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Changes in brain network properties in major depressive disorder following electroconvulsive therapy: a combined static and dynamic functional magnetic resonance imaging study
(Annals of Palliative Medicine, 2022-06-29) Sariah, Adellah
Background: Major depressive disorder (MDD) is a common and intractable mood disorder. Electroconvulsive therapy (ECT) is a common means of brain electrical stimulation for the treatment of MDD, but the neurobiological mechanism of its clinical symptom relief effect is still to be explored. This study aims to explore how ECT plays a role in depression remissions by investigating the changes of static and dynamic brain network characteristics in MDD patients before and after ECT. Methods: Resting-state functional magnetic resonance imaging (fMRI) scans were obtained from nine MDD patients twice before and after a full course of ECT, all of whom responded to ECT as defined by at least a 50% reduction from baseline Hamilton Depression Scale (HAMD) scores. Both static and dynamic characteristics of the functional brain network were compared between the pre- and post-ECT scans for all participants, and the correlations between changes in clinical symptoms and altered network metrics were also investigated. Results: The clustering coefficient and local efficiency in static brain networks were increased significantly, while the global flexibility of dynamic brain networks was decreased significantly after ECT. Several regions of interest (ROIs) that changed significantly at the local level were also identified, which involved regions of the cerebellum, hippocampus as well as frontal and temporal cortices. Although not significant, the decrease of HAMD scores were associated with trends of changed network metrics after ECT. Conclusions: Our results suggest that ECT may alleviate the depressive symptoms of MDD by decreasing the randomness of the brain network as reflected by changes in both static and dynamic network properties and that the temporal gyrus, frontal gyrus, hippocampus, and cerebellar regions may play key roles in such mechanisms. These findings have important implications for our understandings of ECT and depression. However, this study is limited by a relatively small sample size and the results should be confirmed in larger samples
Clinical outcomes and retention among HIV infected adolescents and adults initiated on protease inhibitors antiretroviral therapy regimen in Dar es salaam; A Longitudinal retrospective descriptive study.
(Research Squaire, 2021-01-06) Sariah, Adellah
Background: Globally antiretroviral therapy access has increased and significantly changed HIV morbidity and mortality patterns. In sub-Saharan Africa there are reports of increasing rates of failure to second-line antiretroviral treatment (ART) hence, assessment for clinical outcomes is critical. Objectives: To assess clinical outcomes and retention using programmatic indicators among HIV-infected adolescents and adults receiving second-line ART in Tanzania. Methods: In this longitudinal retrospective cohort study, we enrolled HIV-infected individuals aged 15 years and above who were initiated on second-line ART (Protease Inhibitor based regimen) due to documented failure of first-line ART between July 2012 and September 2015. We evaluated mean change in CD4 cell count, HIV viral load and retention using survival analysis. Results : A total of 1446 participants were enrolled, the mean duration of second-line therapy was 37.0 months± SD 26.50 and the median CD4 cell count at initiation of the second line was 290 cells/mm3. Virologic suppression <50 copies/ml was increasing over time and reached 58% at 36 months. Six months after switching, 80% of patients were retained and thereafter. Predictors of retention were male gender with hazard ratio (HR) 1.04; 95% CI 1.0-1.1 P-value 0.037 and younger age (25 -39 years) with HR 1.1; 95% CI 1.0-1.2 P-value 0.006. Additionally, adherence > 90% increased the likelihood of retention with a strong correlation HR 1.4; 95% CI 1.1-1.7 P-value 0.00. Clinical stage III and IV at switch were less likely to be retained HR 0.6; 95% CI 0.5-0.6 P-value 0.000 and higher CD4 cell count was associated with less retention HR <1; 95 % CI 0.4-0.6 P-value 0.000. Conclusion: There was a low rate of viral suppression (<50copies/ml) 58% 36 months after switch however, more than 87% of participants were retained to care after switch. Predictors of retention were male gender, younger age (25-39 years) and adherence > 90%. Therefore, improving viral suppression after switching to second-line requires further interventions.
Challenges facing mothers who practice Kangaroo mother care in health facilities; a case of Dar es Salaam
(International Journal of Nursing and Health Science, 2017) Mbao, Ezekiel H.
