Newsletter GRANDIR | La lettre d’information sur le VIH pédiatrique en Afrique

In Brazzaville, Congo, the Serment Merveil organization has started a social and economic support programme for families of children living with HIV. The Serment Merveil example demonstrates the importance of understanding beneficiaries’ psychosocial situations before setting up a program to help them: the organization conducted a study to evaluate the psychosocial and social problems that confront children living with HIV beforehand.
First, the organization collected the number of children living with HIV from 0-18 years old from logbooks of centers that provide care and support for people living with HIV in Brazzaville. Then Serment Merveil conducted a survey among the families to evaluate the degree of psychological, social and familial vulnerability of children. The study documented if parents were deceased, what kind of relative between the children and their current guardians, the number of meals the children had per day, the kinds of medicines they were taking, their school level...

The results identified 210 children living with HIV (with a median age of 11) half of whom had lost either their mother and/or their father. 69% were on antiretroviral treatment. 79% ate only one meal a day. And 40% of school-age children were not in school (they were unable to attend school either because of their illness and/or the extreme poverty of their families). The majority of their guardians were in a very precarious situation (60% were unemployed).
The children were also seen by a psychologist: these consultations showed that a third of these children had emotional problems (they were very introverted, had difficulties forming attachments with adults or other children). 18% of the children lagged behind in terms of their psychological development, mainly among orphans. 95 % of the children attending school were two classes behind their peers. It is also important to state that some children (12 %) were sexually active and had already had unprotected sex.
Finally, only 6% of the children seen by a psychologist were aware of their own HIV status.

After conducting this psychosocial study, Serment Merveil adapted its program of support to children infected by HIV by targeting the families most in need. Around 50 guardians took part in a microcredit programme in 2008 that helped them to set up income generating activities and thereby improve the children’s conditions of life (increasing the number of meals per day, helping them to attend school…). At the same time, 80 children living with HIV received some psychosocial support (school kits, support groups, home visits…).

Growing UP! will host two events at the 15th International Conference on AIDS and STDs in Africa, which will take place from December 3-7 in Dakar:

Aminata, who tested HIV+ two months ago, comes in for a consultation because her 7-month old daughter Astou has been eating poorly for a few weeks and has had diarrhea for the last 8 days. Astou drinks powdered milk for babies over 6 months old that Aminata received free from an organization. She weighs 5 200 g at 64 cm. She weighed 5 600 g a month ago and 5 800 g two months ago. The clinical examination does not clearly indicate anything specific: the child is asthenic, urinates little, has a 37°9 C fever, and her abdomen is sensitive but soft. Astou is not on medication and she drinks herbal teas without any noticeable improvement.

Here is the recommended treatment:

Immediately:
The clinical signs point to a dehydration of between 5 and 10%.

Astou’s weight evolution:
At 5 months: weight for age between –1 and –2 SD; at 6 months, weight for age – 2 and –3 SD ; today: weight for age <-3 SD, weight for heigh <-3 SD and heigh for age between –1 and –2SD, with diarrhea.
Astou has probably a relatively recent moderate malnutrition complicated by acute dehydration.

Once Astou is rehydrated, it is necessary to re-evaluate her nutritional state, draw her weight and height curves, and confirm this classification.
Malnutrition can be caused by several factors:

Additional lab test:
In the short term: systematic examinations not necessary if there is a good initial evolution.
Kidney functions check up, electrolytes (if available) if dehydration worsens. Infectious check up if her fever increases. Examination of feces by microscopy if diarrhea persists.
Then:
PCR if available. If not, a blood and CD4 cells count to look for either extreme lymphopenia or very low CD4 count.
There are several risk factors for infection for Astou (no ART for her mother or at birth, breast-feeding for the first months). This history means that it’s necessary to look for possible HIV infection.