Caregiver Income Research Articles

Systematic review of burden&quality of life in caregivers of children with schizophrenia (SyREN)

Abstract Background Schizophrenia is a chronic, disabling disorder that affects 23.6 million people worldwide, with patients often needing extensive assistance and care. Main caregivers are frequently family members who may present a reduced quality of life (QoL) due to the high-level burden of care. Literature mostly focuses on the burden caused by other mental disorders or by schizophrenia in both the adult and child population. We aim to assess the burden and QoL in caregivers of children and adolescents with schizophrenia. Methods We conducted a Systematic Review of articles published between 2013 and 2023 on MEDLINE, Scopus, Web of Science, APA PsycARTICLES, CINAHL. We included studies in which a validated instrument was used to measure the burden of caregiving and QoL for adult caregivers of children and adolescent schizophrenic patients. The results were reported following the PRISMA guidelines. Results We identified 1388 studies. We removed 610 duplicates. After screening 788 studies on title and abstract and 52 for full-text, we included one cross-sectional study in China based on the STROBE Checklist. Significant correlations between burden of care and schizophrenia severity, children’s age, period of care, education, sex, residence, and income were reported. Additionally, we screened 7 qualitative studies. Social stigma and struggle were the most frequently reported feelings, and financial burden was the most common external factor associated with a worse quality of life. Conclusions This review revealed a significant research gap in this field. This lack of focused research underscores the urgent need for targeted investigations into the experiences of caregivers of children and adolescents with schizophrenia. Addressing these knowledge gaps will improve support systems and interventions tailored to the unique needs of this population, such as disease-specific advisory, mental health services, social and financial support, and self-help groups. Key messages • We identified a research gap for burden and quality of life in informal caregivers of children with schizophrenia. Education, sex and income of caregivers relate to the burden of care. • Further research is needed to develop strategies to improve support systems and interventions tailored to the unique needs of this population.

Life Course Models of Child Maltreatment: Effects on General Psychopathology Outcomes in a Longitudinal Sample.

The study compared life course models (LCM; accumulation, recency, and sensitive period) of child maltreatment and general psychopathology in a large, national longitudinal data set of 1354 youth ages birth-16years (657 boys, 53.2% Black, 59.7% <$40K caregiver income). Previous research has supported the accumulation and recency models, albeit with shorter or fewer time periods of outcome measurement. We extend this work by modeling the impact of combined abuse and neglect allegations on a general psychopathology factor (dysregulation profile). Cross-sectional structural equation models were constructed using LCMs and tested across two-year periods from 4-16years old and compared using Akaike Information Criterion weights. The recency variable generally explained the greatest proportion of variance in psychopathology. Notably, maltreatment more proximal to the time of outcome measurement had the strongest effect, suggesting that more recent maltreatment may have stronger effects on general psychopathology. These results lend support to a recency effect of maltreatment on psychopathology outcomes, although substantive overlaps with the accumulation model are noted.

Determinants of diarrheal disease in children undergoing complementary feeding in a low-income urban setting in Kenya.

This study aimed to identify and characterise the determinants influencing the occurrence of diarrheal diseases in children aged 6-24 months undergoing complementary feeding within a low-income urban community in Kenya. This study followed a cross-sectional design and recruited caregivers of children aged 6-24 months from 302 households. The dependent variable was the 2-week diarrhoea prevalence among children, with independent variables including sociodemographic characteristics, child immunisation and feeding status, and water and sanitation facilities. Data analysis was performed using SPSS. Descriptive statistics and logistic regression analyses were used to assess associations between independent variables and the occurrence of diarrheal diseases. The majority of caregivers were female (n = 282, 93.4%), aged 25-34 years (n = 156, 51.7%), had attained secondary school education (n = 154, 51%), were unemployed (n = 162, 53.6%), and earned Ksh 10,000 (USD 100) or less. 296 (98%) indexed children were fully vaccinated against rotavirus. Most households used improved drinking water sources (n = 272, 90.1%). Most caregivers did not regularly wash their hands with soap and water (n = 225, 74.5%). The 2-week diarrhoea prevalence among children was 34.1% (103/302), with 69.9% (72/103) of these cases seeking care at a healthcare facility. Logistic regression analysis revealed that children of caregivers earning Ksh 20,000 and below (aOR = 2.9[1.3-6.5], p = 0.01), and those from households using unimproved sanitation facilities (aOR = 1.9 [CI 1-3.4], p = 0.042), had significantly higher odds of having diarrhoea. The study found a high prevalence of diarrhoea in Kenyan children aged 6-24 months, with caregiver income and household sanitation facilities significantly impacting the occurrence of the disease. The study suggests integrated approaches, including education, income generation, hygiene, and improved nutrition, to address the burden of diarrheal disease.

