As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay. We aim to describe the differences in development in rural Rwandan children at 24-36 months of age born preterm and/or LBW compared to their peers born term or normal birth weight (term/NBW), and to assess factors associated with poor development. We conducted a cross-sectional study using secondary data analysis from two combined datasets from 2014, using Ages and Stages Questionnaire (ASQ-3) for developmental assessment and anthropometrics for nutritional status (stunting and wasting). Demographic and clinical factors associated with poor developmental outcomes in univariate regression at α = 0.20 were included in a full model; we used backward stepwise penalized multivariable logistic regression to identify a final model at α = 0.05. In total, 445 children were included; 405 term/NBW, and 40 preterm and/or LBW. Half of them (n = 234; 52.6%) had developmental delay, including 207 (51.1%) among term/NBW and 27 (67.5%) among preterm and/or LBW (p = 0.048). In the final model, term/NBW children with stunting alone had a significant increase in the odds of developmental delay (OR 2.05, 95% CI 1.37-3.07), and children with wasting had a borderline statistically significant increased odds of developmental delay (OR 5.79, 95% CI 0.98-34.39). Being preterm and/or LBW and not stunted completely predicted delay. Half of the children had developmental delay in our sample from rural Rwanda. Preterm and/or LBW infants were more likely to have developmental delay, and the main predictor of developmental delay was stunting, with high rates of stunting observed also in term/NBW infants. Interventions to reduce undernutrition and prevent prematurity and LBW, alongside investments to promote early stimulation for optimal development, are needed if gains in addressing developmental delay are to be made.

There is a growing number of children affected by HIV in Africa. Research on HIV-exposed uninfected children (HEU) is also growing. This systematic review focuses on the psychological well-being of HEU and its association with school intervention, outcomes, and enrollment in the African context, which is where the rate of HIV reaches its highest levels. Research on public databases was conducted according to PRISMA standards. Only studies on HEU primary school children in Africa, both quantitative and qualitative, were included. Out of 1510 papers retrieved, 50 met the inclusion criteria. These studies demonstrate that HEU children are more likely to perform worse in school compared to their counterparts who were not exposed to HIV and to show poorer concentration in the classroom. Children with parents suffering from AIDS are worried for them and have to take household responsibility, resulting in school dropouts, juvenile work, and risky behaviors. Few interventions have been conducted in the school environment with some of them being successful; therefore, future research should involve schools to create an inclusive environment where HEU children could enhance their potential and improve their psychological health.

Background: Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. Methods: This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12–36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. Results: Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=−0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. Conclusions: Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.

Despite the implementation of a free healthcare policy for pregnant women and children under five since 2006, neonatal mortality remains high in Burundi. I

Background: Families of children with disabilities in low-resource settings face heightened challenges to family functioning and wellbeing. Improving a child and caregiver’s environment in these settings requires a broader understanding of the family ecosystem. This study aims to investigate factors that should be considered to enhance family functioning and inform family-centered interventions. Methodology: We conducted 34 in-depth interviews with 30 caregivers of children with disabilities aged 6–8 years enrolled in a larger cluster randomized trial of the Sugira Muryango parenting intervention. Additionally, six focus group discussions were conducted with 36 community workers, and 6 Early Childhood Developmental (ECD) advocates participants. Guided by the SAFE Model for child protection, content analysis was used to understand threats to child protection and caregivers’ well-being among caregivers of children with disabilities enrolled in Sugira Muryango. Results: Consistent with the domains outlined in the SAFE Model, our analysis revealed the following threats to child safety: 1) Safety/Freedom from harm, including father’s mental health and substance abuse, abandonment and stigma related to a child’s disability; 2) Access to basic physiological needs and healthcare, including lack of basic necessities (food, utilities and housing), additional needs related to caring for a child with disabilities, caregiver mental health needs, limited access to health insurance and mother illness; 3) Family and connection to others, including the single-parent dilemma, lack of support from family and community, and father abandonment; and 4) Education and economic security, including additional expenses due to the child’s disability and financial stress related to health care costs. Conclusion: Improving family functioning and wellbeing among caregivers of children with disabilities in limited resources requires a deep understanding of socioecological forces operating on the family system. These findings provide further evidence of how the threats to child safety highlighted by the SAFE Model can inform how researchers, and policy makers design and implement family-centered interventions tailored to children with disabilities in low-resource settings.