COGNITIVE DEVELOPMENT DURING ADOLESCENCESome analytical considerationsBYMARISEN MWALECharacterized as a zoologist by training, an epistemologist by vocation, and a logician by method, Piaget is best known for his contributions to developmental psychology. He regarded himself as an interdisplinary thinker; perhaps the identification genetic epistemologist best described his orientation. Epistemology is the branch of science concerned with the methods, limits, and validity of knowledge. The term genetic is used in the sense of genesis or development; indeed, Piaget did not study the genes of his subjects, and the idea of genetic influences on the acquisition of knowledge applies only in a very broad sense. In regard to the nature-nurture controversy, Piaget was neither a maturationalist nor an environmentalist, but is better characterized as an interactionist or constructionist. He came up with four stages of cognitive development. The sensorimotor Preoperational Concrete operational Formal operationalEach of Piagets four stages represent a stage in development of intelligence [hence Sensorimotor intelligence, preoperational intelligence, concrete operational intelligence, and formal operational intelligence] and is a way of summarizing the various schemas a child has at a particular time.The ages given are approximate, because children move through the stages at different rates due to differences in both the environment and their biological maturation. Children also pass through transitional periods, in which their thinking is a mixture of two stages. The concept of developmental stage is often taken to mean that development is discontinuous. But for Piaget, development is a gradual and continuous process of change although later stages build on earlier ones [which is why sequence is invariant].The sensorimotor stageThis is the period during infancy. Development at this stage is based on information obtained from the senses [sensori] and from the actions or body movements [motor] on the part of the infant. Infants learn about the world primarily through the senses and by doing. The infants greatest developmental achievement is the realization that objects in the environment exist whether perceived or not. This basic understanding is called object permanence.Infants begin to recognize that hidden objects do not cease to exist. A second major achievement or accomplishment at this stage is the beginning of logical goal-directed actions. For example, if a child wants to get what is in a covered container he or she may build a scheme as follows: Get the lid off Turn the container upside down Shake if the item falls Watch the item fall on the floorThe child may also reverse this action by refilling the container. But a very young child will struggle to get the contents out. So the child moves from reflex action to goal directed activity.The preoperational stageThis stage takes place during early childhood from 2-7 years. This period is also denoted the preschool period. This is a stage before the child masters logical and mental operations. These are actions carried out by thinking them through instead of literally performing them. Because, the child has not mastered these operations, hence the reference preoperational. The fact however is that the child is moving towards mastery. According to Piaget, the first step from action to thinking is the internalization of actions. This means, performing an action mentally not physically.The first type of thinking that is separate from action, involves making an action scheme symbolic. So the ability to form and use the symbolic words, gestures, signs and images- is a major accomplishment at this stage. This accomplishment moves children closer to mastering mental operations. This ability to work with symbols such as using the word [bicycle] or a [picture] of a bicycle that is not actually present is called the sembiotic formation. During the preoperational stage there is rapid development of the very important symbolic system---language.As the child moves through this stage, the developing ability to think about objects in symbolic form remains limited to thinking in one direction only or using one-way logic. It is very difficult for the child to think backwards---reverse thinking.According to Piaget, preoperational children are egocentric. This is the tendency to see the world and the experiences of others from ones own perspective only. The child cannot appreciate that other people might see things differently. Egocentrism does not imply that the child is selfish however. Rather it simply means children often assume that everyone else shares their feelings, reactions, and perspectives. Furthermore egocentrism is also evident in the childs language. Children happily talk of what they are doing even though no one is listening. This happens when a child is alone or with a group of other children. In a group, each child talks enthusiastically without real interaction or conversation. Piaget calls this the collective monologue. Other weaknesses include transductive reasoning, animism and artificialism.Transductive reasoning involves drawing an inference about the relationship between two things based on a single shared attribute. An example being cats must be dogs because they all have four legs. Animism refers to the belief that all inanimate objects are alive. Artificialism is the belief that natural features have been designed and constructed by people, for example, the question why is the sky blue? might produce an answer from a preoperational child that somebody painted it.Preoperational children also lack the abilities to apply: Conservation Classification SeriationThe concrete operational stageThis stage takes place during the later primary to middle school years from 7-11 years. The basic characteristics of this stage are: The recognition of the logical system of the physical world. The realization that elements can be changed or transformed but still conserve many of their original characteristics. The understanding that these changes can be reversed. Operational thought is reversible----logical operations can be reversed by canceling an operation. Operational thought is associative----thought is not limited to one avenue.In this stage mental tasks are tied to concrete objects and situations.According to Piaget, a students ability to solve conservation problems depends on the understanding of basic aspects of reasoning such as identity, compensation and reversibility.Conservation is the understanding that any quantity [e.g. number, liquid quantity, length and substance], remains the same despite physical changes in the arrangements of objects. Piaget believed that preoperational children cannot conserve because their thinking is dominated by the perceptual nature of objects [appearance].Elements of conservation include: Identity Compensation ReversibilityIdentityIt is the principle that quantity or mass in objects remains the same over time.For instance a round mould when reshaped into a sausage still retains the same volume and characteristics regardless of the change. With complete mastery of identity, the student knows that if nothing is added or taken away the material remains the same.CompensationIt is the principle that changes in one dimension can be offset by changes in another as in changes in matter form from liquid to gas, solid to fluid. With an understanding of compensation the student knows that an apparent change in one dimension can be compensated for by a change in another dimension.ReversibilityIt is the ability to think things through a series of steps and return to the starting point. The child is able to comprehend that if 1 + 3 = 4 then 4 3 = 1-----in other words he or she can reverse mathematical or any other computations. With an understanding of reversibility the student can actually cancel out the change that has been made. A grasp of reversibility means that the student has mastered two-way thinking.CentrationInvolves focusing on only a single perceptual quality at a time. In a test of conservation a child is presented with two tubes of the same volume but of different dimensions-----the other narrow but high and the other squat but wide.Queried which has more liquid when liquid of the same volume is pouredinto both of the two dimensionally different tubes:A child in the preoperational stage would deduce the narrow one has more liquid even though both have the same volume of liquid while a child in the concrete operational stage would be able to understand that the two have the same volume and hence hold the same amount of liquid.This would be the case even when the situation was reversed. Preoperational children lack the ability to decentre. As documented in the example above they only focus on the perceptual nature in this case length and height of the object.Apart from conservation other important operations achieved at this stage include: Classification SeriationClassificationClassification is the grouping of objects into categories. Classification depends on the students abilities to form simple characteristics of objects in a set and group the objects according to their characteristics. Given a mixture of fruits---mangoes, bananas, applesthe child is able to group them into sets of [M], [B], and [A].SeriationSeriation is the process of making an orderly arrangement from large to small or vice versa. The preoperational child has difficulty arranging objects on the basis of a particular dimension e.g. color, length and shape. With abilities to handle operations like conservation, classification and seriation; the student has finally developed a complete and very logical system of thinking. This system of thinking is, however, tied to physical reality. The concrete operational child is not yet able to reason about hypothetical, abstract problems that involve the coordination of many factors at once.The formal operational stagePiagets formal operations include, among others, the use of propositional thinking, combinatorial analysis, proportional reasoning, probabilistic reasoning, correlational reasoning, and abstract reasoning. The concept formal implies that what matters is form and logic rather than content. With the progression through these stages, mental operations become increasingly more abstract, more complex, more logical, and the boundaries of the mental structures become more permeable and thus, provide thought processes with greater flexibility.This stage takes place during junior and senior secondary school from 11-15 years and older yet not all people acquire this level of abstract/logical thinking. This stage deals with mental tasks involving abstract thinking and coordination of a number of variables. All the earlier operations and abilities continue and are integrated. The focus of thinking shifts from what is to what might be. Situations do not have to be experienced to be imagined. A student at this stage attains hypothetical deductive reasoning as a major achievement at this stage.This is a formal operations problem-solving strategy in which an individual begins by identifying all the factors that might affect a problem and then deduces and systematically evaluates specific solutions, for example moving from general to specific.Adolescent thought is thus more abstract than child thought. Adolescents are no longer limited to actual, concrete experiences as anchors for thought. They can conjure up make-believe situations, events that are strictly hypothetical possibilities or purely abstract propositions, and try to reason logically about them. The abstract quality of the adolescents thought at the formal operational level is evident in the adolescents verbal problem-solving ability. While the concrete operational thinker would need to see the concrete elements A, B, and C to be able to make the logical inference that if A= B and B= C then A= C, the formal operational thinker can solve this problem merely through verbal presentation. This reflects a reasoning ability connoted Transitive inference: the ability to solve problems verbally and logically.Furthermore children who function at the concrete operational stage cannot solve the transitive inference problem if it is placed on a purely verbal and hypothetical plane e.g. John is taller than Mary, Mary is taller than Jane. Who is the tallest? They are unable to consider all the possible combinations in relation to the whole problem [Harris and Butterworth, 2002].Another indication of the abstract quality of the adolescents thought is his or her increased tendency to think about thought itself. One adolescent commented, I began thinking about why I was thinking what I was, then I began thinking about why I was thinking about why I was thinking about why I was. If that sounds abstract, it is, and it characterizes the adolescents enhanced focus on thought and its abstract qualities. Accompanying the abstract nature of formal operational thought in adolescence is thought full of idealism and possibilities. While children frequently think in concrete ways, or in terms of what is real and limited, adolescents begin to engage in extended speculation about ideal characteristics- qualities they desire in themselves and in others.Such thoughts often lead adolescents to compare themselves and others in regard to such ideal standards. And during adolescence, the thoughts of individuals are often fantasy flights into future possibilities. It is not unusual for the adolescent to become impatient with these newfound ideal standards and become perplexed over which of many ideal standards to adopt. It is sometimes said that the adolescents thought is more like a scientists than a childs. This implies that the adolescent often entertains many possibilities and tests many solutions in a planned way when having to solve a problem. This kind of problem solving as already alluded to has been called hypothetical deductive reasoning. Basically this means that in solving a problem, an individual develops hypotheses or hunches about what will be a correct solution to the problem, and then in a planned manner tests one or more of the hypotheses, discarding the ones that do not work.Adolescents can thus think about possibilities, think through hypothesis, think ahead, think about thought and engage in perspective thinking. Perspective thinking relates to the awareness that different people have different thoughts about the same situation. While children are egocentric adolescents are socio-centric. According to Muuss [1996] adolescents not only think beyond the present but analytically reflect about their own thinking. Piaget calls this type of reasoning second-degree thinking which involves operations that produce thinking about thinking, statements about statements, or more significantly operations on operations.The other distinctive property of formal thought is the reversal of direction between reality and possibility. A type of thinking which proceeds from what is possible to what is empirically real [Inhelder and Piaget, 1958].Combinational systems of operations defined as the matrix of all possible combinations of all possible values of all possible variables inherent in the problem also constitutes formal operations. Combinational analysis can be exemplified by an experiment requesting to determine which combination of five chemicals produces a yellowish-brown liquid and which returns the liquid to its original colorless state.Yet another cognitive ability attained at this stage is Propositional analysis entailing the ability to follow and understand logical deductions in the light of two premises---one specific, the other general---- and a conclusion.E.g. :A] All human beings are mortal.John is a human being.Therefore John is mortal.B] All planets orbit the sun.The earth is a planet.Therefore the earth orbits the sun.ELKIND: IMMATURE ASPECTS OF ADOLESCENT THOUGHTAccording to David Elkind [1967, 1976, 1978] two important aspects of thinking about the self and others that develop in adolescence are egocentrism and perspective taking. David Elkind believes two types of thinking represent the emergence of egocentrism in adolescents. These are the imaginary audience and the personal fable. Imaginary audience is the belief that others are as pre-occupied with the adolescents behavior as he or she is. Attention-seeking behavior, so common in early adolescence, may reflect this interest in an, imaginary audience, that is the desire to be noticed, visible, and on stage.Particularly during early adolescence, individuals see themselves as constantly on stage, believing they are the main actors and all others are the audience. The construction personal fable on the other hand refers to the adolescents sense of personal uniqueness and indestructibility. Their sense of personal uniqueness makes them feel that no one can understand how they really feel that they are special. Another aspect of the personal fable involves the belief that one is indestructible. This results in feelings of invulnerability or insusceptibility and therefore risk-taking behaviors such as alcoholism/drug and substance abuse as well as sexual promiscuity.BIBLIOGRAPHYBerger, K [1999] The developing Person: Through Childhood andAdolescence. New York: Worth Publishers.Birch, A [1977] Developmental Psychology: From Infancy toAdulthood. Houndsmill: Macmillan.Cole, M [1963] Psychology of Adolescence. New York: HoltReinehart and Winston, inc.Cole, M and Cole, S [1993] The Development of Children. New York: W.H.Freeman and Co.Dembo, M [1991] Applying Educational Psychology. New York: Longman.Elkind, D [1984] Egocentrism in adolescence. Child Development, 38, 1025-1034.Erickson, E [1968] Identity: Youth and crisis. New York: W. W. Norton.Gross, R [2001] Psychology: The Science of Mind and Behavior;Kent: Greengate.Hall, G.S [1904] Adolescence, Englewood Cliffs, and N.J: Prentice Hall.Kalat, J [1990] Psychology: An Introduction; Belmount: Wordsworthy.Kaplan, P [1986] Childs Odyssey: Child and Adolescent Development. New York: West Publishing Co.Marcia, J [1980] Ego identity development; in J.Adelson Handbook of Adolescent psychology. New York: Wiley.Module [2001] Adolescent Psychology: Domasi College ofEducation.Mussen, P et al [1980] Essentials of Child Developmentand Personality. New York: Harper and Row.Muuss, R [1996] Theories of Adolescence, New York: The Mc Graw-Hill.Mwale, M [2008] Behavioural change vis--vis HIV/AIDS Knowledge mismatch among adolescents: The case of some selected schools in Zomba. Nordic Journal of African Studies, 17[4]: 288-299.Mwale, M [2008] Adolescent risk-perception, cognition andself-assessment in relation to the HIV/AIDS pandemic: The Case of some selected schools in Zomba, Malawi, Psychology and Developing Societies, 20 [2]: 229-240.Mwamwenda, S [1990] Educational Psychology: An African Perspective. Durban. Butterworks.New Combe, N [1996] Child Development: Change over time, New York: Harper Collins College Publishers.Nsamenang, A [2000] Adolescence in Sub-Saharan Africa.Psychology and Developing societies,10[1]: 75-97.Rogers, C [1969] On becoming a person. Boston: HoughtonMifflin.Santrock, J [1990] Adolescence; Duduque: Wm. C. Brown.Szekeres, G [2000] HIV in adolescence; Bulletin of experimental Treatment for AIDS; San Francisco: AIDS Foundation.