Kangaroo mother care has been proved scientifically to reduce morbidity and mortality of preterm infants since it maintains bonding between mother and infant as a result of skin to skin contact, protects infants against infection, stimulates milk secretion, reduces hospital long stay for the infant and provides good sleep pattern to infants because of comfortability from the mother. The objective of this study was to assess challenges facing mothers who practice kangaroo mother care method for their preterm or low birth weight babies in Dar es Salaam. The study adopted a descriptive cross-sectional design. Mwananyamala hospital which is located in Kinondoni municipality was purposively selected for the study. The study population included mothers who practice kangaroo mother care method in the kangaroo unit of the hospital. Data was collected using structured interviews, focus group discussion and observation. Fifteen individual interviews and one focus group discussion were conducted. Data was analysed using content analysis methods where themes were developed from the responses. Major factors that affect kangaroo mother care include little knowledge of kangaroo mother care, fatigue of mothers, lack of cooperation from health care workers and unconducive environment of the wards. Recommendations from the study are that mothers should be educated on the importance of kangaroo mother care during the perinatal period, health care workers should encourage mothers to practice kangaroo method and hospital administrators should furnish the kangaroo wards with the necessary equipment.
Exploration of heroin use behaviors and its associated risk factors among youth with heroin-dependence in Dar es Salaam, Tanzania.
(American Journal of Psychology and Behavioral Sciences, 2014) Mbao, Ezekiel H.
Objective: Heroin abuse among youth in Tanzania continued to increase over the past decades. This study sought to explore heroin abuse among youth in Dar es Salaam. Methodology: The study comprised of 16 participants (15 males) aged between 18 to 25 years who were obtained through snow ball sampling technique. In-depth interviews and focus group discussions were conducted to inquire their general knowledge, attitude, practices and the associated risks on heroin use. The sample size was determined by saturation principle; till when the researchers found no further new information emerging from in-depth interviews. Main findings: Most participants reported peer pressure and lack of formal employment as contributing factors for engaging in heroin use. Though most participants acknowledged heroin use to be accompanied with several consequences, but found difficult to abstain from it. The underlying reasons for these were continuous peer pressure, lack of effective drug rehabilitation services and withdrawal syndrome. The risk factors that reported to be associated with heroin use included mental illnesses, marital conflicts, risk to infections, robbery, legal problems, and rejection from families, friends and community at large. Conclusion and recommendations: This study demonstrated that individuals with heroin dependence encounter several difficulties towards abstinence including complexity of peer pressure and other patterns of social networks. Thus, future studies are warranted to explore the complex relationship between heroin use and associated risk factors in Tanzania.
Socio-demographic determinants of health seeking desires of youth involved in substance abuse in Kinondoni Municipality - Dar Es Salaam, Tanzania.
(The International Journal Of Humanities & Social Studies, 2020-07-31) Mbao, Ezekiel H.
The main purpose of this study was to identify and assess the role of socio-demographic factors associated with health seeking desires by young people involved in substance abuse in the Kinondoni Municipality of Dar es Salaam in Tanzania. The background of this study is in the fact that although little, if anything is known about social and demographic factors associated with the tendency of youth involved in substance abuse to seek health support and rehabilitating services. The study was informed by the Health Belief Model. The study was also guided by the positivist and constructivist paradigms based on a combination of quantitative and qualitative data resulting from a mixed method of research approach. The study was nested in a cross-sectional descriptive survey with a blending of both quantitative and qualitative approaches. The main target population was youth involved in substance abuse including persons who regularly interact with them in a variety of ways. Data was collected by using closed ended questionnaires, in-depth interviews, focus group discussions (FGD’s) and documentary reviews. The methodology and support theories were triangulated to authenticate collected data. The respondents and participants in the study were randomly and purposively sampled out. Quantitative data was analyzed by using the Statistical Package for Social Sciences (SPSS) version 20.0 while qualitative data was analyzed using content analysis. The findings show that sex, education level, and income were significant sociodemographic factors associated with the tendency and urge of youth involved in substance abuse to seek health support services. The age, marital and occupational status of the respondents were identified to be among the suspect sociodemographic determinants of the desire of persons involved in substance use to seek health support. The researcher concluded that social and demographic factors such as sex, education, income, age, marital status and occupation were associated with the urge of the concerned persons to seek health support. The researcher recommends that more efforts should be made to prevent and control substance abuse among the youth through inter alia strategies that integrate the identified factors. The government and Civil Society Organizations (CSOs) should team up and collaborate in accommodating these socio-demographic factors in their planning initiatives in the joint effort to stamp out substance abuse in Tanzania.
