[Show abstract][Hide abstract] ABSTRACT: UNICEF and the International Children's Palliative Care Network undertook a joint analysis in three sub-Saharan countries-Zimbabwe, South Africa, and Kenya-to estimate the palliative care need among their children and to explore these countries' capacities to deliver children's palliative care (CPC). This report concerns the findings from South Africa. The study adopted a cross-sectional mixed-methods approach using both quantitative and qualitative data obtained from primary and secondary sources. CPC need was estimated using prevalence and mortality statistics. The response to the need and existing gaps were analysed using data obtained from a literature review, interviews with key persons, and survey data from service providers.The findings show very limited CPC service coverage for children in the public sector. In addition, services are mainly localised, with minimal reach. Less than 5% of the children needing care in South Africa are receiving it, with those receiving it being closer to the end of life. Barriers to the delivery of CPC include fear of opioid use, lack of education on CPC, lack of integration into the primary care system, lack of policies on CPC, and lack of community and health professional awareness of CPC needs and services. Estimating the need for CPC is a critical step in meeting the needs of children with life-threatening conditions and provides a sound platform to advocate for closure of the unacceptably wide gaps in coverage.
International journal of palliative nursing 03/2014; 20(3):130-4.
[Show abstract][Hide abstract] ABSTRACT: Over the past decade, there has been increasing global attention to mitigating the impacts of the HIV/AIDS epidemic on children's lives. Within this context, developing and tracking global child vulnerability indicators in relation to HIV and AIDS has been critical in terms of assessing need and monitoring progress. Although orphanhood and adult household illness (co-residence with a chronically ill or HIV-positive adult) are frequently used as markers, or definitions, of vulnerability for children affected by HIV and AIDS, evidence supporting their effectiveness has been equivocal. Data from 60 nationally representative household surveys (36 countries) were analyzed using bivariate and multivariate methods to establish if these markers consistently identified children with worse outcomes and also to identify other factors associated with adverse outcomes for children. Outcome measures utilized were wasting among children aged 0-4 years, school attendance among children aged 10-14 years, and early sexual debut among adolescent boys and girls aged 15-17 years. Results indicate that orphanhood and co-residence with a chronically ill or HIV-positive adult are not universally robust measures of child vulnerability across national and epidemic contexts. For wasting, early sexual debut, and to a lesser extent, school attendance, in the majority of surveys analyzed, there were few significant differences between orphans and non-orphans or children living with chronically ill or HIV-positive adults and children not living with chronically ill or HIV-positive adults. Of other factors analyzed, children living in households where the household head or eldest female had a primary education or higher were significantly more likely to be attending school, better household health and sanitation was significantly associated with less wasting, and greater household wealth was significantly associated both with less wasting and better school attendance. Of all marker of child vulnerability analyzed, only household wealth consistently showed power to differentiate across age-disaggregated outcomes. Overall, the findings indicate the need for a multivalent approach to defining child vulnerability, one which incorporates household wealth as a key predictor of child vulnerability.
AIDS Care 09/2010; 22(9):1066-85. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The global agenda for children affected by HIV and AIDS is rapidly moving forward in new and important directions. Over the past 5 years, the evidence base on children and HIV/AIDS has expanded considerably and a new global consensus on how to effectively respond to the challenges faced by children affected by HIV and AIDS has emerged. Recent work commissioned and completed by the Interagency Task Team (IATT) on Children and HIV/AIDS and the Joint Learning Initiative on Children and HIV/AIDS (JLICA) synthesizing the evidence base on children affected by HIV/AIDS has been instrumental in this regard. Drawing upon the evidence base, this paper focuses upon two critical shifts in global consensus on how to improve the response to children affected by HIV and AIDS that are particularly relevant for policy and programming. Firstly, there is increasing agreement that the global response to children should be AIDS sensitive, rather than AIDS exclusive. Although there are some AIDS-specific vulnerabilities children face, as a result of poverty and social exclusion, it is broadly recognized that many of their needs are shared with other vulnerable children. Secondly, it has become evident that short-term responses to mitigating impacts on children's lives are ineffective. Rather, given that the impacts of the epidemic, especially the effects of chronic poverty, will be felt for generations, government-led national responses that enhance systems of care, support, and protection for children are required. Indeed, global consensus has consolidated around the urgent need to strengthen and scale up child-sensitive social protection for all vulnerable children, including those affected by AIDS. For development partners, this presents a signal opportunity to support capacity-building initiatives in ministries responsible for social protection and to provide technical and financial support to strengthen social protection mechanisms for the benefit of all vulnerable children.
Vulnerable Children and Youth Studies 09/2010; 5(3):208-216.