PSYCHOSOCIAL DEVELOPMENT DURING ADOLESCENCE
Some analytical considerations
BY
MARISEN MWALE


THE SELF AND IDENTITY

Adolescents carry with them a sense of who they are and what makes them different from everyone else. This sense of who an individual is and what makes him or her different from others is referred to as self-identity.
Adolescents cling to this identity and develop a sense that the identity is becoming more stable. Real or imagined, an adolescents developing sense of self and uniqueness is a motivating force in life. The two concepts comprising the word self-identity are self and identity.












THE SELF

Early in psychologys history, William James [1890] distinguished two intimately intertwined aspects of the self. The self as subject [the I self] and the self as object [the me self] and there are four major distinctions between the two aspects according to James:

Firstly the I self is the actor or knower, the me self is the object of what is known or ones knowledge of oneself [an empirical aggregate of things objectively known].
Secondly the I self is the active observer, and the me self is the observed [the object of the observing process].
Thirdly the I self conveys the sense of independence, agency, and volition and the me self conveys a sense of dependency.
Forth some researchers refer to the I self as the existential self and the me self as the categorical self.

Development proceeds in a sequence from the existential to the categorical self which is considered a duality according to Lewis and Brooks-Gunn [1979]. That is from a conception that I am, I exist, and to what or who I am [Lapsey & Rice, 1988; Lewis & Brooks-Gunn, 1979]. The task of developing the I self that is the self as subject, is to develop the realization that it is existential in that it exists as separate from others. The me self, namely, the self as object, is referred to as categorical in that the developing child must construct categories by which to define himself or herself [e.g., age and gender labels].

Lewis [1991, 1994] further refers to the I self as subjective self-awareness since when attention is directed away from the self to external objects, people, and events one is the subject of consciousness. In contrast, the idea of me can also be described as objective self-awareness which involves focusing on the self as the object of consciousness. James also identified particular features or components of both the I self and the me self.


Components of the I self include:

1. Self-awareness that is an appreciation for ones internal status, needs, thoughts and emotions.
2. Self-agency that is the sense of the authorship over ones thoughts and actions.
3. Self-continuity that is the sense that one remains the same person over time.
4. Self-coherence that is a stable sense of the self as a single, coherent, bounded entity.

Components of the me self include the:

1. Material me the body as flesh.
2. Social me- the self that interacts with others.
3. Spiritual me- what in theology is considered the soul.




Self-concept and self-esteem

An increasing number of clinicians and developmentalists believe that the core of the selfits basic inner organization, is derived from regularities in experience [Kohut, 1977; Strobe, 1988]. Individuals carry forward a history of experiences with caregivers that provide the adolescent with expectations about whether the world is pleasant or not. And in adolescence, the individual continues to experience the positive or negative affect of social agents.

Despite developmental changes and context changes [increased peer contact, a wider social world] an important feature of the selfs health development is continuity in care-giving and support, especially in the face of environmental challenges and stresses. Many clinicians stress that difficulties in interpersonal relationships derive from low self-esteem, which in turn derives from a lack of nurturance and support [Bowlby, 1988; Erickson, 1968, Rogers, 1961, Sullivan, 1953].











Carl Rogers and Susan Harters views of self concept and self esteem

Carl Rogers and Susan Harters view has been instrumental in promoting the importance of self-concept in the adolescents development and the role of nurturance and support in achieving a health self-concept. Like Sigmund Freud, Rogers and Harter [1961, 1980] began their inquiry about human nature with troubled personalities.

They explored the human potential for change. In the knotted, anxious, defensive verbal stream of his clients, Rogers for instance concluded that individuals are prevented from becoming who they are. Rogers believed that most individuals have considerable difficulty developing their own true feelings which are innately positive. As children grow up significant others condition them to move away from these positive feelings. Parents, siblings, teachers, and peers place constraints on the adolescents behavior. Thus, Rogers believed that adolescents are the victims of conditional personal/positive regard meaning that love and praise are not given unless the adolescent conforms to parental or social standards. The result, says Rogers, is that the adolescents self esteem is lowered. Through the individuals experience with the world, a self emerges.

Rogers considered the congruency between the real self, that is, the self as it really is as a result of ones experiences, and the ideal self which is the self an individual would like to be. The greater the discrepancy between the real self and the ideal self, the more maladjusted the individual will be, said Rogers. To improve their adjustment, adolescents can develop more positive perceptions of their real self, not worry so much about what others want and increase their positive experiences in the world. In such ways, the adolescents ideal and real self will be more closely aligned. Rogers thought that each adolescent should be valued regardless of the adolescents behavior. Even when the adolescents behavior is obnoxious, below standards of acceptance, or inappropriate, adolescents need the respect, comfort and love of others.

When these positive behaviors are given without contingency, it is known as unconditional personal/positive regard. Rogers strongly believed that unconditional positive regard elevates the adolescents self worth and positive self-regard. Unconditional positive regard is directed at the adolescent as a human being of worth and dignity, not to the adolescents behavior which might not deserve positive regard.
















Strength of perspective

The view sensitized psychologists to the importance of self-perceptions, to the considering of the whole individual and the individuals positive nature, and to the power of self understanding in improving human relations and communication with others.

Weakness

Critics point out that while it is well and good to have a positive view of development, Rogerss view is almost, too optimistic, possibly overestimating the freedom and rationality of individuals. Critics also argue that the approach encourages self love or narcissism. A major weakness is that it is extremely difficult to test scientifically.


In general self concept is the sum total of an individuals feelings and perceptions about one self while self esteem is an evaluation and effective dimension of ones self concept---an evaluation of ones worth.