Factors associated with maternal death among women of child bearing age on the community perspectives; A case study of Kisemvule Village in Mkuranga District, Tanzania 2019
(Journal of Trauma and Rehabilitation, 2020-03-10) Mbao, Ezekiel H.
Objective: In the world, 303,000 women lose their life due to the complications related to pregnancy and childbirth. Tanzania is ranked 6th and 4th among the countries with high maternal mortality globally and Africa respectively. About 23 women in Tanzania are dying daily due to preventable causes, related to pregnancy and childbirth that is approximately one woman every hour. The objective of this study was assessment of risk factors on community setting associated with maternal death among women of child bearing age. Methods: During the study both quantitative and qualitative design was employed in which under quantitative cross-sectional descriptive study was undertaken. Results: We enrolled 124 women of child bearing age. The mean age was 17.7. (37%) mentioned preeclampsia as the most risk factor leading to maternal death, 21% reported abortion, 13.7% mentioned anemia, and 12.1% reported postpartum hemorrhage, and 10.5% pregnancy induced hypertension (PIH), 3.2% ante partum hemorrhage and 2.4% early pregnancy. Other risk factors that seemed to cause maternal death included; delay to seek health facility to pregnant mother (8.9%), long distance from health facility to people’s residents (57.%), poor transport system in the village to reach the present health care facility (4.8%), negligence from health workers was also reported by the women as contributing factor (13.7%), economic condition-poverty (7.3%) absence of emergency blood bank in the health facility(4.8%), and poor nutrients to pregnant mother (3.2%). More studies are needed in the community so as to explore more understanding on the risk factors among women of child bearing age
The relationship between work stress and employees’ performance in public health sectors: a case of Mbeya Regional Hospital, Tanzania
(The International Journal of Humanities &Social Studies, 2020) Mbao, Ezekiel H.
The study aimed at assessing the relationship between work stress and employees’ performance in public health Sectors at Mbeya Regional Hospital in Tanzania. Descriptive cross-sectional research design informed the study, employed on a sample of 120 respondents attained through stratified sampling. The primary data were collected using structured questionnaires while secondary data were captured through documentary analysis. The multiple regression analysis was used in analyzing data with the aid of Statistical Package for Social Science (SPSS) version 20. Findings revealed that the significant number of doctors; nurses and medical attendants experience high level of job performance accompanied with moderate level of work stress. The total work stress scores were statistically significantly positively related to employees’ performance. Likewise, the results showed that workplace stress sub-scales were insignificantly positively related to employees’ performance. The results suggest that work place stress keeps employees on their toes leading to better performance. The study recommends that for the hospital to maintain the current and future performance levels, its management should moderate stress levels in order to harness the positive side of work place stress, short of which the negatives side of work place stress may prevail.
Challenges of monitoring reproductive health services: a case study of antenatal clinics in Kinondoni municipality, Dar Es Salaam.
(2015) Mbao, Ezekiel H.
Introduction: Antenatal Care (ANC) is one of the interventions that have the potential of significantly reducing the maternal mortality rate when properly conducted. Objectives: The purpose of this research was to assess the challenges of monitoring and evaluation of reproductive health services using ANC clinics as a case study and identify strategies for addressing the challenges. Methods: The study was descriptive cross sectional employing both qualitative and quantitative methods. The sample population included nurse-midwives who manage ANC clinics in Kinondoni Municipality. Results: Of the 30 respondents, 24 respondents noted the need to improve monitoring of the ANC services. Challenges noted were low information use, inadequate human resource, and lack of feedback data from higher authorities. Conclusion: There is need to improve information flow and use, have frequent supportive supervision visits, seminars and workshops to update nurse midwife managers with knowledge and skills of monitoring and evaluation, and development of a culture of information.
