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Chaudhury, Sumona

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Chaudhury

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Sumona

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Chaudhury, Sumona
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    The Neurodevelopment and Mental Health of Children Affected by HIV in Sub-Saharan Africa
    (2016-09-30) Chaudhury, Sumona; Seage, George R.; Williams, Paige L.; Lockman, Shahin
    This dissertation assesses neurodevelopment in children affected by HIV in Botswana, by examining associations between a range of factors and neurodevelopmental outcomes at 24 months of age and adjusting for potential confounders through linear regression. We followed children from birth to approximately 24 months to assess their neurodevelopment with an adapted version of Bayley Scales of Infant Development third edition (BSIDIII: cognitive, gross motor, fine motor, expressive and receptive language domains) and with the Development Milestones Checklist (DMC: locomotor, fine motor, language and personal-social domains), a parent-completed questionnaire. Chapter I compares neurodevelopment between HIV-exposed uninfected (HEU) children whose mothers took antenatal 3-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) within a prospective study, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional). We observed that neurodevelopmental outcomes at 24 months of age were generally at least as good among HEU children exposed in utero to ART when compared to those exposed in utero to ZDV. Chapter II compares neurodevelopment between HEU vs. HIV-unexposed uninfected (HUU) children in Botswana, within a prospective observational study. We observed that neurodevelopmental outcomes at 24 months among HEU children were generally as good as those among unexposed children. Results from Chapter I and II provide reassurance, easing concerns that HIV or ARV-exposure may detrimentally affect neurodevelopment in young children. Chapter III examines the potential of a family-based intervention for use in reducing harmful alcohol use and intimate partner violence, to protect and promote child mental health, within families affected by HIV in Rwanda. Quantitative data from a randomized controlled trial (RCT) were analyzed to demonstrate significant reductions in alcohol-use and intimate partner violence within HIV-affected families receiving the intervention, when compared to control families. Quantitative and qualitative data from the RCT, were integrated using a mixed-method approach, and support the potential of family-based interventions to reduce adverse caregiver behaviors as a major mechanism for improving child well-being, for families affected by HIV in Sub-Saharan Africa.
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    HIV Status Disclosure through Family-Based Intervention Supports Parenting and Child Mental Health in Rwanda
    (Frontiers Media SA, 2016) Chaudhury, Sumona; Kirk, Catherine M.; Ingabire, Charles; Mukunzi, Sylvere; Nyirandagijimana, Beatha; Godfrey, Kalisa; Brennan, Robert; Betancourt, Theresa
    Introduction: Few evidence-based interventions exist to support parenting and child mental health during the process of caregiver HIV status disclosure in sub-Saharan Africa. A secondary analysis of a randomized-controlled trial was conducted to examine the role of family-based intervention versus usual social work care (care as usual) in supporting HIV status disclosure within families in Rwanda. Method: Approximately 40 households were randomized to family-based intervention and 40 households to care as usual. Parenting, family unity, and child mental health during the process of disclosure were studied using quantitative and qualitative research methods. Results: Many of the families had at least one caregiver who had not disclosed their HIV status at baseline. Immediately post-intervention, children reported lower parenting and family unity scores compared with those in the usual-care group. These changes resolved at 3-month follow-up. Qualitative reports from clinical counselor intervention sessions described supported parenting during disclosure. Overall findings suggest adjustments in parenting, family unity, and trust surrounding the disclosure process. Conclusion: Family-based intervention may support parenting and promote child mental health during adjustment to caregiver HIV status disclosure. Further investigation is required to examine the role of family-based intervention in supporting parenting and promoting child mental health in HIV status disclosure.
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    Cost analysis of large-scale implementation of the ‘Helping Babies Breathe’ newborn resuscitation-training program in Tanzania
    (Springer Nature, 2016) Chaudhury, Sumona; Arlington, Lauren; Brenan, Shelby; Kairuki, Allan Kaijunga; Meda, Amunga Robson; Isangula, Kahabi G.; Mponzi, Victor; Bishanga, Dunstan; Thomas, Erica; Msemo, Georgina; Azayo, Mary; Molinier, Alice; Nelson, Brett
    Background: Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. Methods: We used activity-based costing to examine budget expense data during the two month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Results: Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. Conclusion: HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant costestimation for national rollout of this potentially neonatal life-saving intervention.