IDENTITY

Who am I? What am I all about? What is different about me?
Not usually considered during childhood, these questions surface as common, virtually universal, concerns during adolescence. Adolescents clamor for solutions to these questions that revolve around the concept of identity. According to Erickson [1961] in Identity- Youth and Crisis it is necessary to differentiate between personal identity and ego identity.

The conscious feeling of having a personal identity is based on two simultaneous observations- the perception of the self-sameness and continuity of ones existence in time and space and the perception of the fact that others recognize ones sameness and continuity. Ego identity on the other hand concerns more than the mere fact of existence; it is, as it were, the ego quality of this existence.
The ego is the conscious mind of the individual. Ego identity then, in its subjective aspect, is the awareness of the fact that there is a self sameness and continuity to the egos synthesizing methods, the style of ones individuality, and that this style coincides with the sameness and continuity of ones meaning for significant others.








Erickson and Identity

That today we believe identity is a key concept in understanding the lives of adolescents is a result of Erick Ericksons masterful thinking and analysis.
Erickson [1950, 1968] believed identity versus identity/role confusion is the fifth of lifes eight stages occurring at about the same time as adolescence.
During adolescence, world views become important to the individual, who enters what Erickson calls a psychological moratorium----a gap between childhood security and adult autonomy. Like all stages in Ericksons theory the stage is characterized by a conflict with the possibility of bipolar outcomes.

Erickson suggests that the individual must actually experience both sides of the conflict and must learn to subsume them into higher synthesis.
If the conflict is worked out in a constructive, satisfactory manner, the syntonic or positive quality becomes the more dominant part of the ego and enhances further healthy development through the subsequent stages.
For Erickson, the growth of a positive self-concept is directly linked to the psychosocial stage resolution that constitutes the core of the theory.
However, if the conflict persists past its time, or is resolved unsatisfactorily, the dystonic or negative quality is incorporated into the personality structure.

In the case of adolescents, the dystonic or negative attribute will interfere with further development and may manifest itself in impaired self-concept, adjustment problems and possibly psychopathology. In essence this explains the interplay with risk-taking behavior aptly typified by sexual promiscuity and deviance.


SOME CONTEMPORARY THOUGHTS ABOUT IDENTITY

Contemporary views of identity development suggest several important considerations.

First, identity development is a lengthy process, in many instances a more gradual, less cataclysmic/ violent upheaval/abrupt transition than Ericksons term crisis implies.

Second, identity development is extraordinarily complex [Marcia, 1980, 1987]. Identity formation neither begins nor ends with adolescence. It begins with the appearance of attachment, the development of a sense of self, and the emergence of independence in the family, and reaches its final phase with a life review and integration in old age. Resolution of the identity issue at adolescence does not mean that identity will be stable through the remainder of life. An individual who develops a healthy identity is flexible and adaptive, open to changes in society, in relationships and in careers. This openness assures numerous re-organizations of identitys contents throughout the identity-achieved individuals life.

Third identity formation does not happen neatly and it usually does not happen abruptly. At the bare minimum, it involves commitment to a vocational direction, an ideological stance, and a sexual orientation.
Identity development gets done in bits and pieces.

Decisions are not made once and for all, but have to be made again and again. And the decisions may seem trivial at the time; whom to date, whether or not to break up, whether or not to have intercourse, whether or not to use contraceptives.



Marcia on identity

In an extension of Ericksons work James Marcia [1966, 1980, 1991] proposed four statuses of adolescent identity formation, which characterize the search for an identity- identity achievement, foreclosure, identity diffusion, and moratorium. The four kinds of identities are possible combinations of yes-no answers to two questions:

Has the person engaged in an active search for identity?
Has the person made commitments? [for example, to values, to school, to a job or career path, to who he or she wants to be as a person, or to other aspects of his or her identity]

Diffusion

Diffusion literally means confusion. The individual hasnt really started thinking about issues seriously, let alone formulated goals, or made any commitments and this represents the least mature statuse. Lacking direction; unconcerned about political, religious, moral, or even occupational issues; does things without questioning why; unconcerned why others do what they are doing.


Foreclosure

Foreclosure literally means adopting anothers position without forethought.
The individual has avoided the uncertainties and anxieties of crisis by quickly and prematurely committing to safe and conventional goals and beliefs. Commitment to occupation and various ideological positions; little evidence of the process of self construction; adopted the values of others without seriously searching and questioning; foreclosed on the possibility of achieving own identity. Alternatives havent been seriously considered.


Moratorium

Moratorium literally means a delay. The individual is at the height of the crisis and as described by Erickson, decisions about identity are postponed while the individual tries out alternative identities without committing to any particular one. Currently experiencing an identity crisis or turning point; no clear commitments to society; no clear sense of identity; actively trying to achieve identity.

Identity achievement

Achievement literally means success. The individual has experienced a crisis but has emerged successful with firm commitment to goals and ideologies.
Firm and secure sense of self; commitments to occupation, religion, thought and cultural ideology, beliefs about sex roles and the like; the views, beliefs, and values of others have been considered but own resolution reached.

This represents the most mature statuse. According to Kalat [1990] the individual has experienced several crises in exploring and choosing between lifes alternatives but finally arrived at a commitment or investment of the self in those choices. Although identity moratorium is a prerequisite for identity achievement, Marcia doesnt see the four statuses as Erickson type stages.

An illustration of the answers to the two aforementioned questions resulting in categorization into a statuse may be as below:




Has the person made commitments to values?

Has the person YES NO
engaged in an active
search for identity?

YES Identity achievement Moratorium


NO Foreclosure Identity diffusion





SEXUALITY AND ACHIVEMENT

Among the many developmental events that characterize puberty and the onset of adolescence, none is more dramatic, or more challenging to the young persons emerging sense of identity, than the changes associated with sexual development. Bodily dimensions of boys and girls become increasingly differentiated, as boys develop broader shoulders and show a greater overall gain in muscle development, and girls undergo breast development and develop more rounded hips [Conger, 1984]. Girls experience their first menstruation and boys their first ejaculation.
In both sexes genital organs- the penis and scrotum in boys, the clitoris, vagina, and labia in girls- increase in size, and pubic hair develops.
All of these physical changes require new adjustments on the part of the young person and lead to a changing self-image.

Furthermore, although sexuality in the broadest sense is a lifelong part of being human, the hormonal changes that accompany puberty lead to stronger sexual feelings, although there may be considerable diversity in the ways these feelings are expressed in different individuals and in the same individual at different times. Adolescents may find themselves thinking more about sex, getting sexually aroused more easily, even at times feeling preoccupied with sex. Or they may find themselves excited by and involved in other interests, and not be particularly aware of sexual feelings. At the same age, one adolescent may be involved in sexual experimentation, another may not; one may be in love and going steady, another may feel that it is much too early for such commitments and may prefer to play the field.

Despite such individual variations, integrating sexuality meaningfully, and with as little conflict and disruption as possible, with other aspects of the young persons developing sense of self and of relations with others is a major developmental task for both boys and girls.

How adequately this task is ultimately handled- the extent to which it becomes a source of joy or despair, of challenge and success, or failure and defeat- depends on many factors, ranging from the complexities of early parent-child relationships to contemporary social standards and values [Conger, 1984]. In terms of a cross-cultural perspective, in a recent investigation by Daniel Offer and his colleagues [1988] , the sexual attitudes of adolescents in 10 countries were sampled: Australia, Bangladesh, Hungary, Israel, Italy, Japan, Taiwan, Turkey, and the United States. Adolescents in two countries- Turkey and Taiwan- showed extremely conservative attitudes toward sex.

In traditional cultures such as Turkey and Taiwan, adolescents feel very uncomfortable about sex and feel extremely anxious about it. Nonetheless, in all of the countries studied, having a boyfriend or a girlfriend was viewed as important by the adolescents, especially in West Germany [where 82% rated this important compared to only 73% of the United States adolescents]. Blum [1945] contends that sexual maturity brings in its wake a wave of disturbances not only in the sexual realm but also in the broader phenomena of social behavior. The adolescent, flooded by his own resurgent impulses, must regroup the defensive forces of his ego in an attempt to meet his new onslaught.

According to psychoanalytic theory, individuals at any age may experience an inability to handle impulses, subdue anxiety or to delay gratification, but the maturation of sexual impulses, makes adolescence especially stressful.
A review of research [Swanson, 1996; Roger, 1969; Hill, 1998; Hendry, 2001] suggests that adolescent girls experience more emotional disturbances about sexuality than boys. However, Fiedenberg [1996] believes boys are more emotional and female less emotional than commonly believed.
Boys are moodier, more intense, and more mystical almost.

If either sex experiences stress due to sexuality, the question is what sort of help is required? Is it society itself that needs adjustment for its failure to provide a suitable niche? Sexuality in definition is an aspect of self-referring to ones erotic thoughts, actions and orientation. As children acquire knowledge about male and female and about the roles sexuality expects them, they also become increasingly aware of their own sexuality. During adolescence, the lives of males and females become dominated by sexuality. Sexuality as may be noted, involves the development of sexual identity, attitudes and sexual behavior.

Adolescence is a time of sexual exploration, experimentation and investigation into sexual fantasies and realities. Adolescents have high curiosity about their sexuality. They continually think about whether they are sexually attractive, whether anyone will love them or whether they will ever have children or whether it is normal to have sex. For most adolescents sexual experiences can be both enjoyable and painful. However what is important is the development of correct sexual attitudes and responsible sexual behavior among adolescents. The development of correct sexual attitudes and behavior among adolescents is critical, because adolescents should be able to act responsibly and prevent themselves from the negative effects of sex such as unwanted pregnancy, sexually transmitted disease and other social-moral problems.


BIBLIOGRAPHY

Berger, K [1999] The developing Person: Through Childhood and
Adolescence. New York: Worth Publishers.

Birch, A [1977] Developmental Psychology: From Infancy to
Adulthood. Houndsmill: Macmillan.

Cole, M [1963] Psychology of Adolescence. New York: Holt
Reinehart and Winston, inc.

Cole, M and Cole, S [1993] The Development of Children. New York: W.H.Freeman and Co.

Dembo, M [1991] Applying Educational Psychology. New York: Longman.

Elkind, D [1984] Egocentrism in adolescence. Child Development, 38, 1025-1034.

