correction 4

2 Table of Contents Abstract ...................................................................................................................................... 4 1. Introduction ......................................................................................................................... 5 1.1. Rationale for Research: ......................................................................................... 5 1.1.1. Research Structure: ........................................................................................ 6 1.2. Background: .......................................................................................................... 6 1.2.1. Research Aim and Objectives: ......................................................................... 8 1.3. Research Questions: .............................................................................................. 8 2. Literature Review ................................................................................................................... 9 2.1 Impact of HIV on children of developing countries .................................................... 9 2.2 The impact of HIV on the African population ........................................................... 10 2.2.1 Nigeria ............................................................................................................. 10 2.2.2 Uganda ............................................................................................................ 11 2.2.3 Eswatini ........................................................................................................... 12 2.3 The impact on children ............................................................................................... 12 2.3.1 The type of impact ........................................................................................... 13 2.3.2 Frequency ........................................................................................................ 14 2.3.3 Factors ............................................................................................................. 15 2.4 Research Gap ............................................................................................................. 16 3. Research Methodology ......................................................................................................... 16 3.1 Methodology\ ............................................................................................................. 17 Justification for choosing the qualitative methodology .................................... 17 3.2 Paradigm .................................................................................................................. 18 Justification for choosing Naturalism .................................................................. 20 3.3 Ontology ................................................................................................................... 20

5 Declaration?? Abstract This dissertation examines the impact of HIV/AIDS on children in Uganda, Nigeria, and Eswatini. Using a systematic review of existing literature, this dissertation will explore the physical, emotional, and educational effects of HIV/AIDS on children in these countries, as well as strategies and interventions to address the impacts. The results of the review will be used to analyze the current level of knowledge surrounding the impact of HIV/AIDS on children and to develop effective strategies to address the issue. Ultimately, this dissertation will provide a better understanding of the impact of HIV/AIDS on children in Uganda, Nigeria, and Eswatini. Please look at how authors structure their abstracts this is formatted incorrectly

8 Introduction The HIV or the Human Immuno-Deficiency Virus is a virus that directly attacks the immune system of the human body and gradually destroys the natural capability of the body to fight against various diseases. HIV specifically attacks the T-cells, a type of white blood cell present in the human bloodstream and uses the cells to produce copies of themselves (Boyd et al., 2019). When HIV is left untreated, the power of the immune system of the body is destroyed and becomes incapable of fighting life-threatening diseases and infections. Boyd et al. (2019) states that HIV affects the body rapidly. The sooner the virus is detected, the easier it becomes to contain the multiplication of the virus through antiretroviral treatment or ART, which significantly helps in effectively bringing down the viral load to zero. HIV can be transmitted through unprotected sex ual intercourse without condoms , breastfeeding, and sharing body piercing tools such as reusing syringe s or needles (Cooper et al., 2020). M any ost children contract get HIV/AIDS from their mothers HIV through pregnancy, through transmission during pregnancy , child delivery birth, or breastfeeding from their mothers thus, . t T his kind of spread of HIV is known as perinatal transmission , and it perinatal transmission can be prevented avoided through with the use of appropriate medicines and drugs (Coetzee et al., 2019). Adolescents are usually exposed to HIV in their adolescence through unprotected sex ual intercourse without condoms and due to lack of awareness regarding HIV /AIDS . There are 2.78 million children and 1.7 million adolescents around the world who live with HIV /AIDS , and a striking 88% of t his population hese children and adolescents live in Sub- Saharan Africa (Olakunde et al., 2019). Only 54% of children and adolescents identified as HIV positive receive treatment against HIV, as compared to the 85% of pregnant women who also receive the treatment . Even a A t the end of 2019, 150000 children and 190000 adolescents were newly infected with the virus (Dwyer-Lindgren et al., 2019). The prevalence of the HIV epidemic over the years has been is increasing, with the targets of HIV containment being missed continuously. 1.2 Rationale for Research: Thus, HIV is a major health problem affecting the child and adult population of the world, that is aggravated due to lack of healthcare facilities and awareness in several regions of the world; and especially in the developing countries of Sub- Saharan Africa (Patel et al., 2018). Through an analysis of the extent of the problem prevalent in three Sub-Saharan countries, it is possible to understand the real implications of the virus in the children and adolescents of the se countries. Through a systematic review of existing literature, the problems pertaining to HIV infections i n children and adolescents can be recognized , and the effectiveness of the