Recent use of consumer and personal care products and exposures to select endocrine disrupting chemicals among urban children with asthma.

Emerging studies suggest that endocrine disrupting chemicals (EDCs) in personal care and other consumer products are linked with various adverse health effects, including respiratory and reproductive effects. Despite Black persons using more personal care products than other demographic groups and having a high asthma burden, little is known regarding their consumer product use patterns and associated EDC exposures. To examine the association between recent exposure to select EDCs with specific consumer products and behaviors in a cohort of 110 predominantly Black children with asthma, ages 8-17 years, living in Baltimore City, Maryland. We quantified concentrations of bisphenol A (BPA), bisphenol S (BPS), bisphenol F, two dichlorophenols, four parabens, triclosan, benzophenone-3, and triclocarban in spot urine samples. Questionnaires were used to capture recent (last 24-h) consumer product use and behaviors. Associations between EDCs and consumer product uses/behaviors were assessed using multivariable linear regression, adjusting for age, gender, race/ethnicity, and caregiver income level. Effect estimates were expressed as geometric mean ratios of biomarker concentrations of product-users vs non-users. Increased concentrations to select EDCs were associated with recent use of air freshener (ratios; BPA: 1.9, 95%CI 1.4-2; BPS 1.7, 95%CI 1-2.97; propyl paraben: 3.0, 95%CI 1.6-5.6), scented candles (methyl paraben: 2.6, 95%CI 1.1-6.1), and scented carpet powder (2,5-dichlorophenol: 2.8, 95%CI 1.2-6.3). Additionally, consuming canned food was associated with some increased biomarker concentrations (ratios: BPA: 1.7, 95%CI 1.2-2.4; BPS: 2.1, 95% CI: 1.2-3.6). These findings add to the body of evidence suggesting that recent use of select consumer products in Black children contributes to exposure of chemicals of concern and could potentially inform exposure mitigation interventions. Findings have broad potential health implications for pediatric populations and Black children who may face exposure and health disparities. Little is known about how children's personal care product use and consumer behaviors affect their exposures to endocrine disrupting chemicals (EDCs). This is particularly true for Black children who often experience a disparate exposure burden to many EDCs. This is a significant knowledge gap among children that are uniquely vulnerable to EDCs as they undergo critical windows of growth and development. Our findings show associations between consumer products and EDC exposures in predominantly Black children in low-income settings. Identifying EDC exposure determinants has broad health implications as many of these chemicals have been associated with adverse health risks.

Determinants of undernutrition among settled pastoralists' children aged 6-59 months in Kenya.

The transition from nomadism to sedentary lifestyle has introduced changes in diets and undernutrition is endemic among settled pastoral households. This study aimed to investigate the underlying factors affecting stunting, underweight, and wasting of children aged 6-59 months in Marsabit County, Kenya. A cross-sectional household survey was conducted in six wards capturing pastoral, agro-pastoral, and urban livelihood practices. Using multistage sampling method, 394 children aged 6-59 months participated with written consent from the caregivers. A pretested questionnaire and anthropometric measures were used during data collection. Population characteristics were summarized into means and proportions, while chi-square and analysis of variance were used to evaluate associations between variables. Backward logistic regressions were used to explore predictors of stunting, underweight, and wasting, respectively. The results showed that the mean Height for Age Z-score, Weight for Age Z-score, and Weight for Height Z-score were -1.51, 1.54, and 1.02, respectively. The prevalence of stunting, underweight, and wasting was 38.1%, 23.0%, and 18.5%, respectively. The age of child, source of drinking water, and waste disposal were some of the main factors influencing stunting among children. In conclusion, the prevalence of undernutrition was high compared to the World Health Organization recommended cutoffs. Water sources hygiene, and caregiver's income were some of the main predictors of undernutrition among children. Development agencies need to focus on the supply of potable water, access to toilet facilities, in addition to nutrition education on hygienic complementary feeding practices among pastoral caregivers.

Perceived loss of support to community caregivers during the COVID-19 pandemic in the United States.

