Doctoral Degrees (Paediatrics and Child Health)

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Browsing Doctoral Degrees (Paediatrics and Child Health) by Subject "Caregivers -- Care -- Western Cape (South Africa)"

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    A critical interrogation of the acceptability of antituberculosis treatment in caregivers, children, and adolescents in the Western Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2022-12) Wademan, Dillon Timothy; Hoddinott, Graeme; Reis, Ria; Reynolds, Lindsey; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ANGLISH ABSTRACT: Children often experience greater complexity and challenges both in terms of TB diagnosis and treatment. Although great strides have been made to reduce the length and complexity of treatment for both drug susceptible- (DS) and drug resistant (DR)-TB, daily preparation and administration to children remains challenging, with treatment for DR-TB being more complex to prepare, administer and adhere to. Challenges involved in treatment and care for children with TB can have lasting negative impacts on their overall psychological, social, and economic wellbeing. South Africa accounted for 3.3% of all estimated incident TB cases worldwide in 2021. Here, household, socio-economic, and environmental conditions influence treatment management decisions. This project interrogates the acceptability of antituberculosis treatment (ATT) among caregivers and children in the Western Cape, South Africa. For this project, ‘ATT’ includes the drugs and any additional treatment related processes involved to prevent or cure TB. The predominant definition of treatment acceptability refers to the overall ability of the children and caregivers to use the treatment as intended. Most existing measures and studies use palatability, ease of use, and adherence as proxy measures of treatment acceptability. However, other factors including socio-economic circumstances, health services access, and stigma, may also influence the overall acceptability of ATT. This project describes the historical emergence of increasing interest and investment in new, ‘child-friendly’ drugs towards improving the overall acceptability of ATT among children and their caregivers. Through two empirically driven manuscripts, I describe how broader psychosocial, economic, and contextual factors influence caregivers’ and children’s acceptability of ATT. These data toward are drawn from three qualitative sub-studies of ATT trials at the Desmond Tutu TB Centre (DTTC). These studies are, the Shorter Treatment for Minimal TB in children (SHINE) trial; Tuberculosis Child Multidrug-resistant Preventive Therapy (TB-CHAMP) trial; and the Optimizing and operationalizing paediatric drug-resistant tuberculosis (MDRPK2) study. These data comprise semi structured interviews with children and their caregivers. Children (aged ≤17) and their caregivers (aged ≥18) were recruited to the qualitative sub-studies from the parent trials. The findings suggest that while palatability, adverse effects, and health services access, remain a concern for children and their caregivers, psychosocial, economic, and other contextual factors should be considered part of determining the overall acceptability of ATT. The final manuscript proposes an early-stage conceptual framework to measure the many factors that may influence the acceptability of treatment ATT among children and their caregivers. The conceptual framework presents an opportunity to identify key obstacles within households, communities, and healthcare systems to optimise the degree of fit between patients’ needs and available treatment for children with TB. It provides the first steps towards a global standard against which novel treatment strategies could be measured to determine overall TB treatment acceptability. This project contributes to this emerging field of research by providing evidence of the perceived impact of contextual factors on the acceptability of ATT among children and their caregivers. This project provides a conceptual framework with which future researchers can better determine what factors influence the acceptability of ATT among children and their caregivers.