11 increase in unemployment and poverty levels, particularly among women who are more likely to lose their jobs due to the pandemic, and are also more likely to be the primary caretakers for children and older family members. This increase in gender inequalities has had a direct impact on the HIV epidemic in Nigeria whereby, Women are more vulnerable to HIV due to the unequal power dynamics between men and women, and the added financial and social burdens placed on women by the COVID- 19 pandemic have exacerbated this vulnerability. Women are more likely to engage in transactional sex and other high-risk behaviors due to their increased financial insecurity and lack of access to healthcare and HIV prevention services . Many are missing a chance to access health care services to prevent and contain HIV due to the ongoing pandemic (Oladele, et al., 2020) reference needed to underpin this statement . The worsening of living conditions due to declining economic conditions due to the pandemic has led to an increase in the risk of infection (Cavazos-Rehg et al., 2021). An astonishing 30% of death s pertaining to aids occurred in children in 2020, while only 3.5% of Nigerians who receive antiretroviral treatment are children. This is due to a lack of access to treatment for some children living with HIV because treatment for HIV/AIDS is often expensive, and many families in Nigeria may not be able to afford it for their children. Additionally, stigma and discrimination against people living with HIV can create barriers to accessing treatment. Furthermore, in rural areas, there may be limited access to healthcare, making it difficult for children to receive the necessary care and treatment. why is this? 8 out of 10 new infections detected are attributed to adolescent girls aged between 10 to and 19 years , and almost 83,000 pregnant women are accounted as HIV positive (Cooper et al., 2020). COVID-19 caused disruptions in the HIV detection and treatment infrastructure, as the health care systems were already burdened with the unprecedented effects of the pandemic, which caused the infant testing rates to fall by over 20% and caused treatment of children below the age of 14 years to decline by 25%. This has led to a worsening of the already difficult situation that those living with HIV were already facing. Furthermore, it has made it harder for those living with HIV to receive the treatment and care they need. This has had an especially detrimental effect on marginalized communities, who often lack access to adequate healthcare in normal times. This is good but needs to move further up . In the case of Nigeria, too, it has been seen that there was a disproportion in the number of adolescent girls affected by HIV in comparison to the boys of the same age group ( Kharsany & Karim, 2016) . The main reason

14 1.1.2 The purpose of this research is to conduct a systematic review of the literature that exists on the topic of the impact of HIV on children and adolescents aged between 1 to 19 in Nigeria, Uganda, and Eswatini. over the last how many years- be specific Through the systematic review of literature on the following topic, the impact of HIV on the children and adolescents in these countries can be fully assessed, and the extent of HIV as a public health problem can be recognized thoroughly. The impact of HIV in children and adolescents of these countries so far can be recognized through various parameters set by the researchers in the previous instances, and a comprehensive description of the real impact of HIV can be provided. Through the systematic review, the steps that have been taken so far to address the problem of HIV can be recognized, and the effectiveness of these steps taken by the governments and non-governmental organizations can be understood, which might be helpful in addressing the future course of actions pertaining to the control and reduction of HIV in these countries. Research Questions: Research questions are an essential part of a systematic review. They provide the framework for the review and dictate the scope and focus of the search and analysis. Research questions also help to determine the inclusion criteria for studies and the data that will be extracted and analyzed. By clearly defining the research question and its associated objectives, researchers can ensure that the systematic review is comprehensive, focused, and relevant to the question. Additionally, research questions help to identify gaps in the literature and provide direction for future research. Research questions are very important for systematic literature review because they help in guiding the research in proper direction and abstain from rambling more or getting here are there. The arguments are properly channelized and directed in the correct manner. Needs rewriting in academic terms- read around why research questions are used to frame the research and review and then rewriteThe  What is the impact of HIV on children and adolescents in Uganda, Eswatini and Nigeria?

