Dr%20Franziska%20Meinck: List of publications

Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa’s Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication side-effects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally.

Using data from a randomized field experiment with 552 households, nested within 40 villages and townships in South Africa, we examine the impact of a brief financial literacy training that was integrated into a broader psychosocial parenting intervention. Based on self-reported measures, we document significant improvements in financial behaviors, including higher saving and lower borrowing rates. We also see wider implications for household economic welfare, demonstrated by reduced self-reported financial distress, better resilience to economic shocks, and a greater capacity to securing basic needs. We argue that program impact may run through three effect channels, namely improved self-efficacy, higher family and community social support, and greater optimism. Overall, our findings suggest that “hybrid” program curricula that offer combinations of financial and psychosocial components can add value to stand-alone financial literacy training.

Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior, discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.

ObjectiveTo assess the impact of 'Parenting for Lifelong Health: Sinovuyo Teen', a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices.DesignPragmatic cluster randomised controlled trial.Setting40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.Participants552 families reporting conflict with their adolescents (aged 10-18).InterventionIntervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.Main outcome measuresPrimary outcomes: abuse and parenting practices at 1 and 5-9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5-9 months postintervention. Blinding was not possible.ResultsAt 5-9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P

Objective: Child abuse is a major public health problem. In order to establish the prevalence of abuse exposure among children, measures need to be age appropriate, sensitive, reliable and valid. This study aimed to investigate the psychometric properties of the Adverse Childhood Experiences Questionnaire Abuse Short Form (ACE-ASF). <br/><br/> Methods: The ACE-ASF is an 8-item retrospective self-report questionnaire measuring lifetime physical, emotional and sexual abuse. Data from a nationally representative sample of 15-year-old school-going adolescents (n=1733, 55.5% female) from the Romanian Health Behavior in School-based Children Study 2014 (HBSC) was analyzed. The factorial structure of the ACE-ASF was tested with Exploratory Factor Analysis (EFA) and confirmed using Confirmatory Factor Analysis (CFA). Measurement invariance was examined across boys and girls and internal reliability and concurrent criterion validity were established. <br/><br/> Results: Violence exposure was high: 39.7% physical, 32.2% emotional and 13.1% sexual abuse. EFA established a two factor structure: physical/emotional abuse and sexual abuse. CFA confirmed this model fitted the data well [χ 2 (df)=60.526(19); RMSEA=.036; CFI/TLI=.990/.986]. Metric invariance was supported across genders. Internal consistency was good (.83) for the sexual abuse scale and poor (.57) for the physical/emotional abuse scale. Concurrent criterion validity confirmed hypothesized relationships between childhood abuse and health-related quality of life, life satisfaction, self-perceived health, bullying victimization and perpetration, externalizing and internalizing behaviors and multiple health complaints. <br/><br/> Conclusions: Results support the ACE-ASF as a valid measure of physical, emotional and sexual abuse in school-aged adolescents. Future research is needed to replicate findings in other youth populations and across different age groups.

Background <p>Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa.</p> Methods <p>Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted.</p> Results <p>610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n=35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored &lt;50% in the quality checklist. Living with a partner, living alone, gender-based violence, food insecurity, and employment were correlated with increased sexual risk-taking, while knowledge of own HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs), three evaluated group-based interventions, and one evaluated an individual-focused combination intervention. Three of the interventions were effective at reducing sexual risk-taking, with one reporting no difference between the intervention and control groups.</p> Conclusions <p>Sexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.</p>

