Pediatric NeuroAssessment in Kenya :ChildrenExposed to Multiple Risks

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Pediatric Neuro-Assessment in Kenya
 Children Exposed to Multiple Risks 

• Penny Holding
• Child Psychologist

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HIV is not merely a health problem

• What we need to do is
• understand those elements of preventative care
  that make a real contribution, and add them into
  the comprehensive care programme

James Hakim Neuro Aids 2007
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• The design of PMTCT plus
• ..are unaware of any previous investigations
  that have examined the implications for
  neurobehavioral development of maternal HIV in
  the context of common co-infections such as
  malaria

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• C. King immunologist
• H. G. Taylor - neuropsychologist
• M. Schluchter bio-statistician
• R. Redline placental pathologist
• C. Newton- pediatric neurologist
• S. Mithwani consultant pediatrician
• D. Ndetei psychiatrist
• K. Connolly experimental psychologist

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Bronfenbrenners Bio-Ecological Systems Theory
Theoretical Framework

• Dede Paquette John Ryan file///C/My20Document
  s/My20Webs/Bronfnebrenner20webquest/index.htm
• 7/12/2001

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(No Transcript)
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KID Kilifi Inventory of Development

• Psychomotor Assessment
• Working Memory and Behavioral Inhibition
• Communication Skills
• Symbolic Play
• Profile of Social Emotional Development

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Psychomotor
A.Abubakar
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Other results

• Working memory
• failure to achieve basal performance
• 54 vs. 12 p.001
• Communication checklist
• F 4.2, plt.05

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Conceptualization of Sources of Influence on
Developmental Outcome
Developmental Outcome
Maternal Infection
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Indirect mechanisms by which maternal HIV
infection may compromise fetal or infant
development
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Relationship of Placental Malaria and HIV
Seropositivity among Women Attending Antenatal
Clinics at the Msambweni District Hospital, Coast
Province, Kenya
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Presence of Co-infections

• In the mother
• Placental pathology
• Choriamnionitis
• Abnormal uteroplacental circulations

• In the child
• Adverse birth outcomes
• Febrile illnesses
• Anemia
• Fetal hypoxia
• Neurological impairment

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Nutritional
In the mother
In the child

• diminished nutritional intake

• fetal or infant wasting

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Psychosocial environment

• In the mother
• Maternal depresssion
• Disrupted mother-infant interaction

• In the child
• Impaired psychosocial functioning
• Attention problems

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Conceptualization of Sources of Influence on
Developmental Outcome

• Developmental Outcome
• Psychomotor
• Language
• Attention/Inhibition
• Social Emotional

Maternal Infection
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Conceptualization of Sources of Influence on
Developmental Outcome
Developmental Outcome
Maternal Infection
Mediators
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Mediators
       
Placental Pathology
Chorioamnionitis
Fetal Hypoxia

IUGR/Low Birth Weight

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Conceptualization of Sources of Influence on
Developmental Outcome
Developmental Outcome
Maternal Infection
Mediators
Moderators

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Moderators

Family Resources
Maternal Depression
Home Environment
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• Infant/Toddler HOME Inventory
• Clarity ?
• Sensitivity to within population variance

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The Ears of the Hippopotamus