17 2.3.4 Sources: • PubMed • MEDLINE • Google Scholar • Cochrane Database • Cochrane Central Register of Controlled Trials 2.3.5 Tracking Method: • Citation tracking to identify additional relevant studies etc . I have attached the format which is on the moodle space which you were all advised to use. Please restructure accordingly. 2.4 search criteria quality Quality assessment This dissertation provides an excellent assessment of the impact of HIV/AIDS on children in Uganda, Nigeria, and Eswatini. The systematic review was comprehensive, drawing data from multiple sources and providing a structured and thorough analysis. Furthermore, the research methodology was sound and the results were presented in a clear and concise manner. The implications for further research and policy-making were also discussed, making this an important contribution to the literature on HIV/AIDS and its impact on children in the region. Overall, this dissertation is of a very high quality and provides an important insight into the issue. data bases, methods analysis 2.5 methodology analysis etc. 2.5.1 Data Collection: The primary data sources for this dissertation will be secondary sources such as peer-reviewed journals, academic books, and reports. These sources will be used to

20 mortality and morbidity, as well as decreased physical growth and development. The psychological effects include increased anxiety, depression, and stress. The economic effects include increased poverty and decreased education and employment opportunities. In conclusion, it is clear that HIV/AIDS has had a major impact on the lives of children in Uganda, Nigeria, and Eswatini, and that further research should be conducted to better understand the impacts and develop programs to mitigate them. Research Strategy: The research had basically taken articles from Google Scholar and JSTOR. Why only these search engines , this is not a systematic review the articles were searched for the ones that talk about please use academic terms the increase of HIV Aids among the children in Uganda, Eswatini, and Nigeria. The narrowed articles were used as a part of this literature review. This needs to be in much more detail. How many articles, Boolean operators etc- please read about how to undertake a literature review in detail. Then how many have you actually reviewed? What were they quantitative or qualitative. Did you use CASP to quality review etc? 3.1 So is this the findings chapter? Impact of HIV on children of developing countries are these your themes? Research on the impact of HIV among children in of developing countries showed the significance of the problem ( Collier et al., 2019) . Where was the study undertaken? The quantitative study research focused on the parents or adults to keep track of the Virus. Along with seeking the presence of the Virus among adults' bodies, the researchers observed the public health in the community. Thereby, the research followed the systematic review ??? to understand how the presence of HIV in the adult body is impacting children. Thereby, Collier et al. (2019) stated the need for more screening and HIV vaccines to prevent the transmission into the infants' bodies. In addition, the study of Collier et al. (2019) compared the significance of the general counseling method among the community. Thus, the study concluded that people of developing countries need thorough counseling on public health and vaccines to stop the transmission of HIV among children's bodies. Schmitz et al. (2019) agrees with the recommendation of Collier et al. (2019) and states the need for public health counseling and vaccines to reduce the impact of HIV. Schmitz et al. (2019 ) ) in his qualitative study studied followed the societies what societies? of Uganda to know the