Awareness and decision making on health seeking and utilization behaviors among substance abuse youths .
(American Journal of Psychology and Behavioral Sciences, 2017) Mbao, Ezekiel H.
Substance abuse has continued to increase in Tanzania particularly among youth with minority of them seeking the available health services. This study sought to determine the relationship between awareness and decision making on health seeking and utilization behaviors among youth involved in substance abuse in Kinondoni municipality, Dar es Salaam. Concurrent mixed methodology was used. Data were collected among youth with substance abuse problems through face-to-face interviews (n=300) using a structured survey questionnaire. In addition, in-depth interviews (n=23), and focus group discussions (n=5) were conducted. The quantitative data were analyzed using SPSS version 23. Content analysis was used for analyzing qualitative data. Results showed that (74.3%, n=223) of the respondents did not seek and utilize the available treatment options. The majority (62.4%, n=187) of them did not know that their substance abuse problems can be treated using the available treatment options, and 78.2% (n=235) of the participants had little or no concerns about their substance abuse problems. The majority of participants had little information regarding the treatment of substance abuse and major sources of information about substance abuse treatment options were through friends and families followed by radio and television. The reasons related to not seeking and utilizing the available health services may be associated with the low awareness levels of the available treatment options among individuals with substance abuse, little belief that their substance abuse problem can be treated, and having less or no concern about their substance abuse problem. Thus future studies are needed to examine the accessibility and acceptability of the available rehabilitation services for substance abuse in Dar es Salaam.
Reduced Cortical Thickness in the Right Caudal Middle Frontal is associated with Symptom Severity in Betel Quid-Dependent Chewers.
(Frontiers in Psychiatry, 2020) Sariah, Adellah
Background Findings from brain structural imaging studies on betel quid dependence have supported relations between betel quid chewing and alterations in gray matter volume and white matter integrity. However, the effect of betel quid chewing on cortical thickness and the link between cortical thickness and symptom severity remains unascertained. Methods In this observational study, we compared cortical thickness measures from 24 male betel quid-dependent chewers with 27 male healthy controls. Using FreeSufer, we obtained three-dimensional T1-weighted images that were used to compute the thickness of the cerebral cortex throughout the cortical layer. Results Compared to healthy controls, betel quid dependent chewers displayed significant decreased cortical thickness in the precuneus, entorhinal, right paracentral, middle temporal, and caudal middle frontal gyri. Betel quid dependence scale scores negatively correlated (r = -0.604; p = 0.002) with reduced cortical thickness in the right caudal middle frontal of betel quid-dependent chewers. Conclusion The findings provide evidence for cortical thickness abnormality in betel dependent chewers and further propose that the severity of betel quid symptoms may be a critical aspect associated with the cortical alterations. The observed alterations may serve as potential mechanisms to explain why BQ chewing behavior is persistent among individuals with betel quid dependence.
A multivariate pattern analysis of resting-state functional MRI data in Naïve and chronic betel quid chewers.
(Brain Imaging and Behavior, 2020) Sariah, Adellah
Betel quid (BQ) is the fourth most commonly consumed psychoactive substance in the world. However, comprehensive functional magnetic resonance imaging (fMRI) studies exploring the neurophysiological mechanism of BQ addiction are lacking. Betel-quid-dependent (BQD) individuals (n = 24) and age-matched healthy controls (HC) (n = 26) underwent fMRI before and after chewing BQ. Multivariate pattern analysis (MVPA) was used to explore the acute effects of BQ-chewing in both groups. A cross-sectional comparison was conducted to explore the chronic effects of BQ-chewing. Regression analysis was used to investigate the relationship between altered circuits of BQD individuals and the severity of BQ addiction. MVPA achieved classification accuracies of up to 90% in both groups for acute BQ-chewing. Suppression of the default-mode network was the most prominent feature. BQD showed more extensive and intensive within- and between-network dysconnectivity of the default, frontal-parietal, and occipital regions associated with high-order brain functions such as self-awareness, inhibitory control, and decision-making. In contrast, the chronic effects of BQ on the brain function were mild, but impaired circuits were predominately located in the default and frontal-parietal networks which might be associated with compulsive drug use. Simultaneously quantifying the effects of both chronic and acute BQ exposure provides a possible neuroimaging-based BQ addiction foci. Results from this study may help us understand the neural mechanisms involved in BQ-chewing and BQ dependence.
