outcome of stroke inpatients according to human immunodeficiency virus status: a feasibility study

Background: Stroke in human immunodeficiency virus positive (HIV+) individuals is becoming an increasing concern. Being significantly younger than typical stroke patients, the impact of functional challenges on quality of life and burden on society becomes more eminent. Objectives: This feasibility study aims to determine the requirements for a large descriptive cohort, to adequately describe the functional outcome of stroke patients with varying HIV status. Method: All stroke patients meeting the inclusion criteria were recruited over a 6-month period at a South African inpatient rehabilitation centre. Data were collected on admission and discharge using outcome measures including the Barthel Index (BI), Berg Balance Scale (BBS) and the use of assistive devices used to describe independence with activities of daily living (ADL), mobility and safety post-stroke. Statistical analysis was performed using Stata version 14.2. Results: The feasibility study identified appropriate procedures and barriers to a successful study in addition to describing preliminary data on participant demographics, relevant medical history and functional outcomes post-stroke. Limitations that affected feasibility included minimal recruitment sites, length of data collection period, timely communication of participant discharge plans and dates, and confirmation of participant HIV status. An appropriate comparison between sub-groups could not be made because of disproportionate group sizes, median age differences and no assessor blinding. Conclusion: To increase generalisability and the understanding of the unique HIV+ stroke profile, multiple recruitment sites, longer data collection periods, assessor blinding and age-matched groups with HIV status confirmation are recommended

Influence of post-stroke depression on functional independence in activities of daily living

BACKGROUND: Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. METHODS: The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. RESULTS: A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). CONCLUSION: Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components

An inferential comparison between the capabilities and achievements of 1st-year medical and nursing students at the University of the Free State, Bloemfontein, South Africa

Background. Research indicates that academic stressors; living circumstances; working conditions and where students undertake leisure activities affect academic performance; capabilities and achievements (functionings). Objective. To investigate how 1st-year medical and nursing students perceived their own capabilities compared with their actual achievements (functionings). The article focuses on the achievements (functionings); as these students were admitted through a selection process; indicating their potential capability to succeed. Methods. In this descriptive; comparative study; all 1st-year medical and nursing students at the University of the Free State; Bloemfontein; South Africa were invited to complete a validated questionnaire to reflect their capabilities (scope) and achievements (outcomes). The questionnaire incorporated seven domains: happiness; achievements; health; intellect; social relations; environment and integrity. Data were analysed using descriptive statistics (frequencies; medians; means; standard deviations and standard errors). Results. All respondents valued the domains positively with regard to the outcomes (functionings). On average; nursing students valued the domains 17.4% lower than the medical students. Integrity was valued the highest by all. Health scored the lowest in the medical group; and environment (where students study and undertake leisure activities) the lowest in the nursing group. Conclusions. Medical schools should include wellness in their curricula; limit the degree of physical and emotional exhaustion associated with training; and have realistic expectations of students. Programmes should allocate enough time for students to manage their time well to take part in physical activity and eat healthy foods. Nursing students' work environment should improve. More time should be made available for leisure activities and improvement to students' study environment

Jeunes enfants et adolescentes chefs de menages a Oicha ; Nord-Kivu/Congo. Retombees socio-medicales

Le phenomene 'enfants chef de menage' est devenue frequente globalement. Si ces manifestations sont presque similaires malgre le milieu ou il survient; les causes elles varient entre malades chroniques des parents; deces des parents ou deplacement des parents aux champs. Neanmoins la litterature est rare sur les enfants chef de menage au Congo et aussi le deplacement aux champs comme cause d'enfants chef de menage est nouveau dans litterature. D'ou l'objet de cette etude; est de decrire les conditions d'enfants chef de menage des enfants dont les parents deplaces pour les champs.Methodes : etude transversale de 181 menages diriges par les enfants et selectionnes par convenance a Ocha a qui un questionnaire a ete administre. Resultats : les enfants sont confrontes aux problemes medicaux (grossesses; agression sexuelle; abus sexuel; et maladies des enfants la nuit); social (dettes contractees dans le quartier; division du travail et indiscipline;) scolaires (arreter la scolarisation; chasser pour raison de minerval; etc.) Conclusion : les consequences medicales; sexuelles; educatives sont donnees et leurs implications (dans les pratiques; les recherches et la politiques sanitaires) ont ete donnees

Is Assessing Participation in Daily Activities a Suitable Approach for Measuring the Impact of Disease on Child Development in African Children?

introduction:The Participation in Activities of Daily Living (PADL) instrument was developed out of a need for a culturally appropriate tool to measure the impact of ill health on children's well-being. Objective: We sought to devise a psychometrically sound instrument to measure well-being through participation in daily activities for rural school-age children in Kenya. Method: The study was carried out at the Kenya Medical Research Institute/Centre for Geographic Medicine Research - Coast; in the Kilifi district of Coast Province. The process that was followed ensured an integration of community reported activity; use of a relevant vocabulary and a careful translation of concepts in the adaptation of an instrument used in other contexts. The reliability; validity and sensitivity of the PADL were evaluated in studies with clinical and community samples. Results: Factor analysis suggested five potential summary scores measuring levels of participation and attitude to participation (alphas 0.56-0.91). Variability in children's responses on participation was significantly associated with ill health and level of schooling. Conclusion: The format and content of the questionnaire items concerning participation in activities of daily living were appropriate for use with rural children. The precise nature of the activities needs to be determined in context; taking into account both the nature of the health experience and the expected structure of a child's day