Coronavirusdisease (COVID-19) had a negative impact on the health and well-being of community caregivers. Few studies examine the pandemic's negative impact on the availability of social networks of caregivers. This article uses data collected during COVID-19 before vaccination to examine caregivers' reports of perceived lost and reduced network support. We assessed the personal networks of a nationally representative sample of 2214 community caregivers in the United States. We analyzed associations between caregiving factors and caregivers' perceptions of lost and reduced network support. Changes in care recipient living circumstances during COVID-19, longer-term caregiving, care recipient hearing/vision/mobility problems, caregiver travel/socializing restrictions, caregiver race/ethnicity, caregiver income, caregiver age, network connectivity, family relationships, and network members' age were associated with perceived lost/reduced support during the pandemic. Findings provide insights for the development of social network interventions to support caregivers and help them cultivate support networks resilient to public health crises.

Prevalence of probable substance use disorders among children in Ugandan health facilities

BackgroundGlobally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda.MethodsWe conducted a health facility cross-sectional study, involving 854 children aged 6–17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software.ResultsThe overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD.ConclusionsOur findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Lower academic performance among children with perinatal HIV exposure in Botswana.

Studies have reported a higher risk of suboptimal neurodevelopment among children who are HIV-exposed uninfected (HEU) compared to children HIV-unexposed uninfected (HUU). Actual academic performance among school-aged children by HIV exposure status has not been studied. Academic performance in Mathematics, Science, English, Setswana and overall among children enrolled in the Botswana-based FLOURISH study who were attending public primary school and ranging in age from 7.1 to 14.6 years were compared by HIV exposure status using a Cochran-Mantel-Haenszel test. Lower academic performance was defined as a grade of "C" or lower (≤60%). Unadjusted and adjusted logistic regression models were fit to assess for an association between HIV exposure and lower academic performance. Between April 2021 and December 2022, 398 children attending public primary school enrolled in the FLOURSH study, 307 (77%) were HEU. Median age was 9.4 years (IQR 8.9-10.2). Only 17.9% of children HEU were breastfeed versus 100% of children HUU. Among children HEU, 80.3% had foetal exposure to three-drug antiretroviral treatment, 18.7% to zidovudine only and 1.0% had no antiretroviral exposure. Caregivers of children HEU were older compared to caregivers of children HUU (median 42 vs. 36 years) and more likely to have no or primary education only (15.0% vs. 1.1%). In unadjusted analyses, children HEU were more likely to have lower overall academic performance compared to their children HUU (odds ratio [OR]: 1.96 [95% confidence interval (CI): 1.16, 3.30]), and lower performance in Mathematics, Science and English. The association was attenuated after adjustment for maternal education, caregiver income, breastfeeding, low birth weight and child sex (aOR: 1.86 [95% CI: 0.78, 4.43]). In this Botswana-based cohort, primary school academic performance was lower among children HEU compared to children HUU. Biological and socio-demographic factors, including child sex, appear to contribute to this difference. Further research is needed to identify modifiable contributors, develop screening tools to identify the risk of poor academic performance and design interventions to mitigate risk.

Characteristics and Factors Associated with Ability of Caregivers to Care for Hemodialysis Patients.

BACKGROUND The care ability of caregivers markedly impacts the patient' s quality of life and such ability may be influenced by various factors. This study aimed to explore the factors affected the care ability of caregivers for hemodialysis patients. MATERIAL AND METHODS This cross-sectional study involved 271 caregivers of hemodialysis patients. Various basic sociodemographic data of patients and caregivers were collected using questionnaires. The care abilities of caregivers were evaluated by the Caregiver Task Inventory (CTI). Univariate and multivariate linear regression analyses were used to identify the independent factors associated with the care ability of caregiver. The independent samples t test was used to further explore the impact of the independent factors on caregiver's care ability. RESULTS The mean age was 54.88±10.73 years for the patients and 44.68±15.22 years for the caregivers. Among the 271 hemodialysis patients, 59.04% were male. Multivariate regression analysis showed that female caregivers (standardized ß=-0.140, P=0.002), lived with patients (standardized ß=-0.381, P<0.001), high annual income of caregivers (standardized ß=-0.281, P<0.001), receiving caregiving training (standardized ß=-0.183, P<0.001), and patients without other chronic diseases (standardized ß=0.200, P<0.001) were associated with better care abilities of caregivers. CONCLUSIONS The gender and annual income of caregivers, receiving caregiving training, cohabitation with patient, and other concurrent chronic diseases of patients were the independent influencing factors for the care ability of caregivers for hemodialysis patients. Our study emphasized the necessity of implementing comprehensive socioeconomic and educational support to improve the care ability of caregivers.