Acute and chronic effects of betel quid chewing on brain functional connectivity.
(Frontiers in psychiatry, 2020-03-17) Sariah, Adellah
Background: The active alkaloid in Betel quid is arecoline. Consumption of betel quid is associated with both acute effects and longer-term addictive effects. Despite growing evidence that betel quid use is linked with altered brain function and connectivity, the neurobiology of this psychoactive substance in initial acute chewing, and long-term dependence, is not clear. Methods: In this observational study, functional magnetic resonance imaging in a resting-state was performed in 24 male betel quid-dependent chewers and 28 male controls prior to and promptly after betel quid chewing. Network-based statistics were employed to determine significant differences in functional connectivity between brain networks for both acute effects and in long-term betel users versus controls. A support vector machine was employed for pattern classification analysis. Results: Before chewing betel quid, higher functional connectivity in betel quid-dependent chewers than in controls was found between the temporal, parietal and frontal brain regions (right medial orbitofrontal cortex, right lateral orbital frontal cortex, right angular gyrus, bilateral inferior temporal gyrus, superior parietal gyrus, and right medial superior frontal gyrus). In controls, the effect of betel quid chewing was significantly increased functional connectivity between the subcortical regions (caudate, putamen, pallidum, and thalamus), and the visual cortex (superior occipital gyrus and right middle occipital gyrus). Conclusion: These findings show that individuals who chronically use betel quid have higher functional connectivity than controls of the orbitofrontal cortex, and inferior temporal and angular gyri. Acute effects of betel quid are to increase the functional connectivity of some visual cortical areas (which may relate to the acute symptoms) and the basal ganglia and thalamus.
Why did I stop? And why did I restart? Perspectives of women lost to follow-up in option B+ HIV care in Dar es Salaam, Tanzania
(BMC public health, 2019) Sariah, Adellah
Background: Despite an increased uptake of option B+ treatment among HIV- positive pregnant and breastfeeding women, retaining these women in care is still a major challenge. Previous studies have identified factors associated with loss to follow-up (LTFU) in HIV care, however, the perspectives from HIV-positive pregnant and breastfeeding women regarding their LTFU in option B+ needs further exploration. We explored reasons for LTFU and motivation to resume treatment among HIV-positive women initiated in option B+ in an Urban setting. Methods: A descriptive qualitative study was conducted at three public care and treatment clinics (CTC) (Buguruni health center, Sinza hospital, and Mbagala Rangitatu health center) in Dar es Salaam, Tanzania between February and May 2017. In-depth interviews were conducted with 30 HIV-positive pregnant and breastfeeding women who were lost to follow up in the option B+ regimen. Analysis of data followed content analysis that was performed using NVivo 10 computer-assisted qualitative data analysis software. Results: Eleven women were lost to follow-up and did not resume Option B+, while 19 had resumed treatment. The study indicated a struggle with long term disease amongst HIV-positive pregnant and breastfeeding women initiated in option B+ treatment. The reported reasons contributing to LTFU among these women appeared in three categories. The contribution of LTFU in the first category namely health-related factors included medication side effects and lack of disease symptoms. The second category highlighted the contribution of psychological factors such as loss of hope, fear of medication side effects and HIV-related stigma. The third category underscored the influence of socio-economic statuses such as financial constraints, lack of partner support, family conflicts, nondisclosure of HIV-positive status, and religious beliefs. Motivators to resume treatment after LTFU included support from health care providers and family members, a desire to protect the unborn child from HIV-infection and a need to maintain a healthy status. Conclusion: The study has highlighted the reasons for LTFU and motivation to resume treatment among women initiated in Option B+. Our results provide further evidence on the need for future interventions to focus on these factors in order to improve retention in life-long treatment.