Erickson, E [1968] Identity: Youth and crisis. New York: W. W. Norton.

Gross, R [2001] Psychology: The Science of Mind and Behavior;
Kent: Greengate.

Hall, G.S [1904] Adolescence, Englewood Cliffs, and N.J: Prentice Hall.


Kalat, J [1990] Psychology: An Introduction; Belmount: Wordsworthy.

Kaplan, P [1986] Childs Odyssey: Child and Adolescent Development. New York: West Publishing Co.

Marcia, J [1980] Ego identity development; in J.Adelson Handbook of Adolescent psychology. New York: Wiley.

Module [2001] Adolescent Psychology: Domasi College of
Education.

Mussen, P et al [1980] Essentials of Child Development
and Personality. New York: Harper and Row.

Muuss, R [1996] Theories of Adolescence, New York: The Mc Graw-Hill.


Mwale, M [2008] Behavioural change vis--vis HIV/AIDS Knowledge mismatch among adolescents: The case of some selected schools in Zomba. Nordic Journal of African Studies, 17[4]: 288-299.

Mwale, M [2008] Adolescent risk-perception, cognition and
self-assessment in relation to the HIV/AIDS pandemic: The Case of some selected schools in Zomba, Malawi, Psychology and Developing Societies, 20 [2]: 229-240.


Mwamwenda, S [1990] Educational Psychology: An African Perspective. Durban. Butterworks.

New Combe, N [1996] Child Development: Change over time, New York: Harper Collins College Publishers.

Nsamenang, A [2000] Adolescence in Sub-Saharan Africa.
Psychology and Developing societies, 10[1]: 75-97.

Rogers, C [1969] On becoming a person. Boston: Houghton
Mifflin.

Santrock, J [1990] Adolescence; Duduque: Wm. C. Brown.

Szekeres, G [2000] HIV in adolescence; Bulletin of experimental Treatment for AIDS; San Francisco: AIDS Foundation.

MORAL REASONING IN ADOLESCENTS:

Some analytical considerations

The issue of rightness and wrongness is a complex phenomenon.

Whether a given action is acceptable or unacceptable may depend on many factors including the specific circumstances involved, legal consideration and own personal code of ethics. Moral development is the process by which individuals acquire a sense of right and wrong, to use in evaluating their own actions and the actions of others [Turiel, 1998]. Moral development begins early and continues throughout the life span. Theories of moral development attempt to find answers to moral issues and how children reason or respond to moral dilemmas and how their moral growth is stimulated.

PIAGETS THEORY

One of the earliest theories of moral development was put forward by Jean Piaget. Piaget theorized that the way humans think out moral issues depends on their level of cognitive development. In essence there is a direct relationship between cognitive development and moral development. According to Piaget young children are egocentric. That is to say they have difficulty taking others perspective into consideration. This tendency is typical of children below the age of seven or in Piagets pre-operational stage of cognitive development. Children at this age generally believe that rules are inflexible mandates provided by some higher authorities, are arbitrary and cannot be changed. Breaking a rule will automatically lead to punishment.

Young children tend to judge the gravity or wrongness of an action depending on how much harm has been made regardless of the motive or intention behind an action. For instance a child who intentionally breaks 1 cup while trying to steal sugar is considered to have committed a lesser offence than another who breaks 15 cups accidentally while opening the cupboard door. Piaget called this kind of morality heteronomous morality or morality that is subject to rules imposed by others where a child shows blind obedience to authority. The child perceives justice as resting in the person of authority; this idea is referred to as ethics of authority. The period is also referred to as moral realism or the morality of constraint, characterized by the view that rules are absolute.

After age eight children are able to understand that rules are not absolute but are rather formed through social consensus and are thus subject to change ----are tentative. In the case of infraction or violation of a rule older children are now capable of considering whether the individual acted intentionally---they consider the motive behind the action. Piaget referred to this stage as morality of co-operationthe level at which children understand that people both make up rules and can change the rules, which are now seen as a product of peoples agreements. This stage reflects the change to a social orientation, an ethics of mutual respect. Moral judgments shift from an objective to a subjective orientation: the primary concern is no longer simply the objective amount of damage caused by the immoral act, but the intention or motivation now becomes more important. Children now appreciate the reciprocity of relationships.

For Piaget, the highest stage of moral development, characteristic of adolescence, is moral autonomy. Dependent on the attainment of formal or abstract reasoning ability, moral autonomy commonly begins at puberty. In a game situation, like monopoly, chess, dominos- the adolescent reveals interest not only in the rules by which the game is played but also in possible new rules to make the game more interesting or more challenging.

KOHLBERGS THEORY OF MORAL DEVELOPMENT

Kohlberg developed his theory of moral development in the 1950s.

Like Piaget, he proposed three levels of moral development. The first level, which he called Pre conventional, is where moral reasoning is based solely on a persons own needs and perceptions. The second level, Conventional is where the expectations of society and law are taken into account. The last level, Post Conventional is where judgments are based on abstract, more personal principles that are not necessarily defined by society rules. Each of these levels is then divided into two stages.

Kohlberg used moral dilemmas which required difficult ethical choices to assess the levels of reasoning in children at different ages. He was not especially interested in the specific choices children or adults made but their underlying moral reasoning in those choices.

Level 1----- Pre conventional morality

Children think in terms of external authority. Rules are absolute; acts are wrong because they are punished or right because they are rewarded.

Stage 1

The punishment obedience orientation

Punishment and obedience are an individuals main concerns.

The main motivation for obeying a rule is to avoid punishment and achieve gratification.

Being right means obeying authority.

Stage 2

The instrumental-relativist orientation/ Personal reward

The individual adopts an orientation of individualism and exchange.

Rules are followed if they are in the individuals best interest.

Deals and compromises with others are sometimes used to solve problems.

Revealing a hedonistic orientation, morally right behavior depends on what satisfies ones own desires.

In both stages in level1- the child is egoistic/ a hedonist.

Everyone has the right to do what he wants with himself and his possessions, even though his behaviour conflicts with the rights of others.

Level 2-----Conventional Morality

Judgments at this stage are based on the conventions of friends, family and society and on their approval.

Stage 3

The interpersonal-concordance orientation/Good boy or Good girl orientation

Moral reasoning is guided by mutual interpersonal expectations and conformity.

People try to do what is expected of them.

The concern is to meet external social expectation.

Concept of right is there but nobody has the right to do evil.

Intentions become more important in judging a persons behaviour.

Stage 4

Authority and social order-maintaining orientation/Law and order orientation

Individuals place importance on the social system, including laws, and on fulfilling obligations.

There is strong belief in law, order, duty and legitimate authority.

The observance of the golden rule------do unto others as you would have others do unto you-----is often the criterion in making moral judgments.

Maintaining the established order for its own sake.

Level 3------Post conventional morality

Moral thinking involves working out a personal code of ethics or self accepted moral principle. Acceptance of rules is less rigid----one might not comply with some of the societys rules if they conflict with personal ethics.

Stage 5

The social-contract legalistic orientation

People recognize and try to balance the importance of both social contracts and individual rights.

Moral behavior reflects a concern for the welfare of the larger community and a desire for community respect.

More flexible understanding that we obey rules because they are necessary for social order but the rules could be changed if there were better alternatives.

Stage 6

The universal-ethical principle orientation/Morality of individual principle and conscience

Behaviors conform to internal principles [justice and equality] to avoid self-condemnation and sometimes may violate societys rulesmotivation is feeling right with oneself.

Individuals adopt an orientation towards universal principles of justice, which exist regardless of a particular societys rules.

Reasoning assumes a conscience that is based on self chosen ethical principles that place the highest value on human life, equality and dignity.

Civil disobedience is not out of disrespect for law and order, but out of respect for a morality higher than the existing law.

Visionaries or moral leaders such as Abraham Lincoln, Nelson Mandela, and Martin Luther displayed this form of morality.

Evaluating Kohlbergs theory

Kohlbergs theory has generated enormous interest. It is the most nearly complete theory of moral development and psychologists have found that moral development in many situations seems to proceed roughly along the lines Kohlberg suggested even in other cultures such as Turkey and Israel.

But the theory has not gone without any criticism.

First, the scoring of scenarios is somewhat subjective and can lead to errors of interpretation. Kohlberg used moral dilemmas or scenarios and respondents were categorized into a moral level or stage according to their response to the scenario or moral dilemma. There was no objectivity in such a criteria due to the fact that classifications depended on the researchers perceptions of the response.

Second, stages of moral development seem to be less domain general than Kohlbergs theory suggests [Kurtines & Greif, 1974]. The level of peoples responses may vary, depending on the particular scenario to which they respond. In essence given different scenarios or dilemmas, peoples responses may render them classified into different stages which may rather compromise the reliability and validity of the theory. Further, evidence indicates that, contrary to the assumption of stage theories, people may regress to earlier stages of moral reasoning under certain circumstances such as under stress.

Third, Kohlbergs own finding that people can regress in their behavior points out the weak link that often exists between thought/reasoning and action/behavior. [Kurtines & Greif].

The link between moral thought and moral behaviour is often

weak thought/reasoning does not necessarily translate into

behaviour. Kohlberg needless to say put too much emphasis on

moral thought than on moral behaviour.

Moral judgment/reasoning/thought refers to the intellectual

or reasoning ability to evaluate the goodness or rightness

of a course of action in a hypothetical situation. Moral behavior

refers to the individuals ability in a real life situation to resist the

temptation to commit immoral acts. Someone may indeed nurture a

higher level of moral development, but not act in ways consistent with

that understanding. This inconsistency is an element of cognitive

dissonance in social psychology reflecting a discrepancy often

existing between attitude/thought/reasoning and subsequent

behaviour. The implication here is therefore that people in essence

often preach what they themselves do not practice.

Forth, the theory was originally validated on a relatively small sample of white, middle-class American males less than 17 years of age.

Thus the theory is androgenic or centered on males. Although some

investigators have found cross-cultural support for Kohlbergs theory,

others have found that in certain circumstances, such as the lifestyle of

the communal Israeli kibbutz what is viewed as a higher level of

morality differs from the value systems Kohlberg suggested.