Little is known about adolescent exposure to and factors associated with violence in Malawi. The aim of this research was to describe the prevalence of exposure to violence among adolescents in Malawi, and test the hypotheses that such exposures are associated with genderbased violent attitudes, and with internalizing and externalizing problems. In 2014, 561 primary school pupils were interviewed (50% girls), and logistic regression analysis was performed on gender-stratified data, adjusting for sociodemographic differences. Both girls and boys had witnessed domestic violence (28.5% &amp; 29.6%), experienced emotional abuse at home (23.1% &amp; 22.9%), physical abuse at home (28.1% &amp; 30.4%), physical abuse at school (42.4% &amp; 36.4%), and been bullied (33.8% &amp; 39.6%). Among girls, internalized violent attitudes towards women were associated with emotional abuse at home (OR 2.1) and physical abuse at school (OR 1.7). Condoning rape was associated with physical abuse at school (OR 1.9). Bullying perpetration was associated with emotional abuse at home (OR 4.5). Depression was associated with emotional abuse at home (OR 3.8) and physical abuse at school (OR 2.4). Among boys, violent attitudes towards women and condoning rape were not associated with violence exposure. Bullying perpetration was associated with having been a victim of bullying (OR 2.9) and physical abuse at school (OR 2.7). Depression was associated with emotional abuse at home (OR 2.9), domestic violence (OR 2.4) and physical abuse at school (OR 2.5). These findings can inform programs designed to reduce violence victimization among Malawian girls, both in homes and schools.

Physical, emotional and sexual child abuse are major problems in South Africa. This study investigates whether children know about post-abuse services, if they disclose and seek services, and what the outcomes of help-seeking behaviour are. It also examines factors associated with request and receipt of services. Confidential self-report questionnaires were completed by adolescents in South Africa as part of a communitybased study of children aged 10-17 (n=3515) in two provinces. Child abuse, disclosure and outcomes of help-seeking were measured using internationally recognized measures. Prevalence of frequent (&gt;weekly) physical abuse was 7.4%, frequent emotional abuse 12.4%, and lifetime contact sexual abuse 9.0%. 98.6% of children could name one suitable confidante or formal service for abuse disclosure, but only 20.1% of abuse victims disclosed. Of those, 72% received help. Most common confidantes were caregivers and teachers. Of all abuse victims, 85.6% did not receive help due to non-disclosure or inactivity of services, and 14.4% received help: 4.9% from formal health or social services and 7.1% through community vigilante action. Emotional abuse, sexual abuse and female gender were associated with higher odds of help-seeking. While children in South Africa showed high knowledge of available services, access to formal services among abused children was low and not all those requesting services received them. Notably fewer children received help from formal services than through community vigilante action. Urgent action is needed to improve service access for child abuse victims.

Background <p>Parenting quality is important in child development. In the presence of HIV poverty and life stress, parenting may be challenged and child development affected.</p> Methods <p>This study examines cross-sectional associations of situational factors such as poverty, mental health, HIV status, living with a biological parent, and stigma with good parenting and child outcomes (n=989; age=4-13 years) within the Child Community Care study (South Africa and Malawi). A parenting measure was created from 10 variables comprising 6 child and 4 parent ratings. These were highly correlated. Total parenting score was generated on a 10 point continuous scale, with a good parenting cut off then defined as &gt;=8 out of a possible 10. </p> Results <p>Five factors were associated with good parenting. Positively associated with good parenting were being the biological parent of the child, parental mental health and dwelling in households with multiple adults. Poverty and stigma were negatively associated with good parenting. Using multiple mediation analysis, a positive direct effect of good parenting was found on child self-esteem, child behaviour and educational risks with a partial mediation via child depression and trauma.</p> Conclusions <p>These data highlight possible intervention points. Influences on parenting could be seen through being the biological parent, parental mental health, poverty and stigma. In these challenging environments, health, nutrition, mental health, education, and treatment to keep parents alive are all clearly identified as potential pathways to ensure child well-being. 19 </p>

Background <p>There is limited research on the factors associated with parenting and the subsequent outcomes for children and adolescents in southern Africa. Evidence from the global north shows the importance of parenting on child development. There is a pressing need for such research in the global south, in order to inform the development of effective interventions to support families</p> Method <p>This working paper presents findings from the analyses of two different observational studies of caregiver-pre-adolescent (4-13 years, referred to as the ‘pre-adolescent study’) and caregiver-adolescent (10-17 years, referred to as the ‘adolescent study’) dyads. Regression and structural equation modelling techniques are used to identify practices constituting good and harsh parenting, factors associated with these parenting behaviours and child and adolescent outcomes.</p> Results <p>Poverty and stigma were found to be negatively associated with good parenting of pre-adolescents whilst biological parents, depression and multiple adults within a household were positively associated. Good parenting in pre-adolescents was associated with fewer educational risks and behavioural problems as well as increased self-esteem, mediated by child trauma and depression. In adolescents, family disadvantage (poverty, AIDS-ill caregiver and caregiver disability) were found to be associated with an increase in harsh parenting and poor caregiver mental health, both of which were associated with increased adolescent health risks.</p> Conclusion <p>These findings show the importance of parenting for pre-adolescent and adolescent outcomes in southern Africa. They also show that structural disadvantage factors are major predictors of less good parenting. Better support for parents living in high-risk contexts is clearly essential if we are to promote the health and well-being of the next generation.</p>

Purpose <p>Adolescent health is a major concern in LMIC but little is known about its predictors. Family disadvantage and abusive parenting may be important factors associated with adolescent psychological, behavioral and physical health outcomes. This study, based in South Africa, aimed to develop an empirically-based theoretical model of relationships between family factors such as deprivation, illness and parenting and adolescent health outcomes.</p> Methods <p>Cross-sectional data were collected in 2009-2010 from 2477 adolescents (aged 10-17) and their caregivers using stratified random sampling in KwaZulu-Natal, South Africa. Participants reported on socio-demographics, psychological symptoms, parenting and physical health. Multivariate regressions were conducted, confirmatory factor analysis employed to identify measurement models and a structural equation model developed.</p> Results <p>The final model demonstrated that family disadvantage (caregiver AIDSillness and poverty) was associated with increased abusive parenting. Abusive parenting was in turn associated with higher adolescent health risks. Additionally, family disadvantage was directly associated with caregiver mental health distress which increased adolescent health risks. There was no direct effect of family disadvantage on adolescent health risks but indirect effects through caregiver mental health distress and abusive parenting were found.</p> Conclusions <p>Reducing family disadvantage and abusive parenting is essential in improving adolescent health in South Africa. Combination interventions could include poverty and violence reduction, access to health care, mental health services for caregivers and adolescents, and positive parenting support. Such combination packages can improve caregiver and child outcomes by reducing disadvantage and mitigating negative pathways from disadvantage among highly vulnerable families.</p>

Background <p>An estimated one billion children experience child abuse each year, with highest rates in low and middle income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting, and reduce adolescent behavior problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.</p> Methods <p>This is a pragmatic cluster randomized controlled trial, with stratified randomization of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavior problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24 month follow-up is planned, but this will depend on financial and practical feasibility given delays related to high levels of ongoing civil and political violence in research sites.</p> Discussion <p>This is the first known trial of a parenting programme to prevent abuse of adolescents in a low or middle income country. The study will also examine potential mediating pathways and moderating factors.</p>

Low ART-adherence amongst adolescents is associated with morbidity, mortality and onward HIV transmission. Reviews find no effective adolescent adherence-promoting interventions. Social protection has demonstrated benefits for adolescents, and could potentially improve ART-adherence. This study examines associations of 10 social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10-19-year-olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa's Eastern Cape were traced and interviewed in 2014-2015 (n = 1175 eligible). About 90% of the eligible sample was included (n = 1059). Social protection provisions were "cash/cash in kind": government cash transfers, food security, school fees/materials, school feeding, clothing; and "care": HIV support group, sports groups, choir/art groups, positive parenting and parental supervision/monitoring. Analyses used multivariate regression, interaction and marginal effects models in SPSS and STATA, controlling for socio-demographic, HIV and healthcare-related covariates. Findings showed 36% self-reported past-week ART non-adherence (&lt;95%). Non-adherence was associated with increased opportunistic infections (p = .005, B .269, SD .09), and increased likelihood of detectable viral load at last test (&gt;75 copies/ml) (aOR 1.98, CI 1.1-3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR .57, CI .42-.76, p &lt; .001); HIV support group attendance (aOR .60, CI .40-.91, p &lt; .02), and high parental/caregiver supervision (aOR .56, CI .43-.73, p &lt; .001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection 39-41%, with any two social protections, 27-28% and with all three social protections, 18%. These results demonstrate that social protection provisions, particularly combinations of "cash plus care", may improve adolescent adherence. Through this they have potential to improve survival and wellbeing, to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents.

<p style="text-align:justify;"> <b>Introduction:</b> Advances in biomedical technologies provide potential for adolescent HIV prevention and HIV‐positive survival. The UNAIDS 90–90–90 treatment targets provide a new roadmap for ending the HIV epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to antiretroviral therapy (ART) remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents’ capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations.<br/> <b>Discussion:</b> New evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support (“cash, care and classroom”). These interventions have the potential to reduce the social and economic drivers of HIV risk, improve utilization of prevention technologies and improve adherence to ART for adolescent populations in the hyper‐endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach and that it holds powerful potential for improved HIV, health and development outcomes.<br/> <b>Conclusions:</b> Social protection is a largely untapped means of reducing HIV‐risk behaviours and increasing uptake of and adherence to biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda: to actively combine programmes that increase availability of biomedical solutions with social protection policies that can boost their utilization. </p>

Sexual abuse has severe negative impacts on children’s lives, but little is known about risk factors for sexual abuse victimization in sub-Saharan Africa. This study examined prospective predictors of contact sexual abuse in a random community-based sample of children aged 10 to 17 years (N = 3,515, 56.6% female) in South Africa. Self-report questionnaires using validated scales were completed at baseline and at 1-year follow-up (96.8% retention rate). Cross-sectional and longitudinal associations between hypothesized factors and sexual abuse were examined. For girls, previous sexual abuse (odds ratio [OR] = 3.44, 95% confidence interval [CI] = [2.03, 5.60]), baseline school dropout (OR = 2.76, 95% CI = [1.00, 6.19]), and physical assault in the community (OR = 2.17, 95% CI = [1.29, 3.48]) predicted sexual abuse at follow-up. Peer social support (OR = 0.84, 95% CI = [0.74, 0.98]) acted as a protective factor. Previous contact sexual abuse was the strongest predictor of subsequent sexual abuse victimization. In addition, peer support moderated the relationship between baseline assault and subsequent sexual abuse. For boys, no longitudinal predictors for sexual abuse victimization were identified. These results indicate that the most vulnerable girls—those not in school and with a history of victimization—are at higher risk for sexual abuse victimization. High levels of peer support reduced the risk of sexual abuse victimization and acted as a moderator for those who had experienced physical assault within the community. Interventions to reduce school drop-out rates and revictimization may help prevent contact sexual abuse of girls in South Africa.

<p><strong>Background</strong> Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa.</p> <p><strong>Methods</strong> Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person’s disability as hypothesised mediators.</p> <p><strong>Results</strong> For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed.</p> <p><strong>Conclusions</strong> These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa.</p>

There is now conclusive evidence of the major and long-lasting negative effects of physical and sexual abuse on children. Within Africa, studies consistently report high rates of child abuse, with prevalence as high as 64%. However, to date, there has been no review of factors associated with physical and sexual child abuse and polyvictimization in Africa. This review identified 23 quantitative studies, all of which showed high levels of child abuse in varying samples of children and adults. Although studies were very heterogeneous, a range of correlates of abuse at different levels of the Model of Ecologic Development were identified. These included community-level factors (exposure to bullying, sexual violence, and rural/urban location), household-level factors (poverty, household violence, and non-nuclear family), caregiver-level factors (caregiver illness in particular AIDS and mental health problems, caregiver changes, family functioning, parenting, caregiver-child relationship, and substance abuse), and child-level factors (age, disability, physical health, behavior, and gender). These findings identify key associated factors that are potential foci of child abuse prevention interventions. In addition, there is a clear need for further rigorous longitudinal research into predictive factors and culturally relevant interventions.