Effects of General Characteristics, Emotional Labor, Empathy Ability, and Wisdom on the Psychological Well-Being of Female Caregivers Visiting the Homes of Vulnerable Care Recipients and the Elderly.

The purpose of this study is to analyze how general characteristics, emotional labor, empathy ability, and wisdom affect the psychological well-being of female caregivers. The research design is a descriptive correlational study. Data were collected using a self-report questionnaire, and analyzed using the SPSS Windows 27.0 program for hierarchical regression analysis. The results showed that there were differences in psychological well-being according to the work experience, education, and monthly income of 129 participants. In the analysis of the factors affecting the participants' psychological well-being, model 1 showed 18.9% explanatory power with educational experience (ß = -0.23, p = 0.012) and monthly income (ß = 0.25, p = 0.007). In model 2, educational experience (ß = -0.23, p = 0.004), monthly income (ß = 0.20, p = 0.017), and emotional labor (ß = -0.41, p < 0.001) were the affecting factors, and the explanatory power increased by 16.1%, showing 35.0% overall. In model 3, educational experience (ß =-0.28, p < 0.001), emotional labor (ß = -0.35, p < 0.001), empathy ability (ß = 0.23, p = 0.001), and wisdom (ß = 0.52, p < 0.001) were the affecting factors, and the explanatory power increased by 36.9%, showing 71.9% overall. To enhance the psychological well-being of the participants, the head of the caregiving center should consider the education and income of caregivers. The center should also operate programs and prepare policies to reduce emotional labor and enhance empathy ability and wisdom.

Factors associated with low antiretroviral therapy enrollment of children in the Simiyu region: A cross-sectional Creswell mixed-methods sequential explanatory design.

Despite substantial antiretroviral therapy (ART) coverage in other groups with the human immunodeficiency virus (HIV) in Tanzania, there is a progressive decline in ART enrollment among HIV-infected children. This study aimed to determine the factors affecting the enrollment of children with HIV in ART and to identify an effective, sustainable intervention to address children's ART care enrollment. To achieve this, we conducted a cross-sectional study using a mixed-method sequential explanatory design, including children with HIV aged 2 to 14 years in the Simiyu region. Stata™ and NVIVO™ software were used to perform quantitative and qualitative data analyses, respectively. In the quantitative analyses, we considered 427 children, with a mean age of 8.54 ± 3.54 years and a median age of 3 years (interquartile range: 1-6 years). The mean length of ART initiation delay was 3.71 ± 3.21 years. Additionally, independent child enrollment predictors included distance to the facility (adjusted odds ratio [AOR]: 3.31; 95% confidence interval [CI]:1.14-9.58), caregivers' income (AOR: 0.17; 95% CI: 0.07-0.43), and fear of stigma (AOR: 3.43; 95% CI: 1.14-10.35). In qualitative analyses, 36 respondents reported that stigma, distance, and lack of HIV-positive status disclosure to their fathers were causes for low enrollment in ART. Overall, this study demonstrated that a caregiver's income, distance to obtain HIV care services, HIV-positive status non-disclosure to the father, and fear of stigma played a significant role in children's enrollment in HIV care. As such, HIV/acquired immunodeficiency syndrome programs would benefit from having intensive interventions to address distance, such as scaling up care and treatment centers, as well as techniques to reduce stigma in the population.

The burden of caregivers of schizophrenia outpatients during the COVID-19 pandemic: A same-sample comparison with the pre-pandemic burden.

The coronavirus disease 2019 (COVID-19) has affected the vulnerable Brazilian population. In this study, we investigated the burden of COVID-19 on caregivers for patients with schizophrenia. This study assessed objective and subjective burden of caregivers for patients with schizophrenia during the COVID-19 pandemic and compared the measurements obtained in the study to that before the pandemic. The study included 50 caregivers who were assessed using the Sociodemographic Questionnaire, and the Family Burden Interview Schedule, Brazilian version (FBIS-BR). An adaptation of the Clinical Global Impression-Improvement (CGI-I) was made, in which caregivers evaluated their 'clinical' impression about the patient during the COVID-19 pandemic in comparison to pre-pandemic mental status. Most caregivers were female, aged between 24 and 80 years, who were in contact with the patient for about 88.56 hours/week. In relation to caregiver burden, there was a significant increase in the total subjective burden (p < .001), but not in the total objective burden. The following subjective domains of the burden showed a significant increase: assistance in daily life (p < .001) and worries about patients' present and future life (p = .033). There was a decrease in the objective burden related to supervision of patients' problematic behaviors (p = .031). Although the caregiver's income did not change significantly during the COVID-19 pandemic, there was an increase in the percentage of caregivers who perceived the frequency of financial burden imposed by the patient as 'very frequent' and 'always or almost always'; conversely there was a significant decrease in the subjective perception of the caregiver that the patient imposed financially 'no burden' or a 'seldom burden' (from 34% to 4%). Although the objective burden of the caregivers, during the pandemic, was similar the pre-pandemic levels, caregivers' subjective burden increased reinforcing the need for special attention to the caregiver in this global emergency.

Depression Among the Caregivers of Breast Cancer Patients and its Association with the Quality of Life.

This study investigated the prevalence of depression among the Jordanian caregivers of patients with breast cancer and its effect on their health-related quality of life (QOL). This was a cross-sectional study with a sample that consisted of 122 caregivers recruited from 2 hospitals in Jordan over 5 months. A validated questionnaire was used to assess the prevalence of depression symptoms and the aspects of QOL among the participants using Beck's Depression Inventory-II score and the 36-Item Survey Form (SF-36) score. Depression symptoms were revealed in 27.9% of caregivers. Regarding the QOL, the mental health (MH) subscale was considerably associated with caregivers' age (P=0.007). The marital status of caregivers was significantly associated with pain (Bodily Pain BP) (P=0.015), Beck's Depression Inventory (BDI; P=0.009), and social functioning (SF) (P=0.008). The number of caregivers' siblings was considerably associated with MH (P=0.040) subscale. The monthly income of caregivers was associated with BP (P=0.042). The residency of caregivers was considerably connected with role limitations because of emotional problems (RE) (P=0.027) and role limitations due to physical health (RF) (P=0.013) subscales. There was a significant correlation between the existing family history of depression with RF (P=0.009), RE (P=0.005), SF (P=0.003), and energy/fatigue (Vitality VT) (P=0.001) subscales. Furthermore, the physical activity of caregivers was connected with the RF (P=0.030), general health (GH) (P=0.018), RE (P=0.015), and MH (P=0.003) subscales. Around a third of the caregivers revealed depression symptoms. The QOL subscales for these caregivers were connected with various health and social factors, such as age, number of siblings, marital status, monthly income, residency, family history of depression, and physical activity. The evaluation of the mental and physical well-being of caregivers should always be considered and managed to help them to cope with their QOL.

The impact of the COVID‐19 pandemic on young children and their caregivers

The COVID-19 pandemic has adversely impacted child development and the well-being of caregivers, and such evidence ought to be used to inform public policy decisions. This study investigated the impact of COVID-19 on children's behaviours and their caregivers' needs. A cross-sectional study was conducted with 153 caregivers of children (from 0 to 5years old) from three public daycare centres in Brazil. The Nurturing Care Framework of the World Health Organization was used to guide the assessment of caregivers' needs. Online data collection using a questionnaire was conducted from June to July 2020. The COVID-19 pandemic increased stressors such as low family income, unemployment, sadness, depression and anxiety of caregivers. Their most commonly reported needs were related to offering age-appropriate playful activities (49.7%), organizing the care routine of children at home (41.8%) and educating children when they do something wrong (39.9%). Additionally, the results showed that misbehaviour, aggressiveness and agitation occurred more frequently among preschoolers than infants or toddlers (p ≤ 0.05). During the COVID-19 pandemic, public policies should provide mental health support to caregivers, as well as information about security, safety and early learning opportunities for childcare at home.