Apart from that the theory is ethnocentric [perspective biased

towards ones culture and judging others basing thereof] and

eurocentric [that is biased towards the west] where people

are generally individualistic hence lacking a cosmopolitan

perspective. It may therefore not apply in communal or collective

societies because of its parochial nature. It is also argued that the

scenario or dilemma responses were somewhat based on intuition that

is instinctive knowledge or insight without conscious reasoning.

Fifth Kohlberg emphasized on cognitive reasoning about morality but overlooked other aspects of moral maturity such as character and virtue that operate to solve moral problems in everyday life [Walker and Pitts, 1998; Woolfolk, 2000]. The theory does not differentiate between social convention and moral issues in which an example of a convention may be- receive things with both hands and an example of

a moral issue maybe- do not steal.

Finally Kohlberg also fails to adequately reflect the connectedness with and concern for others in individuals. Carol Gilligan [1982, 1985] argues that Kohlbergs theory emphasizes a justice perspective that is a focus on the rights of the individual rather than a care perspective that sees people in terms of their connectedness.

GILLIGANS ALTERNATIVE TO KOHLBERGS THEORY

Carol Gilligan [1982] has proposed one alternative model of moral development arising from the criticisms to Kohlbergs theory. She suggested that women tend to have a different conception of morality than do men.

According to Gilligan, whereas men tend to focus on abstract, rational principles such as justice and respect for the rights of others, women tend to view morality more in terms of caring and compassion. They are more concerned with issues of general human welfare and how relationships can contribute to it and be strengthened.

In particular women seem better able to show empathy, or the ability to understand how another person feels, when interacting with others. In general men tend to have a more competitive orientation, women a more co-operative orientation. Gilligan conducted several studies before she came up with her stage theory of moral development for women. Unlike Kohlbergs study which used males only, Gilligan used adolescents both girls and boys aged 10-15 in her study. Thus her theory was not androgenic. However like Kohlberg she also used hypothetical dilemmas. One popular dilemma was the story of the porcupine, which went on like this:

A porcupine [nungu] was seeking refuge from the cold and asked to share a cave with the mole [mphuko] family. The moles agreed but the cave was too small, such that each time porcupine moved, its spikes scratched the moles. Moles complained bitterly and asked porcupine to leave their cave. But the porcupine refused and instead asked the moles to leave if they felt uncomfortable.

When the adolescents were asked what they thought of the situation?

Boys were quick to seek justice. Porcupine should leave because that is moles house. But girls looked for solutions that would take care of both of them. They suggested covering the porcupine with a blanket. From this study Gilligan concluded that:

Women are more concerned with caring than men.

What looks like weakness in women portrays their moral strength- caring is more virtuous than justice.

Gilligan like Kohlberg also thinks that moral development has three basic levels. She calls Level 1- preconventional morality, which reflects a concern for self and survival. Level 11- conventional morality, shows a concern for being responsible and caring for others. Level 111- postconventional morality, shows a concern for self and others as interdependent. Gilligan believes that Kohlberg underemphasized the care perspective in the moral development of both males and females and that moralitys highest level for both sexes involves a search for moral equality between oneself and others [Muuss, 1988].

BIBLIOGRAPHY

Berger, K [1999] The developing Person: Through Childhood and

Adolescence. New York: Worth Publishers.

Birch, A [1977] Developmental Psychology: From Infancy to

Adulthood. Houndsmill: Macmillan.

Cole, M [1963] Psychology of Adolescence. New York: Holt

Reinehart and Winston, inc.

Cole, M and Cole, S [1993] The Development of Children. New York: W.H.Freeman and Co.

Dembo, M [1991] Applying Educational Psychology. New York: Longman.

Elkind, D [1984] Egocentrism in adolescence. Child Development, 38, 1025-1034.

Erickson, E [1968] Identity: Youth and crisis. New York: W. W. Norton.

Gross, R [2001] Psychology: The Science of Mind and Behavior;

Kent: Greengate.

Hall, G.S [1904] Adolescence, Englewood Cliffs, and N.J: Prentice Hall.

Kalat, J [1990] Psychology: An Introduction; Belmount: Wordsworthy.

Kaplan, P [1986] Childs Odyssey: Child and Adolescent Development. New York: West Publishing Co.

Marcia, J [1980] Ego identity development; in J.Adelson Handbook of Adolescent psychology. New York: Wiley.

Module [2001] Adolescent Psychology: Domasi College of

Education.

Mussen, P et al [1980] Essentials of Child Development

and Personality. New York: Harper and Row.

Muuss, R [1996] Theories of Adolescence, New York: The Mc Graw-Hill.

Mwale, M [2008] Behavioural change vis--vis HIV/AIDS Knowledge mismatch among adolescents: The case of some selected schools in Zomba. Nordic Journal of African Studies, 17[4]: 288-299.

Mwale, M [2008] Adolescent risk-perception, cognition and

self-assessment in relation to the HIV/AIDS pandemic: The Case of some selected schools in Zomba, Malawi, Psychology and Developing Societies, 20 [2]: 229-240.

Mwamwenda, S [1990] Educational Psychology: An African Perspective. Durban. Butterworks.

New Combe, N [1996] Child Development: Change over time, New York: Harper Collins College Publishers.

Nsamenang, A [2000] Adolescence in Sub-Saharan Africa.

Psychology and Developing societies,10[1]: 75-97.

Rogers, C [1969] On becoming a person. Boston: Houghton

Mifflin.

Santrock, J [1990] Adolescence; Duduque: Wm. C. Brown.

Szekeres, G [2000] HIV in adolescence; Bulletin of experimental Treatment for AIDS; San Francisco: AIDS Foundation.

Factors determining VCT efficacy as a preventative public health tool and precursor to behavioral change vis--vis the HIV/AIDS pandemic in Malawi and other selected sub-Saharan African countries: A systematic review of literature.


BY


MARISEN MWALE: PH FELLOW- COM/CDC/MACRO

LECTURER

DEPARTMENT OF EDUCATION AND TEACHING STUDIES

E-mail: marisen.mwale@yahoo.co.uk

Mailing address: Mzuzu University
Private Bag 201
Luwinga
Mzuzu 2
Malawi



Abstract

According to UNAIDS, 42 million people in the world have HIV infection. Sub-Saharan Africa remains the region most heavily affected by HIV, accounting for 67% of all people living with HIV and for 75% of AIDS deaths in 2007 [UNAIDS, 2008]. Notably, the majority of new infections in the region are preventable and are spread through unsafe sex. It is only recently that VCT services have been considered important as an entry point for prevention and care interventions for HIV/AIDS not only in Malawi but in sub-Saharan Africa as a whole. As empirical findings rightly document, VCT can however lead to the practice of safe sexual behaviors and increased condom use thus preventing further spread of the disease [Vidanapathirana et al, 2007]. Systematic review on impact of VCT on risk behavior in developing countries shows increased condom use following voluntary screening and VCT is also useful in targeting persons at high risk because risky behaviors are positively associated with the decision to uptake the HIV test [Miller, 1996]. It is upon this background that the current systematic review focuses on VCT with the thesis that perceived susceptibility to contracting HIV acts as a strong predictor of the health promotive screening action, which in turn acts as a potential precursor to Behavioural change relative to the HIV/AIDS pandemic.



Key words: VCT; Home-based service; Preventative health device; Diagnostic tool







Introduction


Malawi is among the ten countries with the highest HIV prevalence in the world, estimated at 12% of adults aged 15-49 years by the National HIV Prevention Strategy
(2009), and pegged at 11.9% by the Joint United Nations Programme on HIV/AIDS -other countries with the highest global prevalence being; Swaziland- 26.1%, Lesotho- 23.2%, Botswana- 23.1%, South Africa- 18.1%, Zimbabwe- 15.3%, Namibia- 15.3%, Zambia- 15.2%, Mozambique- 12.2%, and Kenya- high but not documented; in such descending order(UNAIDS/WHO, 2008). Although trends in HIV prevalence from sentinel surveillance indicate a slight decline, overall the downward trend in prevalence appears relatively shallow. In addition, some behavior indicators are stagnating or even worsening. The proportion of male youth aged 15-24 years having sex with more than one non-regular partner is high and condom use with non-regular partners is low. Further, three-quarters of the infection is in adults 20-40 years of age encompassing the most productive segment of the population with gross repercussions on the country in all sectors of development. According to the Biological and Behavioural Surveillance Survey (NAC, 2006) the proportion of respondents expressing an interest in getting tested for HIV amongst targeted high risk groups [Male vendors, Male primary-school teachers, Female primary school teachers, Male secondary school teachers, Female secondary school teachers, Male police officers, Female police officers, Long-distance truck drivers, Male estate workers, Female estate workers, Female boarder traders, Fishermen, Female sex workers (FSW)] was consistently lower than those who had ever tested for HIV indicating an unmet need in terms of HIV counseling and testing. The
same survey also documents that efforts to reach target population groups with messages regarding HIV and AIDS need to be continued through a diverse set of channels to reach those with little access to mass media such as television. It is thus unequivocal that HIV/AIDS is not only a public health, social, economic, and development issue challenging the individual and collective well-being and security of people in Malawi. Rather, the challenge of HIV/AIDS demands a high level of commitment, strong multisectoral collaboration and sustained action among all key stakeholders and the entire populace. Routine testing in hospitals and other health care facilities, for example, significantly increases uptake and case finding among the attendees of these facilities, but cost and convenience issues often limit the use of health care facilities among most risk group strata in sub-Saharan countries. Although community-based approaches- like mobile Voluntary Counseling and Testing [VCT] units or home-based VCT provision- have been shown to dramatically increase the uptake of testing services, the rates of patronage still remain insignificant derailing the goals to attain universal HIV testing and counseling [HTC] and underscoring the need for such stringent measures as door to door testing in Malawi. In the Action Plan for the National HIV Prevention Strategy- 2009-2013 [NAC, 2009], the strategic approach for among others Prevention of Mother to Child HIV transmission [PMCT] in Malawi provides for Universal HTC [including provider initiated testing and counseling] for women and their partners, and adolescents in child bearing age. The broad activities for the strategic action emphasizes on scaling up access to VCT in all districts, including early infant diagnosis at all PMCT sites; training of health workers to provide both pediatric and adult HTC services as well as psychological support- especially for children; production of Information Education and Communication [IEC] materials on HTC; the conducting of advocacy sessions in VCT; and the provision of VCT services including couple counseling through door to door, outreach, and mobile services. The strategic plan also emphasizes the involvement of Ministry of Health [MOH] partners in the provision of HTC services and general implementation of the plan. It is upon this background that the systematic review focuses on VCT with the thesis that perceived susceptibility to contracting HIV acts as a strong predictor of the health promotive action which in turn acts as a potential precursor to Behavioural change relative to the HIV/AIDS pandemic.







