RESUMO
BACKGROUND: Given the limited integration of mental health services into pediatric HIV care in sub-Saharan Africa, there is limited information on the nature of mental health service use sought by caregivers of children and adolescents living with HIV/AIDS. METHODS: We analyzed data from a sample of 135 children and adolescents living with HIV/AIDS and attending a pediatric HIV care service whose parents or caregivers had sought for mental health care for their emotional or behavior problems in the past year. We assessed complementary alternative medicine use, socio-demographic characteristics and types of behavioral problems using a SOCIO-DEMOGRAPHIC questionnaire and the child behavioral checklist (6 - 18) respectively. Logistic regression models were used to explore factors independently associated with specific patterns of mental health service use. RESULTS: Of 135 parents/caregivers interviewed, 38 (28.15%) sought mental health care from only complementary and alternative medicine (CAM) providers (traditional or faith healers), 38 (28.15%) from only conventional medical providers (general physicians, general nurses, psychiatrists or HIV counselors) and 59 (43.70%) sought care from both). Severe HIV disease in the young children [PRR = 2.09, 95%CI = 1.36 to 3.2, p-value = 0.001] and thought problems [PRR 1.26, 95%CI = 0.81 to 1.72, p-value = 0.04] in adolescents were independently associated with complementary and alternative medicine use. CONCLUSION: Caregivers of children and adolescents with progressive HIV disease and thought problems were more likely to seek mental health services from complementary and alternative medicine providers.
RESUMO
BACKGROUND: There is limited literature on the knowledge about Autism Spectrum Disorder (ASD) among child and adolescent health professionals from resource limited settings. METHODS: 40 child and adolescent health professionals were purposively sampled from the two national referral hospitals in Uganda. Participants completed a standardized questionnaire that collected data on socio-demographic characteristics, the Knowledge about Childhood Autism among Health Workers (KCAHW) and the challenges related to diagnosing and managing ASD. General linear model with the Poisson regression was used to evaluate bivariate and multivariate factors associated with limited knowledge about ASD. RESULTS: The study participation rate was 90% with the majority being females (N = 21, 58%). Also, most (N = 20, 55.6%) were mental health professionals working at the Butabika pediatric out-patient clinic while (N = 16, 44.4%) were pediatric health professionals working at the Mulago mental and neurological pediatric clinics. The mean score on KCAHW was 11.8 (SD = 3.75). The participants (36.1%) who scored below the mean score were regarded as having limited knowledge about ASD. Health workers with limited knowledge about ASD (KCAHW score < 11.8) were less likely to have a degree [adjusted Prevalence rate ratio (aPRR) = 0.26, 95%CI = 0.08 to 0.78, p-value = 0.018. Mental health and Non-mental health workers had comparable KCAHW mean scores. Clinical Psychologists, Psychiatrists, psychiatry residents and pediatric nurses had the highest KCAHW scores while psychiatric nurses and medical social workers had the lowest scores. CONCLUSION: The proportion of child and adolescent health professionals with limited knowledge about ASD is substantial. There is urgent need to increase focus on training in autism spectrum disorders especially among non-specialist health workers.