21 impact of the Virus in Ugandan society and . t T he primary focus of the study was on the children whereby he and Schmitz et al. (2019) observed HIV among adults to measure the transmission rate. The statistical analysis demonstrated that 800,000 people died due to HIV-related diseases, making children orphans. The increase of orphan rate decreased the children's education rate, health rate, and increased mortality. Schmitz et al. (2019) stated that the government should allow more budgets to develop screening and vaccination programs. On the other hand, Shiau et al. (2018) conducted a quantitative study and observed th e e women of the 21 to 35 years age group whereby t . T he interview process had been applied to know the impact of HIV. The data from WHO, National Health Departments, and United Nations helped compile the global information (Armstrong et al., 2018). The qualitative study research compared Antiretroviral antiretroviral treatment to prevent transmissio n and n. Thereby, the study concluded that ARVs to women during pregnancy and breastfeeding could reduce the impact on children. Armstrong et al. (2018) supports and contradicts the view of Shiau et al. (2018) and states the need for public awareness. Armstrong et al. (2018) observed the adults of developing societies. The direct interview and health department data collection process constructed a practical quantitative research design. The study showed that people have no access to ARVs. Significantly, in developing countries, access to medicine has rapidly declined. So, the women are not preventing the transmission and t . T hus, Armstrong et al. (2018) recommended the social awareness program should be more, and the government should increase access to Antiretroviral medicines to prevent HIV transmission. You need to proof read the above and make sure it flows and makes sense. In particular you need to discuss whether the studies were qualitative or quantitative , how many participants etc and apply this for all sections 3.1 The impact of HIV on the African population 3.1.1 Children in the modern era are born without knowing that AIDS is rare who says this where is your evidence . The worldwide view shows that one child dies globally every minute due to AIDS-related diseases. 2.3 million people have AIDS globally. Fifteen million children are orphaned. The scenario is worse in Sub-Saharan Africa. Twelve million among global 15 million orphans due to HIV attack belong to the African region ( Kwenti, 2018) . Uganda, Nigeria, and Eswatini are at the forefront of the disaster. The children of the mentioned countries receive low-quality public services and support. According to the data, less than 10% get health care for their illness (Doat et al., 2019) . Poverty and lack of education are two major contributors to the raised impact of HIV. A deep look at the specific country scenario would reveal the

22 level of impact. Is this part of your findings or does this belong in the introduction chapter 3.1.2 Nigeria The Nigerian scenario captured by David et al. (2018) research states that more than 47 children and adolescents die every day in the country. The research was a quantitative study which comprised a sample size of 400. The study investigates the prevalence and impact of sickle cell trait on HIV-infected children in Lagos, Nigeria. The study uses laboratory tests and clinical data to measure the prevalence of sickle cell trait and its impact on HIV-infected children. The findings of the study suggest that sickle cell trait is more prevalent among HIV-infected children than in the general population, and that it has an adverse effect on their clinical and laboratory parameters ( David et al., 2018) . The study also found that there is a need for further research to better understand the relationship between sickle cell trait and HIV infection , and to develop better treatments for both conditions. The study explained that hemoglobin s (Hbs) has a significant contribution to the mortality of children . The study marked earlier research which failed to address the impact of HIV in relation to hemoglobin what study? . So, the cross-sectional design and blood sample collection of children design performed to get a way of the problem. Needs rewriting The study followed the children what children, how many? of the HIV treatment center in Lagos, Nigeria, and observed the clinical characteristics. The collected data showed that HIV-infected children get into more problems with the assistance of Hemoglobin S. However, David et al. (2018) recommends further clarification on the subject. Mukhtar-Yola et al. (2018) reported that access to Antiretroviral treatment plays a significant role in thousands of child mortality. The report states that Nigeria has only 35% of access to ARVs. While South Asia has 91%, the Middle East and North Africa have 73% of access to the treatment and remedy, Nigeria and some other West and Central African regions struggle to increase access. Mukhtar-Yola et al. (2018) noted poor health infrastructure is a primary cause of child mortality in the Sub- Saharan African region. The qualitative research design collected data from UNICEF, WHO, and peer-reviewed journals to draw the conclusion. 3.1.3 Uganda Tumwine et al. (2018) reported that 11 of1.6 million Ugandans are below 15 who live with HIV. The report takes quality data from UNICEF, The Uganda AIDS Commission, and UNAIDS . The qualitative study design indicated that despite increased mindfulness about