Functional Status of Patients on Maintenance Haemodialysis and Burden of Their Caregivers: An Example from a Tertiary Referenz Hospital in Cameroon

Background: Patients on maintenance hemodialysis (MHD) often depend on caregivers due functional status impairment (FSI). We evaluated the functional status of patients on MHD and the burden on their caregivers in Douala. Material and methods: A fourth month cross-sectional study including consenting adult patients on MHD in Douala general hospital and their caregivers. Functional status of patients was assessed using the overall functional status scale. A FSI score between 1-5/13 was considered moderate, and severe when above 5/13. Caregiver burden was assessed with the Zarit caregiver burden scale; a score between 21 to 40 was considered light to moderate burden, and severe if &gt;41. Logistic regression was used to look for associated factors to FSI and caregivers burden (p &lt;0.05). Results: In 184 patients, the mean age 47.29 (13.75) years. FSI was moderate in 60.33% (111/184) and severe in 8.69% (16/184). Caregiver burden was light to moderate in 48.91% (90/184), severe in 38.59% (71/184). Factors associated with FSI were: older patients, low patient and caregiver income, diabetes, longer duration on dialysis and being accompanied by his child. Factors associated with caregiver burden were: male gender, patient’s age ≥ 70 years, low patient’s income, inability to do shopping and laundry, age of caregiver ≥ 50 years, and caregiver being a student. Patient functional dependence increased the caregiver’s burden by 3.87 times (p=0.001). Conclusion: FSI and caregiver’s burden were relatively high with many associated factors. The caregiver burden increased with the degree of patient dependence.

How Lonely are Older Americans Act National Family Caregiver Support Program Participants?

Older Americans Act (OAA) family caregiver services connect family members caring for older adults with a diversity of community-based resources and supports. Social isolation and loneliness are known public health threats, and family caregivers may face greater vulnerability to loneliness given the often-intensive time demands of care provision. Policy stakeholders and aging services providers are increasingly focused on combating loneliness among older adults and family caregivers. To inform efforts to reduce loneliness, we conducted descriptive analyses to identify characteristics of the participants in the OAA National Family Caregiver Support Program associated with higher rates of loneliness, measured with the 3-item UCLA Loneliness Scale. Using data from the 2019 National Survey of Older Americans Act Participants, we examined how caregiver loneliness varied based on caregiver age, gender, income, race and ethnicity, living alone, rurality, and self-reported health, as well as care recipients’ health status and difficulties with ADLs. Among our sample of 1,824 family caregivers, rates of loneliness were high overall (70%). Loneliness was significantly higher for caregivers with poor health (71.4%), incomes less than $20,000 (75.3%), living alone (75.4%), aged 65 or older (73.2%), Hispanic caregivers (82.2%) and caregivers for care recipients with 3 or more ADLs (76.0%). Findings underscore the importance of increasing social engagement opportunities for family caregivers. Policies and programs focused on reducing caregiver loneliness should be accessible to all family caregivers but should prioritize outreach and engagement for groups at higher risk of loneliness.

Direct and indirect costs of acute diarrhea in children under five years of age in Indonesia: Health facilities and community survey

SummaryBackgroundDiarrhea remains a major cause of child morbidity and mortality in low- and middle-income countries. Reliable data on the economic burden of diarrhea is required to support the selection of appropriate health intervention programs. This study aimed to estimate the costs of acute diarrhea in children under five years of age in Indonesia, a large middle-income country with a substantial diarrheal burden.MethodsDirect medical cost data were extracted retrospectively for 1050 children under five years of age with acute diarrhea receiving inpatient care across 45 health facilities in seven Indonesian provinces during 2017–2020. Direct medical costs for children treated in outpatient settings were estimated by collecting unit costs associated with standard diarrhea case management in children. A structured interview of 240 caregivers of inpatients was also conducted retrospectively to estimate direct non-medical costs as well as indirect costs from caregiver income loss.ResultsThe weighted average direct medical cost for treatment of acute diarrhea as an inpatient and outpatient across health facility types was US$99.8 (SD±$56.8)(35% room costs, 29% professional fees, 26% medication costs, 10% diagnostic costs) and US$7.6 (SD±$4.3) (34% diagnostic costs, 28% medication costs, 27% professional fees, 10% registration fees), respectively. The average direct non-medical household cost for an acute diarrheal admission was US$4.90 and the indirect cost was US$9.90.ConclusionThere is a significant economic burden associated with acute diarrhea in children in Indonesia. This study, based on a wide variety of health care settings and geographical regions, provides data to inform the economic evaluation of rotavirus vaccines and other diarrheal prevention programs.FundingThis work was supported by a research grant from the Murdoch Children's Research Institute (MCRI) and PATH; and the Indonesian Technical Advisory Group on Immunization (ITAGI).