Problem analysis


According to UNAIDS, 42 million people in the world have HIV infection. Sub-Saharan Africa remains the region most heavily affected by HIV, accounting for 67% of all people living with HIV and for 75% of AIDS deaths in 2007 [UNAIDS, 2008]. Notably, the majority of new infections in the region are preventable and are spread through unsafe sex. It is only recently that VCT services have been considered important as an entry point for prevention and care interventions for HIV/AIDS. Research has shown that VCT can lead to the practice of safe sexual behaviors and increased condom use, thus preventing further spread of the disease [Vidanapathirana et al, 2007]. Systematic review on impact of VCT on risk behavior in developing countries shows increased condom use. VCT is also useful in targeting persons at high risk because risky behaviors are positively associated with the decision to take the HIV test [Miller, 1996]. VCT strengthens prevention efforts through risk-reduction strategies for HIV infected people and above all else provides evidence-based approaches to specific recommendations for prevention and control of HIV/AIDS [CDC, 2001] as well as being one of the monitoring and evaluating indicators of a second-generation HIV surveillance system [UNAIDS/WHO, 2002]. Access to VCT services nevertheless, remains limited and demand is often low in many high prevalence countries of sub-Saharan Africa. Furthermore, the quality and benefits of VCT, in particular with regard to confidentiality, counseling and access to clinical and social support, vary enormously.

The crux of the problem however emanates from adverse concern with the limited success of various programmes of Public Health in initiating Behavioural change relative to the HIV/AIDS pandemic not only in Malawi but sub-Saharan Africa in general. The issue in perspective being the failure of large numbers of eligible adults to participate in HIV screening VCT- programmes provided at no charge in centers conveniently located in various neighborhoods. The current systematic review therefore aims at exploiting those factors facilitating or inhibiting such positive responses to the health promotive action relative to the HIV/AIDS pandemic thus militating against Behavioral change.
VCT efficacy review

HIV testing is the process by which blood or body fluids are analyzed for the presence of antibodies or antigens produced in response to HIV infection [WHO, 2003]. Through VCT, an individual undergoes counseling, enabling him or her to make an informed choice about being tested for HIV. This decision must be entirely the choice of the individual, and he or she must be assured that the process will be confidential [UNAIDS, 2000]. It is usually combined with pre- and- post-test counseling. The pre-test counseling prepares the client by explaining and discussing the HIV test process, myths and misinformation about HIV/AIDS, implications of testing, risk assessment, risk prevention, and coping strategies. The main aim of post-test counseling is to help clients understand their test results and initial adaptation to their seropositive or seronegative status with referral as required. VCT is one of the key tools in HIV/AIDS prevention, and it includes benefits at the individual, community, and national levels.

Poor accessibility of health facilities, fatalism, HIV-related stigma, and confidentiality are however the main barriers to use of VCT services in sub-Saharan African countries. Although several strategies to increase the uptake of VCT among sub-Saharan populations have been suggested, factors that act as motivators for and barriers to uptake of VCT are rather elusive and difficult to delineate. It is estimated that up to 90% of HIV-positive individuals in low-income countries do not know their HIV status and may be unsuspectingly spreading the disease [UNICEF, 2006]. This according to the World Health Organization [2006] and UNAIDS [2008] underscores an urgent public health priority to immediately scale up HIV testing, treatment, and counseling in most sub-Saharan African countries which command the status of being epicenter to and bear a disproportionate brunt of the global pandemic. More so for Malawi, as in other high HIV- prevalent countries of sub-Saharan Africa, residents of rural areas often lack opportunities to be tested for HIV and to learn their status [Kimchi, 2005]. While VCT has been available in various facilities in Malawi for years, most testing centers are located in major urban areas. The dearth and paucity of evaluative studies on the efficacy, impact and effectiveness of VCT programs in Malawi in particular justifies the need to conduct such studies if further progress is to be made. That however does not militate against the fact that tangible work on the ground is being done in that field.

In a study conducted on Likoma island in Malawi [Helleringer, et al, 2009] aimed at measuring the uptake of home-based VCT and estimate HIV prevalence among members of the poorest households in a sub-Saharan population, it was observed that despite the fact that less than a quarter of the study population had previously participated in facility based VCT, the home-based provision of VCT was very well accepted in the study population. Specifically when present at home at the time of the VCT teams visit, more than 75% of respondents accepted to be tested and immediately retrieved their HIV test results. Uptake was even higher among the poorest, suggesting a strong unmet need for VCT in the most disadvantaged subgroups of the population. The finding is interesting and insightful in the sense that it highlights an unmet gap of accessibility to VCT services especially in rural Malawi begging the question as to whether the majority of people are really not motivated to uptake VCT or rather that the service itself is not readily publicized through IEC and not readily accessible to the targeted masses. Empirical findings in fact demonstrate that social marketing of VCT through criteria as IEC is one of several identified strategies for scaling up VCT services [WHO/UNAIDS, 2001]. These include innovative methods of communication and community mobilization campaigns.

The analyses presented in the Likoma study also confirmed earlier findings in other studies reflecting large socioeconomic disparities in uptake of VCT at health facilities [e.g., hospitals, health centers] in general. Through informal field diary recordings and observations- complaints of ill-treatment and negligence by health practitioners as well as lack of respect for the underprivileged has been noted to be rife in Malawian health facilities in general- [a factor that has created psychological fatalism, disdain, apathy or otherwise for the public facilities per se in some quarters of the population as reflected for instance in problematic vaccination campaigns and preferred patronage of alternative traditional sources of medicine]. It might therefore as well not be an overstatement to attribute the low uptake of VCT to such other extraneous variables. In fact an analysis of reactions to VCT in rural Malawi in 2004, using testing with delayed results, revealed that there is an overall acceptance and enthusiasm for VCT in rural Malawian communities with only eight percent of individuals approached for testing refusing testing [Thornton et al, 2005].

In a similar study that occurred parallel to a larger MDICP project funded by the National Institute of Child Health and Human Development [NICHD] and specifically hypothesized that rural Malawians would respond more enthusiastically to, and favor, rapid testing in other settings rather than routine health facilities as well as over testing with delayed results, it was found out that most respondents favored VCT and the dissemination of results within their homes over other areas such as hospitals with many reasons being given for this preference [Kimchi, 2005]. According to the study results, one of the most prominent justifications for the home-based service preference was that the home protected their privacy and the confidentiality of the test results in a way that getting tested in a hospital or other service center could not. This specifically highlights the pertinent need for an opportunity to come together, to discuss serostatus results in a safe setting, and to negotiate a risk-reduction plan a strategy that could be considered in all studies of serodiscordant couples, and may have potential to reduce the high rate of transmission among such couples in developing countries.


The Likoma and MDICP studies therefore document the implication that home-based provision of VCT services has a potential of not only increasing the uptake of VCT among the general population who may not have contact with routine health services or who are reluctant to visit them due to other extraneous variables as highlighted in the foregoing. This also promises to substantially reduce the socioeconomic gradient in VCT utilization observed in several African countries with substantive ramifications in the fight against the pandemic. Above all else home-based VCT has the potential to promote couples-oriented testing with empirical data depicting current strong self-selection among couples in the use of VCT [Glick, 2005]. This also has implications for scaling down and mitigating an emerging threat in exponential prevalence rates in the name of discordant coupling. In particular, relative to discordancy a study of VCT carried out among a cohort of Rwandan women showed that HIV-seroconversion rates decreased in seronegative women whose partners were tested, but not in women whose partners were not tested [Allen, et al 1992]. The question however, still remains as to whether VCT has the efficacy to change behaviour relative to the HIV/AIDS pandemic.


The most common study design in measuring VCT efficacy is the one-group pretest and posttest design. Self-reported behaviors of VCT clients are recorded prior to and at some interval after the intervention, and any change in behavior is attributed to the intervention. Few evaluations attempt to identify appropriate comparison groups, and only one study used a control group in the context of a randomized trial. In this unique study which is documented by Coates et al [2000], and was conducted in Tanzania and Kenya (as well as in Trinidad), individuals or couples who had been recruited were randomized into VCT and basic health information arms. Overall, this research provided evidence of some reduction in self-reported risk behaviors following HIV testing or VCT. Two main patterns emerged. The first was that risk-reducing behavior change tended to be larger among individuals who tested positive than among those who tested negative [Allen, Serufilira, et al. 1992; VCT Efficacy Study Group 2000a; van der Straten et al. 1995; Lutalo, Kidugavu, and Wawer 2000]. This conforms to a general pattern observed for VCT elsewhere, including in the United States [Weinhardt et al. 1999; Wolitski et al. 1997]. One contrasting finding comes from reviews of data from Ugandas AIDS Information Center VCT program [UNAIDS 1999], which showed that at 6-month follow-up, reported condom use had risen strongly for both HIV-positive and HIV-negative clients. However, the share of HIV-negative clients who were sexually active also increased.

Another interesting empirically documented finding is that counseling of couples and/or partner testing appears to be effective at altering risk behavior as well as more effective than individual testing and counseling when the two are compared [Kamenga et al. 1991]. In some cases, individual testers also report risk reduction. Overall in the three sites of the multicountry VCT efficacy study [VCT Efficacy Study Group 2000a]- the percentage of individual testers reporting unprotected intercourse with nonprimary partners declined significantly from baseline and significantly more for the VCT group than for the health information arm [35% vs. 13% reduction for men, 39% vs. 17% for women]. Although offering less reason for optimism about those who test negative the foregoing findings present an important implication vis--vis the efficacy of VCT in promoting Behavioural change relative to the HIV/AIDS pandemic. However factors that potentiate uptake of testing whatever strategy may be utilized need to be delved into since they are fundamental for VCT Policy implementation and evaluation and as well significant for an overall public health impact. The need to address this prevailing gap hinges upon the backdrop that VCT will have significant impact on the epidemic only if it is able to attract large numbers of HIV-positive individuals, particularly those who are not yet ill, are asymptomatic, are unaware of their serostatus, are still sexually active and hence posit an exponential probability of further transmitting and spreading the virus.