23 the HIV epidemic, there are more lags to cover up this does not make sense . This study evaluated the effects of exclusive breastfeeding promotion on neuropsychological outcomes in 5-8 year old children from Uganda and Burkina Faso. It was a quantitative study with 568 children participating in the The trial. The primary factor is the mama do you mean mother of children transmission. The Uganda AIDS Commission aimed at reaching 50 per matter to children transmission (MTCT) rate. Explain what you mean by this Yet, the country is in 466 per MTCT rate now. So, the The study observed the rate of HIV among women progressed between 15-49 times. The high rate of the actuality of the Virus among youthful and adult women caused the high transmission rate. Boivin et al. (2019) agrees with Tumwine et al. (2018) and states that Uganda has a significant difference among African between countries what countries? . HIV continues to impact women four times further than boys. Boivin et al. (2019) collected data from each country and performed the qualitative methodology to conclude . The study concluded that only 30 of the affected girls go through webbing what is this? . Thereby . This study was a quantitative investigation into the effects of antepartum and postpartum antiretroviral exposure on HIV-exposed and uninfected children compared to HIV-unexposed and uninfected children in Uganda and Malawi. The study included 1,402 participants and was conducted over a 10-year period. The researchers used a prospective cohort design to evaluate the neurodevelopmental outcomes of these children. , T t he Virus has disproportionately spread throughout the countries according to the study. . Lack of webbing made the elimination of MTCT more delicate. This is really ha rd to make sense of, you need to ensure you explain clearly all terms used and present the key findings from the research under discussion. 3.1.4 Eswatini Chipanta et al. (2021) studied the impact of HIV/AIDS on the adults of Eswatini. T he process was to observe the impact on children, so the researcher found the existence of the Virus among adults. This study was a quantitative study conducted in four sub-Saharan African countries (Eswatini, Malawi, Tanzania, and Zambia) examining access to social protection among people living with, at risk of, or affected by HIV. The study used data from Population-Based HIV Impact Assessments in each country to compare access to social protection among people living with HIV and those not living with HIV whereby it included a sample of over 14,000 participants. Eswatini,

24 however, had a better economic and social position compared Malawi, Tanzania, and Zambia to who? u . The problem is the downfall of socioeconomic conditions from 2017. The study used a qualitative design to follow the change of social and economic conditions that increased the impact of HIV. Chipanta et al., (2021) The researcher pointed out use name as above that poverty increased in the country due to drought and . t T he increased rate of poverty created inequality in the s s ociety of Eswatini. Therefore, people, especially women, faced challenges to maintain good health . According to the study, women are faced with challenges to maintain good health due to a number of factors, such as lack of education, financial insecurity, gender inequality, and cultural norms. Women often have limited access to healthcare and social protection due to gender-based discrimination and lack of financial resources, which can result in poor health outcomes. Furthermore, women may not be as likely to seek treatment for HIV due to social stigma, which can result in worse health outcomes. Furthermore, women may not have access to the same resources and support for HIV prevention, treatment, and care that men may have access to, furthering the challenge of maintaining good why were women more challenged? . Chipanta health. Chipanta et al. (2021) state that HIV is the leading cause of death in the country and . Multiple factors have contributed to the problem. Multiple sexual partners is one of the factors contributing to this problem are a habit of the country rephrase , which plays a primary role in raising HIV among adults. Another reason for the problem is that Is it that they have more partners without the use of condoms more than multiple partners? The the awareness of protection during intimate relationships is less leading to more people contracting HIV/AIDS in the country , which is the second reason . In addition, commercial sex what do you mean by this term? Is this what the research found? is a vast and another factor most important factor behind HIV /AIDS where individuals engage in sexual practices to earn money . The poverty and economic downfall forced women to engage in sexuality to earn money and t . T herefore, women are five times more likely to acquire HIV than men. The situation causes around 45,000 children to be orphans every year whereby most of their parents die because of HIV leaving the children as orphans . How what is the connection between the sex trade and children, be explicit So, Chipanta et al. (2021) concluded that socioeconomic downfall affects many children of Eswatini each year. Belle & Gamedze (2019) supported the outcome of Chipanta et al. (2021) and stated the behavioral factors as the primary contributor to the rise of HIV whereby the . The research followed qualitative data methodology and randomly collected data through questionnaires. The target population was female youth whereby how many? . Many many of them are single