Classifying Features Persuading the Use of Long Lasting Insecticide Treated Nets (LLINs) and Its Implications in Exterminating the Incidence of Malaria-Death in Ghana

This is a cross-sectional quantitative study purported to identify features deemed to persuade the usage of LLINs in exterminating incidences of malaria-death in Ghana. The population consisted of mothers and caregivers of children under five in Asamankese a district in the Eastern region of Ghana. Questionnaires were developed based on the profile and the set of study objectives, it sought information on socio-economic variables, knowledge level on LLINs, and influence of climatic and environmental factors on LLINs usage. Data were coded and keyed into SPSS version 20. Frequencies, percentages, means, standard deviations, graphs and tables were used to explore the data. Chi-square test was used to do further investigation. It was revealed that LLINs usage was influenced by a group of features including: background characteristics of household; socio-economic variables, environmental variables and knowledge on importance of LLINs. There was an association between LLINs usage and monthly income of caregivers (p&lt;0.05). Furthermore, there was a significant relationship (p&lt;0.05) between environmental features and LLINs usage. There was a relationship (p&lt;0.05) between one’s knowledge and use of LLINs. In addition, there was a relationship between usage and the number of times per month visits were made to the hospitals for health care. Environmental factors permitted the use of LLINs, Eighty-six (86%) of the respondents who used LLINs did use it because the weather aided them. It is recommended that behavior change education be intensified in the region so that more people can accept and adopt a lifestyle that will protect them from the deadly malaria diseases. Efforts must be made by the major players in the health sector to make the net readily available in the communities at low prices to enable the ordinary Ghanaian to purchase it.

Determinant Factors affecting Quality of Life of Children with HIV/AIDS

HIV/AIDS causes physical problems, such as recurrent infections, growth disorders and malnutrition.HIV/AIDS also causes psychosocial problems, such as being shunned by friends and gettingdiscriminatory behavior. All of the problems described earlier affect children’s mental growth anddevelopment which will affect the quality of life of children with HIV/AIDS.This research is a cross sectional study, conducted at the Intermediate Care Unit of Infection Disease ofChildren Outpatient Clinic in Dr. Soetomo General Hospital Surabaya and Voluntary Counselling andTesting Outpatient Clinic in Gresik General Hospital, Probolinggo General Hospital and TrenggalekGeneral Hospital in November 2019-May 2020. Data collected was descriptively, then statisticallyanalyzed by bivariate and multivariate analysis.According to bivariate analysis, factors significantly related to quality of life of children with HIV/AIDS were age, monthly caregiver income, distance between diagnosis and therapy, immunologicalstatus, nutritional status and treatment adherence. Multivariate analysis showed that age (p=0,014,Odds Ratio [OR] 18,780, confidence interval [CI] 1,810-194,844) and treatment adherence (p=0,010,OR 7,823, CI 1,631-37,516) had a significant relationship with the quality of life of children with HIV/AIDS (p &lt;0.05).In conclusion, age, monthly caregiver income, distance between diagnosis and therapy, immunologicalstatus, nutritional status and treatment adherence are significantly related to the quality of life of childrenwith HIV/AIDS. Age and treatment adherence have the most significant relation with the quality of lifeof children with HIV/AIDS .

Segmenting children’s active school travel behaviour: insights on caregivers’ perceived risks and social norms

PurposeActive school travel (AST) programmes aim to change commuting behaviour to improve children's physical and mental health. However, very limited health education programmes for children use segmentation to create tailored solutions that understand the specific characteristics of each group of children and their caregivers in order to yield better results. The aim of this study is to use a statistical segmentation analysis (two-step cluster analysis) to gain insights on the examination of specific groups to design future health education interventions and campaigns that can improve children's health.Design/methodology/approachGuided by the Ecological and Cognitive Active Commuting (ECAC) framework, a market segmentation analysis was performed. An online survey was designed to collect data from caregivers of children between 5 and 12 years attending school and responsible for taking the child to and/or from school in Victoria and Queensland, Australia. Using 3,082 responses collected from Australian caregivers of primary school children, a two-step cluster analysis was performed.FindingsAnalysis revealed the most important variables for group formation were previous child walking behaviour, distance from school and caregiver income. Perceived risk of the physical environment was the most important psychographic segmentation variable for group formation, followed by social norms. Four distinct groups with different characteristics were identified from the analysis.Originality/valueThis is the first study that applies the ECAC framework to perform market segmentation in the AST context. Results revealed four market segments that demand different tailored solutions. Findings shed light on how to better design AST interventions and campaigns to promote children's health using segmentation techniques.