In that realm, in a study conducted in Botswana (Rajaraman and Surender, 2004) and sought to determine perceptions of personal risk between respondents who had tested for HIV and those who had not, it was reported that those who had not currently tested did not generally consider themselves to be at risk of HIV infection [ sometimes incorrectly given their other information about sexual relationships or exposure- could be a function of cognitive processes such as optimism of personal precautions taken or motivational processes such as wishful thinking] this finding was considered significant because it suggests that testing is still primarily treated as a diagnostic tool rather than a preventative health device, where people seek to find out their HIV status not only to access treatment if tested positive, but also to protect themselves from future infection if tested negative. According to the findings, while this was encouraging to those who had expressed hope that the incentive of treatment would indirectly contribute to HIV prevention by increasing uptake of testing (WHO/UNAIDS, 2005; Merson, Quinn, Richman, Vella and Weiss, 2001) the findings from this study also entail some sobering information.

The findings unveil the increased attention being paid to the role of HIV testing as being typically based on a two-fold Public Health Rationale. First, that apart from the benefits of antiretroviral treatment, informing HIV positive people of their serostatus is crucial if they are to limit further transmission of the virus. Second, that it is hoped those who find out they are HIV negative will take steps to protect themselves from infection in the future. However, as the study documented, emphasis on treatment on its own may further encourage primarily those who suspect that they have symptoms of HIV to be the only to uptake testing. As such, asymptomatic HIV positive people may continue to transmit the virus unknowingly while efforts at increasing knowledge of HIV status among those who are HIV negative may be less effective. The design and implementation of programmes to promote preventive testing amongst those equally likely to be HIV negative should therefore be a priority in efforts to control the spread of HIV/AIDS.


Another finding from the study was that although knowledge and awareness of HIV appeared high in Botswana, it was clear from the study that information alone was not a sufficient catalyst for behavioral change. These results support other accounts of the limitations of conventional health education approaches which tend to rely on information giving alone as the basis for behavioural change. The findings of the study suggest that to some degree beliefs and attitudes do predict behaviour with the relationship between both perceived susceptibility and perceived benefits or barriers and behaviour being evident. It is also apparent that the social and structural circumstances in which respondents live enable or constrain their health related behaviour. Thus health care seeking behaviour is consequently a function of some complex interaction between various social environmental and structural factors.






Conclusion


My most important methodological conclusion is that demand for VCT services may increase both as a diagnostic and public health preventative tool in the medical management of people infected with HIV in Malawi in particular and other high prevalent countries of sub-Saharan Africa in general. The systematic review highlights among other factors the need to reinforce the significance of confidentiality and trust between clients and counselors. Above all else the analysis unravels the unequivocal need to emphasize on home based service provision which may guarantee not only confidentiality but help abate and mitigate the pandemic by targeting a new wave to the crisis vis--vis HIV/AIDS relative to sub-Saharan high prevalent countries in the name of serodiscordant coupling. Also unveiled in relation to home based provision of VCT is an important element that the service innovation may also tap on that exponentially higher poor rural-populace who may not have contact with routine health services or are often reluctant to patronize such service centers in generic hospitals or other facilities due to extraneous variables documented in passing within the review. As the review further postulates, home based VCT service provision also promises to substantially reduce the socioeconomic gradient in VCT utilization observed in several sub-Saharan
African countries with substantive implications in the fight against the pandemic. Notwithstanding, with an efficacious vaccine and cure for HIV and AIDS still elusive, focusing on stringent mitigative strategies such as VCT remains the window of hope in our desperate war against the HIV/AIDS pandemic not only in Malawi but sub-Saharan Africa in general.







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FELLOWSHIP DOCUMENTS

A LOOK AT THE HEALTH BENEFITS OF MEDICINAL PLANTS

ALOE VERA

Clinical applications

• Genital herpes
• Psoriasis
• Wounds
• Shingles
• First degree and second degree burns
• Acne
• Diabetes- improves blood glucose/stabilizes sugar levels
• Hyperlipdemia- lowers blood lipids
• Hepatitis
• Ulcerative colitis
• Immunostimulant- aiding in fighting cancer/limits tumor growth and metastasis particularly in lung cancer
• Improves circulation
• Hypertension- lowers blood pressure
• Reduction in joint inflammation, arthritis, rheumatism
• Laxative- improves peristalsis thus fights constipation
• Lessens the symptoms of heartburn, peptic ulcer and Crohns disease
• Because of its stimulation and boosting of the immune system Aloe Vera is considered a potential treatment for AIDS patients.
• Acemannan one principle of Aloe Vera has been shown to slow the AIDS virus from replicating and spreading through its correlations with increased interferon production [an antiviral protein with the ability to interfere with viral replication by rendering cells refractory to protein synthesis].
• Reduction in Chronic disease risk and helps in recuperation after illness.
• Lowers triglycerides, cholesterol, and blood sugar levels.
• Because of high levels of collagen which help maintain lean body mass may help in weight loss for the obese.
• Detoxifies the body.

Should however be taken in moderation since high intake can result in lowered potassium levels.

GARLIC [allium sativum]

Clinical applications

• Hyperlipdemia- lowers lipid levels
• Thrombosis- reduces formation of clots [platelet aggregation] in blood vessels through the blood thinning cascade effect thus reducing chances of stroke and heart attack.
• Hypertension- lowers blood pressure
• Reduces menstrual pain, muscle pain, nerve pain and arthritis.
• Treats corns, warts, calluses ear infection and other dermatological problems.
• Vermifuge- treats intestinal worms.
• Diabetes- reduces blood sugar levels
• Atherosclerosis
• Immunostimulant- aids in combating cancer/ retards tumor formation and metastasis-spread.
• Increases blood levels of antioxidant enzymes thus acts as an effective remedy against the oxidative effects caused by free radicals.
• Prevents LDL cholesterol oxidation.
• Lowers triglycerides and cholesterol levels.
• Inhibits lipid peroxidation in the liver retarding the aging process of liver cells.
• Maintains the health functioning of the liver.
• Detoxification of the liver and entire body thus improving metabolism.
• Garlic has been used reasonably successfully in AIDS patients to treat cryptosporidium, toxoplasmosis and other opportunistic infections.
• The ethers in garlic though this has not been substantiated empirically act as lipid solvents inactivating the infectivity of viruses including herpes viridae, hepatitis B and HIV [in vitro findings].
• Garlic stimulates the activity of the defensive cells of the body, both lymphocytes and macrophages- these cells which flow with the blood protect us from micro-organisms, and furthermore they are able to destroy cancerous cells, at least in the initial phases of tumor formation.
• The consumption of garlic has a good effect on any infectious disease augmenting the defensive ability of our body, besides directly destroying certain micro-organisms.
• Depurative- purifies the body by enhancing elimination of waste through the kidneys, the liver and the skin.
• Promotes METABOLISM.
• Promotes CATABOLISM.
• Garlic principles act against various types of fungi, yeasts, and some viruses, such as HERPES and HIV 1 and 2- the active principles of garlic are supposed to interact with the nucleic acids of the virus, thus limiting its proliferation.
• Principles act in vitro and in vivo against the following micro-organisms: E Coli, Salmonella typhi, Staphylococcus and Streptococcus, Candida- due to sulfurated essence which diffuses easily throughout the bodys tissues.
• Balances the intestinal flora and stimulates natural immunity.

• Rich in Vitamin C- ASCOBIC ACID and Vitamin B 3 NIACIN PPFactor which acts as a coenzyme within the body facilitating the numerous chemical reactions essential to carbohydrate and fat metabolism allowing these nutrients to provide energy to the cells- lack of NIACIN manifests itself by dry, cracked, red skin as well as muscular weakness and dyspepsia.

Serious deficiency of NIACIN causes PELLAGRA characterized by the so called three Ds--- DERMATITIS, DIARRHOEA, DEMENTIA.

High intake may however reduce clotting effects in platelets prolonging bleeding in injury and child birth thus not recommended in pregnancy.

GINGER [zingiber officinale]

Clinical applications

Antispasmodic- it relaxes all types of muscles

Aromatic- gingers aroma, flavor and warmth help to stimulate the digestive system.

Diuretic hence prevents fluid retention and oedema

Carminative- the volatile oils in ginger relax the stomach and stimulate peristalsis thereby supporting digestion and reducing gas and flatulence/ helps cure and prevent- dyspepsia, slow motility symptoms, constipation, gastroparesis.

Diaphoretic- it induces perspiration and the elimination of toxins through the skin.

Rubefacient- applied to the skin, ginger stimulates and dilates the blood capillaries thus increasing circulation.

Sialogogue- ginger promotes the secretion of saliva.

Stimulant- as a circulatory aid, ginger supports and speeds up the bodys physiological systems.

Cardiovascular- prevents the formation of clots in blood vessels through the cascade effect- preventing obstructions that result in stroke and heart attack.

Rhematism and joint pain prevention

Fatigue, headache, nausea and poor dietary habits remedy.

Energy levels, mood, emotion are improved promoting balance.

Detoxification- ginger expels toxins opens the pores of the skin and stimulates circulation therefore it is considered useful in colds, influenza, mucus congestion and fluid blockages in the body.

Detoxifies the liver with effects in lifting depressive, angry or sad moods.

For the energy and mind ginger inspires confidence due to its metabolic effects and support to body systems.

Ginger principles promote the production of the cytokine Tumor necrosis factor [TNF-] in the alveolar macrophages which might express an antiviral HIV, influenza, Hepatitis B effect.

Improves male health.

Must be avoided however during pregnancy for it may result in abortion although some practitioners content it reduces motion and morning sickness.

MORINGA OLEIFERA

Clinical applications

Best known as excellent source of nutrition and a natural energy booster.

Leaves rich in iron therefore highly recommended for expectant mothers.

Since all essential amino acids are present Moringa may be rightly called a complete food for total nutrition more Vitamin A than carrots, more calcium than milk, more iron than spinach, more Vitamin C than the orange, more potassium than the banana and the protein quality of Moringa leaves rivals that of milk and eggs.