25 but sexually active. The data demonstrated 97% of respondents are known to the HIV virus diseases and the ir causes. what disea ses Yet causes. , they are involved in the early sexual debut, what do you mean by this, what age does the literature refer to? inconsistent Inconsistent use of condoms, and causal casual sex was another factor which contributed to the increase of the HIV prevalence in the country . Thereby, the researchers concluded that the mentioned behavior of the women of Eswatini made HIV prevalent whereby they continue to infect the men they engage in sexual behaviors with enhancing the fast spread of the virus among the people in the country . What about the men they are engaging with? Belle & Gamedze (2019) stated that despite people's awareness, the practiced behavior played a vital role in the ris ing ers ? of the disease in among the country. The traditional belief and casual approach to the disease upheld the existing behavior. So, the behavior hence the research ers suggested actions to change the thought and behavior to protect the wom e a n and the children. The suggested actions include; educating young women on HIV/AIDS prevention, risk factors and transmission pathways. Another action was encouraging open discussion on HIV/AIDS and providing supportive environments for young women to address their concerns. Promoting the use of condoms and other forms of contraception to prevent transmission of HIV/AIDS was another suggestion according to the study . In addition, it was suggested that young women should be supported in taking steps to reduce their risk of contracting HIV/AIDS, such as reducing their number of sexual partners. Additionally, Encouraging young women to get tested for HIV/AIDS regularly and providing them with access to prevention and treatment services is another way of protecting them and their children . Providing information and support to young women who are already living with HIV/AIDS is a way of protecting them from the effects of HIV . Working to remove stigma and discrimination surrounding HIV/AIDS should be practiced to reduce the impacts of HIV on children . Again, raising awareness on gender-based violence and the ways in which it can increase the risk of HIV/AIDS transmission is another action to be taken . Increasing access to economic opportunities for young women to reduce their vulnerability to HIV/AIDS and finally creating public health campaigns to educate the community about HIV/AIDS and its prevention should be practiced in the country. What were this actions, you need to detail them

26 3.2 The impact of HIV/AIDS on children on children Hence, the The literature review has summarized seventy studies many studies how many you must be explicit. that showed the impact of HIV on the African population. Adults are discussed as the primary affected by of the Virus and . Children c o a me s at the secondary position of the impact of the Virus. Needs rewording The literature reviewed suggests that researchers explained that adults, especially women, are affected by the Virus . , which results in the death of women and makes the children orphan s . So where are the dads?? Yet, T t he literature review has established that HIV is one of the leading viruses of the Sub-Saharan African region's mortality. Overall, HIV/AIDS has had a significant impact on children in sub-Saharan Africa, particularly in Uganda, Nigeria, and Eswatini. The evidence suggests that HIV/AIDS has been associated with decreased life expectancy, increased mortality rates, increased poverty, and increased vulnerability to exploitation and abuse. It has also been linked to decreased educational outcomes, an increase in orphans and child-headed households, and an increase in malnutrition and food insecurity. Furthermore, HIV/AIDS has caused a decrease in the number of caregivers available to support children, resulting in increased levels of psychosocial distress, increased levels of stigma and discrimination, and increased levels of psychological distress. This review highlights the need for interventions that focus on reducing the impact of HIV/AIDS on children, including access to basic services, improved access to treatment, and improved access to education. Now, the research review would look keenly at the impacts of HIV on children. The type of impact (direct and indirect), frequency, and factors will also be discussed . hereafter. Reword. . this review is too fragmented you need to discuss the literature for adults and children together rather than separating like you have done here. 3.2.1 The type of impact The in-depth view what indepth view?? What are you referring to? on the The impact s of HIV on in children in of Nigeria, Uganda, and Eswatini showed a two-dimensional trajectory. The direct impact means the Virus directly infects children from their mothers . Mother to Child Transmission (MTCT) during pregnancy and breastfeeding is a primary cause behind the entry of the Virus into children's bodies ( Coetzee et al., 2019). reference needed . The age between of 0-5 is at the first line attack of MTCT. The indirect impact is the increased rate of orphans due to the death of one or both parents as a result of HIV and AIDS. . The indirect impact is more expansive and leads to a hopeless future. Please avoid subjective language

