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BackgroundInterventions to promote positive parenting are often reported to offer good outcomes for children but they can consume substantial resources and they require rigorous appraisal.MethodsEvaluations of the Triple P parenting program were subjected to systematic review and meta-analysis with analysis of biases. PsychInfo, Embase and Ovid Medline were used as data sources. We selected published articles reporting any child-based outcome in which any variant of Triple P was evaluated in relation to a comparison condition. Unpublished data, papers in languages other than English and some book chapters were not examined. Studies reporting Eyberg Child Behavior Inventory or Child Behavior Checklist scores as outcomes were used in the meta-analysis.ResultsA total of 33 eligible studies was identified, most involving media-recruited families. Thirty-one of these 33 studies compared Triple P interventions with waiting list or no-treatment comparison groups. Most papers only reported maternal assessments of child behavior. Twenty-three papers were incorporated in the meta-analysis. No studies involved children younger than two-years old and comparisons of intervention and control groups beyond the duration of the intervention were only possible in five studies. For maternally-reported outcomes the summary effect size was 0.61 (95%CI 0.42, 0.79). Paternally-reported outcomes following Triple P intervention were smaller and did not differ significantly from the control condition (effect size 0.42 (95%CI -0.02, 0.87)). The two studies involving an active control group showed no between-group differences. There was limited evidence of publication bias, but there was substantial selective reporting bias, and preferential reporting of positive results in article abstracts. Thirty-two of the 33 eligible studies were authored by Triple-P affiliated personnel. No trials were registered and only two papers contained conflict of interest statements.ConclusionsIn volunteer populations over the short term, mothers generally report that Triple P group interventions are better than no intervention, but there is concern about these results given the high risk of bias, poor reporting and potential conflicts of interest. We found no convincing evidence that Triple P interventions work across the whole population or that any benefits are long-term. Given the substantial cost implications, commissioners should apply to parenting programs the standards used in assessing pharmaceutical interventions.See related commentary: http://www.biomedcentral.com/1741-7015/10/145

BackgroundAccurate assessment of self-reports of sexual behaviours is vital to the evaluation of HIV prevention and family planning interventions. This investigation was to determine the cross-cultural suitability of the Condom Use Self Efficacy Scale (CUSES) originally developed for American adolescents and young adults by examining the structure and psychometric properties.MethodA self-administered cross-sectional survey of a convenient sample of 511 participants from a private university in Ghana with mean age 21.59 years.ResultA Principal Component Analysis with varimax rotation identified a 14 item scale with four reliable factors labelled Appropriation (Cronbach alpha = .85), Assertive (Cronbach alpha = .90), Pleasure and Intoxicant (Cronbach alpha = .83), and STDs (Cronbach alpha = .81) that altogether explained 73.72% of the total variance. The scale correlated well with a measure of condom use at past sexual encounter (r = .73), indicating evidence of construct and discriminatory validity. The factor loadings were similar to the original CUSES scale but not identical suggesting relevant cultural variations.ConclusionThe 14 item scale (CUSES-G) is a reliable and valid instrument for assessing condom use self efficacy. It is culturally appropriate for use among Ghanaian youth to gauge actual condom use and to evaluate interventions meant to increase condom use. Finally, the study cautioned researchers against the use of the original CUSES without validation in African settings and contexts.

BackgroundGhana has an estimated one million orphans, 250,000 are due to AIDS parental deaths. This is the first study that examined the impact of parental HIV/AIDS status and death on the mental health of children in Ghana.MethodsIn a cross-sectional survey, 4 groups of 200 children (children whose parents died of AIDS, children whose parents died of causes other than AIDS, children living with parents infected with HIV/AIDS, and non-orphaned children whose parents are not known to be infected with HIV/AIDS) aged between 10 and 19 were interviewed on their hyperactivity, emotional, conduct, and peer problems using the Strengths and Difficulties Questionnaire.ResultsChildren whose parents died of AIDS showed very high levels of peer problems [F (3,196) = 7.34, p < .001] whilst both orphaned groups scored similarly high on conduct problems [F (3, 196) = 14.85, p < .001]. Hyperactivity showed no difference and was very low in the entire sample. Emotional problems were very high in all the groups except among the non-orphaned children [F (3, 196) = 5.10, p < .001].ConclusionOrphans and children living with parents infected with HIV/AIDS are at heightened risks for emotional and behavioural disorders and that efforts to address problems in children affected by HIV/AIDS must focus on both groups of children. Parallel to this, researchers should see these findings as generated hypotheses (rather than conclusions) calling for further exploration of specific causal linkages between HIV/AIDS and children's mental health, using more rigorous research tools and designs.

BackgroundThis study investigates factors determining the timing of antenatal care (ANC) visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women.MethodData for the study was drawn from the women questionnaire (N=4,916) of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey.ResultsMajority of Ghanaian women attended ANC visit (96.5%) but many (42.7%) did so late (after the first trimester), while 36.5% had delivery without the assistance of a trained personnel (30.6%) or anyone (5.9%). Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds), religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers) wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest) were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0) and Moslems (OR=1.9, CI=1.1-3.3) were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest).ConclusionsDespite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the year 2015.

BackgroundThe study investigated whether perceived social support varied among children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families (comparison group).MethodThis study employed cross-sectional, quantitative survey that involved 291 children aged 10–18 years in the Lower Manya Krobo District of Ghana and examined their social support disparities.ResultsMultivariate linear regressions indicate that children living with HIV/AIDS-infected caregivers reported significantly lower levels of social support compared with AIDS-orphaned children, other-orphaned children and non-orphaned children independent of socio-demographic covariates. Children who have lost their parents to other causes and other-orphaned children reported similar levels of social support. In terms of sources of support, all children orphans and vulnerable children were more likely to draw support from friends and significant others rather than from the family.ConclusionThe findings indicate a need to develop interventions that can increase levels of social support for orphaned and vulnerable children within the context of HIV/AIDS in Ghana, particularly networks that include the family.

The findings suggest that both children and their informants have diverse yet complementary perspectives on psychological outcomes. The study discusses the theoretical and practical implications of these findings and urgently calls for necessary intervention programmes that target all children affected by HIV/AIDS to effectively alleviate psychological distress and enhance the mental health of these children.

Summary Background High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability...