Completed research activities
Childhood programme
Amagugu: Maternal HIV-disclosure to primary-school-aged HIV exposed children
Principal Investigators Rochat & Bland and Co-Investigators Stein, Tanser and Mkwanazi
Parental HIV-disclosure has consistently been shown to benefit children and to reduce stigma, even improving treatment and mental health outcomes for parents. The aim of this individually randomised control trial was to test the efficacy of the Amagugu intervention which had been developed through careful formative work and shown to be acceptable in a large evaluation study. The trial primary outcome was maternal HIV disclosure to primary-school-aged HIV-uninfected children and was conducted at a collaborating site (Africa Health Research Institute) in KwaZulu-Natal, South Africa. Participants (n=464) were randomly allocated to either the Amagugu intervention (n=235) or enhanced standard of care (n=229) which included once-off counselling at a clinic facility. Lay counsellors delivered the Amagugu intervention which included six home-based counselling sessions of one to two hours and materials and activities to support HIV disclosure and parent-led health promotion.
This study is registered with ClinicalTrials.gov (NCT01922882). Retention at the 9-month endpoint was high (92%). Disclosure at any level was more common in the Amagugu intervention group (n=204 [87%]) than in the enhanced standard-of-care group (n=128 [56%]) with adjusted odds ratio 9·88, 95% CI 5·55–17·57;p<0·0001). Full disclosure was also more common in the Amagugu intervention group (n=150 [64%]) than in the enhanced standard-of-care group (n=98 [43%]; 4·13, 2·80–6·11; p<0·0001). These successful trial results were published in The Lancet HIV in 2018. A follow-up of the Amagugu children was conducted when the children were pre-adolescent - see the adolescent programme on this website. The Amagugu model has been adapted for child development by Draper in DPHRU.
Adaptation of the Amagugu intervention to promote physical activity, gross motor skills and cognitive development in preschool children from low-income settings
Principal Investigator Draper and Co-Investigators Rochat & Howard
The aim of this intervention pilot study was to develop the ‘Amagugu Asakhula’ home-based intervention and assess the feasibility and acceptability of this intervention. Amagugu Asakhula targets preschool-aged children to promote nurturing interactions and encouragement of healthy behaviours (regarding physical activity, screen time, diet and sleep) by the caregivers of preschool children and focuses on children’s cognitive development. The findings indicated that Amagugu Asakhula was both feasible and acceptable with caregivers of preschool children in a low-income urban setting.
Executive function in South African preschool children from low-income settings
Principal Investigator Draper and Co-Investigators Scerif & Howard
This study aimed to improve understanding of executive function in preschool children from low-income South African settings, and how it relates to school readiness and aspects of preschool children’s physical development, specifically physical activity and gross motor skills. On average, children from both settings showed higher than expected scores for executive function (based on Australian norms for the assessment), adequate gross motor proficiency and high volumes of physical activity. In contrast, a high proportion of children, particularly in the rural setting, demonstrated below average scores for school readiness. Executive function was positively associated with self-regulation, attention, school readiness, and gross motor skills.
This study is the first to provide evidence for the importance of executive function and the link between motor and cognitive development in preschool children from low-income South African settings. Another key finding was that there may be factors promoting early executive function skills in these settings but that these skills, although associated, are not transferring to school readiness.
Optimising body composition in early childhood
Principal Investigator Draper and Co-Investigator Norris
This study aimed to assess physical activity, gross motor skills, screen time, sleep and body composition in preschool children from a low-income, rural setting. The findings of this study, combined with findings of previous work in low-income urban settings, were used to inform intervention strategies to optimise body composition in preschool children from low-income settings. Across income settings, physical activity and gross motor proficiency levels were found to be high.
Development of South African 24-hour movement guidelines for birth to 5 years
Principal Investigator Draper
This project involved the development of South African 24-hour movement guidelines for birth to 5 years, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)-ADOLOPMENT approach. The process involved government representatives, health practitioners and academics and it included a phase of stakeholder consultation at various levels. The guidelines were launched in December 2018 and are currently being disseminated.