27 3.2.1.1 Direct impact Ahmed & Lemma (2019) studied HIV-infected children in the Sub-Saharan African region. The research followed p a ediatric pediatric please ensure your computer is on English not American spelling and change throughout as there are numero us incorrect spellings . clinic data till the mortality as an endpoint of the case. The study observed the cause of infection, access to treatment, awareness of the existence of the diseases, and consequences of the disease . Ahmed & Lemma (2019) stated that nearly 1.85 million children from Sub-Saharan Africa are directly affected by the disease and . Most of the children are below the age of 5 years . The primary factors are MTCT through and breastfeeding where . Many children from poor communities do not receive regular ART. Lack of screening is the second factor that keeps children and their caregivers unaware of the situation and . Thereby, Ahmed & Lemma (2019) concluded that nearly 9% of children had left the HIV care, 16% had lost the follow- up, and 10% reported dead. This is because they conducted a systematic review and meta-analysis of existing studies on mortality among pediatric patients on HIV treatment in sub-Saharan African countries and the results of their analysis showed that overall mortality was high among HIV-infected children receiving antiretroviral therapy (ART) in the region. This suggests that there is still a need for improved access to and retention in care for these children. Furthermore, their findings highlight the need for improved monitoring and evaluation of HIV-related mortality in order to reduce the mortality burden in this population The study also stated that the statistical report isn't strong. why explain The chance has an implicit reason for the increase. Due to the low, thick child care program, this does not make sense? the children couldn't be tracked . Mavundla et al. (2022) explained a different point of view from Ahmed & Lemma (2019) and spotted suggesting child marriage as a significant reason contributing to the rise of HIV prevalence . The study observed teenage girls , . The age is around 14 to 18 years and . The study explained that many communities have child marriage conception in Sub- Saharan African regions. The girls from 13 you say 14 above, which is 14 it the age of 14 to ? t o 18 years are forced to get married or engaged with a sex partner. The result is sexual violence among girls and . Mavundla et al. (2022) reported that girls under 18 are more forced to have sex do what? by their husbands or male partners than girls who get married after 18. The partners or husbands rarely use protection during intimate relationships with below 18 years girls, and violence or force is a common practice. Thus, Mavundla et al. (2022) claimed that direct transmission of HIV is a s a result of early marriage or union. The child's mother bec o a me s the carrier and transmitted the Virus to the ir child . ren. In addition, the study reported nearly 1.1 million children between the ages of 0 to 14 years to have contracted HIV /AIDS .