Analgesic- alcoholic extracts of the leaf possess marked analgesic activity.

Anti-inflammatory activity- poultice of leaves is beneficial in glandular swelling.

Antipyretic activity- the antipyretic activity of ethanolic, petroleum ether, solvent ether [ethers have antiviral activity- thus moringas correlation with improved CD4+ counts] and ethyl acetate extracts of seeds was screened using yeast induced hyperpyrexia method. Paracetamol was used as a standard for comparison. The ethanolic and ethyl acetate extracts of seeds showed significant antipyretic activity.

Antiasthmatic activity- a study showed appreciable decrease in severity of symptoms of asthma and simultaneous improvements in respiratory function.

Wound healing properties- when assessed for healing activity in excision, incision and dead space wounds the ethanolic and ethyl acetate extracts of leaves showed significant wound healing activity that is comparable with the standard vicco turmeric cream. PHYTOSTEROLS AND PHENOLIC COMPOUNDS present in these extracts promote the wound healing activity.

Antidiabetic activity- an extract from the Moringa leaf has been shown to be effective in lowering blood sugar levels within 3 hrs ingestion.

Hepatoprotective activity- the methanolic and chloroform extracts [chloroform has antiviral properties due to its lipid solvent properties on enveloped viridae e.g., HIV 1/2, herpes, etc] of leaves of Moringa have shown very significant hepatoprotection aganst CCL induced hepatotoxicity.

Antitumor and anticancer activity- few isolated bioactive compounds from the seeds were tested for antitumor promotive activity using 7, 12 DMBA as initiator and TPA as tumor promoter. From the results, niazimicin, thiocarbamate from the leaves of Moringa oleifera was found to be potent chemopreventive agent in chemical CARCINOGENESIS.

The seed extracts also effective on hepatic carcinogen metabolizing enzymes, antioxidant parameters and skin papillomagenesis.

Antimicrobial activity rich in antimicrobial agents- the active antibiotic principle pterygospermin has powerful antibacterial, antiviral and fungicidal effects.

Antihypertensive, diuretic and cholesterol lowering activities- Moringa leaf juice is known to have a stabilizing effect on blood pressure.

Antispasmodic, antiulcer and anthelmentic activities.

Blindness and eye infection- due to high Vitamin A prevents night blindness and delays outset of cataracts. Juice can be instilled in eyes in cases of conjunctivitis.

Cardiac and circulatory stimulant- Moringa acts on the sympathetic nervous system and acts as a cardiac stimulant.

Antioxidant activity- oils derived from the dried seeds aqueous methanol [80%] and ethanol [70%] extracts of freeze dried leaves showed radical scavenging and antioxidant activities- acts on free radicals. Leaves potential source of natural antioxidants.

Detoxifier.

Considerable efficacy in water purification by flocculation, sedimentation and antibiosis.

Sexual virility- treats erectile dysfunction in men and prolongs sexual activity in women.

Venomous bites- treats by snakes, spiders, scorpions etc

MANDARIN ORANGE

Clinical application

Improves skin texture

Prevents water retention in tissues- oedema

Improves digestion- heals constipation, colitis, abdominal distension

Nervous functioning- thinking, perceiving, memory

Respiratory tract- bronchitis, reduces phlegm, flu, colds

Reproductive- prolapse of the uterus

Eye- high in betacarotene the precursor to Vitamin A thus good for the eyes

Richest in Vitamin C thus prevents disease associated with deficiency

Anti-septic

Anti-depressant

Sedative

Tonic

AIDS- oranges slow but do not completely halt the development of viruses in cells- they increase the production of interferon an antiviral protein produced within the body. Interferon interferes with viral replication by rendering cells refractory to protein synthesis.

Richness in Vitamin C enhances iron absorption.

Organic acids particularly citric acid potentiates the activity of Vitamin C and facilitate the elimination of toxic residues such as uric acid from the body.

Rich carotenoids similar to beta-carotene- which transform into Vitamin A in the body act as powerful antioxidants [beta-cryptoxanthin, lutein, and zeaxanthin].

Thanks to the combination of Vitamin C and other natural chemical substances they contain- oranges increase the disease fighting capabilities of LEUCOCYTES- they increase the number and longevity of these white blood cells attributed to the combined effect of folic acid and Vitamin C.

The flavonoids found in oranges potentiated by Vitamin C inhibit the building of clot forming platelets in the blood thus oranges help make the blood more fluid and improve circulation particularly in the two organs requiring the most consistent blood supply- THE BRAIN and THE HEART.

ORANGES also contain four highly effective ANTIOXIDANTS that mutually potentiate themselves- VITAMIN C, QUERATIN, PROVITAMIN A and FOLIC ACID.

The result is a powerful antioxidant effect on all of the bodys cells

Today it is known that arteriosclerosis and the aging process itself have their biochemical origin in oxidizing phenomena- high doses of VITAMIN C is proven to reduce blood pressure significantly.

Regular orange consumption including the pulp and even the mesocarp is associated with reduced blood cholesterol, lowered blood pressure and lower rates of arteriosclerosis, arterial thrombosis and heart disease.

Oranges help cure constipation and intestinal atony through two mechanisms: they stimulate the empting of the gall bladder [CHOLAGOGIC effect] with the subsequent laxative effect of bile in the intestine and their soft vegetable fiber stimulates peristaltic action in the intestine.

In addition to relieving constipation, oranges alleviate the hemorrhoids that often accompany it. To achieve the best results in both cases an orange treatment should be followed----four to six oranges per day.

May however perpetrate hyperactivity in the baby in pregnancy, and in young children.

CINNAMON [cinnamomum verum/ cinnamomum aromaticum- cassia]

Clinical applications

Rich source of iron, calcium and manganese.

Increases energy and elevates the mood.

Calms the stomach and prevents ulcers.

Contains benzaldehydes an active antitumor agent hence applicable in cancer treatment- researchers are investigating its role in leukemia and lymphomas.

Prevents urinary tract infection and candida.

Improves male health.

Effective remedy for common cold- coarsely powdered and boiled in a glass of water with a pinch of pepper powder and honey, can be beneficially used in influenza, sore throat, and malaria.

Alleviates indigestion, stomach cramps, intestine spasms, nausea and flatulence- a tablespoon of cinnamon water mixed with honey relieves flatulence and indigestion.

Serves as a good mouth freshener.

Cinnamon prevents nervous tension, improves complexion and memory.

Alleviates headache produced by exposure to cold air- apply a paste of finely powdered cinnamon mixed in water on the temples and forehead.

Improves the appetite and treats diarrhea.

Anti-inflammatory properties- thus useful in treating rheumatism and other inflammations as joint stiffness caused by arthritis in general stimulating the healthy functioning of all the vital human organs.

Anti-spasmodic properties- thus useful in treating spasmodic afflictions, asthma, excessive menstruation, paralysis, uterus disorders and gonorrhea and good for female gynecological health.

Provides relief from morning sickness and nasal congestion.

Promotes healthy teeth and gums.

Anti-clotting properties- improves blood circulation thus useful in alleviating stroke, hypertension and other cardiovascular problems.

Sometimes used as a prophylactic agent, to control German measles.

Extracts active against candida albicans, the fungus responsible for vaginal yeast infection.

Extracts active against helicobacter pylori, the bacterium responsible for stomach ulcers.

Antimicrobial properties are due to eugenol and cinnamaldehyde.

Extracts in vitro inhibit the growth of cultured tumor cells.

Useful as a food preservative to inhibit the growth of common

food-bourne bacteria such as Salmonella and E coli.

Boosts the immune system against infection.

Diabetes- stabilizes sugar levels due to water-soluble polyphenolic polymers derived from an antioxidant catechins a compound which increases insulin sensitivity by enhancing insulin receptor function and increase glucose uptake.

A study involving 60 men and women, average age 52 years, who had type 2 diabetes, were given half teaspoon a day of cinnamon for 6 weeks and they showed a 25% decrease in fasting blood glucose levels as well as a 12% drop in blood cholesterol levels and a 30% drop in blood triglyceride levels.

Can be toxic in larger doses due to cinnamaldehyde, the major oily constituent of the bark.

References

Aney JS et. al [2009] Pharmacological and Phamaceutical potential of Moringa Oleifera : A review, Journal of Pharmacy Research, vol. 2. Issue 9 September.

Aloe vera research [1997] Research on clinical uses of Aloe vera, Summary of Articles, Oxford University, htm

Davies JR [2010] Traditional western herbal products- Ginger zingiber offffinale, Herbs Hands Healing, htm

Faley J [2005] Molinga Olefeira: A review of the Medical Evidence for its Nutritional, Therapeutic and Prophylactic properties, Trees for life Journal, 1(5).

Falsetto S [2008] Healing properties of the Orange tree, htm

Grzanna R [2010] Ginger: An Herbal Medicinal Product with Broad Anti-Inflammatory Actions, mhtml.

Hamman JH [2008] Composition and Applications of Aloe vera Leaf gel, Molecules, 13, 1599-1616.

Mhtml:file://C:/ Documents [2010]- Health Benefits of Garlic.

Mama S [2010] Cinnamon and its healing properties, htm

Mandarin Orange, Wikipedia, htm

Moringa, Wikipedia, htm

Ping- Hsien Chuang et. al [2005] Antifungal activity of crude extracts and

essential oil of Moringa Oleifera, ELSERVIER htm.

Vegetarianism and vegetarian nutrition [2010] Cinnamon- Health benefits,

htm.

MAESTRO- ENERGY/IMMUNE BOOSTER[TM]

PRODUCT FOUNDER- MARISEN MWALE

INGREDIENTS:

Moringa oleifera

Aloe vera

Garlic

Ginger

Cinnamon

Mandarine orange

Lemon

Damerera sugar

Missing due to unavailability in Malawi but pharmacologically pertinent:

Morinda citrifolia [noni]

For security of product: -preparation technique still confidential to product trade mark!

Clinical applications- AIDS, Cancer, Hypertension, Diabetes, Asthma, Gastric atony, Ulcer, Hyperlipdemia, Cholestrol, Obesity [ETC]

MARISEN MWALE

FELLOW- [COM/CDC/PEPFAR]