Structural and functional alterations in betel-quid chewers: a systematic review of neuroimaging findings
(Frontiers in psychiatry, 2019) Sariah, Adellah
Background: A number of neuroimaging studies have investigated structural, metabolic, and functional connectivity changes in betel quid (BQ) chewers. We present a systematic review of neuroimaging studies with emphasis on key brain systems affected by BQ chewing to bring a better understanding on the neuro mechanisms involved in BQD. Methods: All BQ neuroimaging studies were identified by searching PubMed, EMBASE, and Google scholar for English articles published until March 2018 using the key words: Betel-quid, resting state, functional MRI, structural MRI, diffusion tensor imaging (DTI), and betel quid dependence basing on the PRISMA criteria. We also sought unpublished studies, and the rest were obtained from reference lists of the retrieved articles. All neuroimaging studies investigating brain structural, and functional alterations related to BQ chewing and BQ dependence were included. Our systematic review registration number is CRD42018092669. Results: A review of 12 studies showed that several systems in the brain of BQ chewers exhibited structural, metabolic, and functional alterations. BQ chewing was associated with alterations in the reward [areas in the midbrain, and prefrontal cortex (PFC)], impulsivity (anterior cingulate cortex, PFC) and cognitive (PFC, the default mode, frontotemporal, frontoparietal, occipital/temporal, occipital/parietal, temporal/limbic networks, hippocampal/hypothalamus, and the cerebellum) systems in the brain. BQ duration and severity of betel quid dependence were associated with majority of alterations in BQ chewers. Conclusion: Betel quid chewing is associated with brain alterations in structure, metabolism and function in the cognitive, reward, and impulsivity circuits which are greatly influenced by duration and severity of betel quid dependence.
Risk and protective factors for relapse among Individuals with Schizophrenia: A Qualitative Study in Dar es Salaam, Tanzania
(BMC psychiatry, 2014) Sariah, Adellah
Background: Relapse in people with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of people with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families, the mental health sector and the country’s economy. So far no study has been done to address relapse in Tanzania. The purpose of the study was to explore perspectives on risk and protective factors influencing relapse of people with schizophrenia and their caregivers attending Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania. Methods: A qualitative study was conducted, involving in-depth interviews of seven people with schizophrenia who are out-patients and their seven family caregivers at MNH. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all study participants. The recorded information was transcribed and analyzed using NVivo 9 computer assisted qualitative data analysis software. Results: Personal risk and protective factors for relapse, environmental risk and protective factors for relapse and suggestions to reduce relapse were the main themes that emerged from this study. People with schizophrenia and their caregivers (all of whom were relatives) perceived non adherence to antipsychotic medication as a leading risk factor of relapse; other risks included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protective factors. Participants suggested strengthening mental health psycho-education sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening the nurse-patient therapeutic relationship in provision of mental health care. Conclusions: This study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a curricular in mental health nursing that aims to produce competent mental health nurse force would improve nursing practice in mental health care service delivery.
Experiences with disclosure of HIV-positive status to the infected child”: Perspectives of healthcare providers in Dar es Salaam, Tanzania
(BMC public health, 2016) Sariah, Adellah
Background: The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child. Health care providers should consider children’s cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers’ experiences in disclosure of HIV-positive status to the infected child. Methods: A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, 2014 in Dar es Salaam, Tanzania. Participants were selected from ten HIV care and treatment clinics (CTC) by purposive sampling. An interview guide, translated into participants’ national language (Kiswahili) was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis. Results: The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma. In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with more emphasis on practical skills and inclusion of disclosure content that is age appropriate for children with HIV. Discussion: The disclosure process was found to be a complex process. Perspectives regarding disclosure in children infected with HIV varied among healthcare providers in terms of their role in the process, clear national guidelines and appropriate standardized training for paediatric disclosure. Consistent with other studies, healthcare providers reported difficulties during disclosure because parents /guardians largely fear blame, social stigma, child's negative emotional reaction when disclosed to and have concerns about the child being too young and immature to understand the HIV condition. Conclusions: In order to prevent inconsistencies during the disclosure process, it is important to have in place clear guidelines and standardized paediatric HIV disclosure training for healthcare providers. This would help improve their skills in paediatric disclosure, leading to positive health outcomes for children infected with HIV.

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