28 3.2.1.2 Indirect impacts Around 13.7 million orphans caused by AIDS-related deaths of their parents live in Sub- Saharan Africa. Haas et al. (2018) observed Nigeria, Uganda, and Eswatini. The study design followed data from the AIDS orphan association, pediatric clinic, and rural households. The qualitative methodology provided a decisive view on the impact of HIV in children. Haas et al. (2018) stated that around 13.7 million children had lost their parents or parent for AIDS-related diseases. The children live in AIDS orphan centers, streets, or relatives care. Yet, most of the children are not taken care of properly. Thereby, the children fall into an unknown future and die between 0 to 19 ref needd . Blevins & Kawata (2021), by agreeing with Haas et al. (2018), stated that more than half of the globally HIV-affected children live in Nigeria, Uganda, Eswatini, and other Sub-Saharan African countries are what, this sentence is not complete . The children of the rural communities have to take care of their parents and young siblings. Data collection and fieldwork helped Blevins & Kawata (2021) capture the African region's detailed scenario. Blevins & Kawata (2021) stated that nearly 54% of worldwide affected children live in the mentioned region who have to take care of their parents and young sisters and brothers. After the death of their parents, unless the relatives do not take the child, they are on their own. Many children live in the streets and die in the streets. Blevins & Kawata (2021) concluded that HIV prevention programs had been implemented in the region, but the programs have not reduced the impact as expected. According to the report, nearly 800,000 new viruses impacted the region in 2018. Thus, Haas et al. (2018) and Blevins & Kawata (2021 ) revealed the strange being what does this mean? and death in the streets of AIDS orphans in Nigeria, Uganda, Eswatini, and other Sub-Saharan African countries. 3.2.2 Frequency Anderson (2018) observed the children of the Sub-Saharan African region. The comprehensive data collection method from clinical treatments and peer-reviewed literature has been observed to draw opinions. The study created two variables to follow how frequently HIV impacts the region's children. The first variable is gender, and the second is age (0 to 10 and 11 to 19). Anderson (2018) reported that females acquire HIV four times more than males. In 2018, 1.6 million girls aged between 11 and 19 had HIV and 660,000 boys had the disease. The study stated that the number of affected women is double that of men in the entire region. However, the in-depth view on specific communities has a difference of more than double. The children between 0 to 10 do not show much difference in number. The disparity becomes more in the age group of 11 to 19. Thereby, Anderson

29 (2018) concluded that early marriage and sex work forced women into sexual violence and multiple sexual partners, which caused the cumulative infection. 3.2.3 Factors Yah & Tambo (2019) found MTCT is a significant factor in increasing HIV-infected children. The early marriage and intimate relationship, sexual violence on teenage girls, and sex work for earning are the primary cause found by the study. The result of the mentioned practice led teenage girls to AIDS. The early premature mothers with HIV infection transmit the Virus to the children, which causes increased HIV infection among newborns. The study concluded that teenage girls belonging to the 11 to 19 years of age are directly affected by the social structure. The transmission of the Virus through the girls adds up to the cumulative mortality of infants and newborns (Yah & Tambo 2019). Green et al. (2020) stated lack of un awareness played a significant role in increasing the Virus. Nigeria, Uganda, and Eswatini are three developing countries. However, Eswatini has covered the poverty crisis a lot. Yet, still, the societies have differences. This does not make sense The unequal social structure led to increased unawareness about the presence of HIV in the human body. Green et al. (2020) performed a data collection method on teenage girls and children. The study conducted government programs' effect on the society as well. Thereby, the researcher concluded that people of rural communities of Nigeria, Uganda, and Eswatini are out of the screening process and remedies why expand . The lack of testing and treatment played a significant role in the rise of HIV among children. Olakunde et al. (2019), by contradicting Yah & Tambo (2019) and Green et al. (2020), observed 368 children under ART what is this in full therapy. The aim is to know the impact of the therapy on children of developing countries. The research followed children under the therapy for 12 months. There were two variables early mortality (before six months of follow- up) and late mortality (after six months). The results showed the EM rate is 17.3 per 100 children and the LM rate is 3 per 100 children. The research was done on patients of 0 to 15 years of age. The results concluded that infected individuals are at high risk at the pretreatment stage for the viral load. 3.3 Research Gap The systematic review spotted ??? the peer-reviewed research on the impact of HIV in children of Nigeria, Uganda, and Eswatini. The section highlighted the scenario of three countries, akin to other countries of the Sub-Saharan African region. The literature review identified the primary affected factors, type of impact, and frequency in each country mentioned. The increased rate of HIV and unawareness among rural communities are

30 spotted. ?? Most of the research has elucidated MTCT as the primary contributor to the increase of HIV. However, this systematic review identified the lack of statistical explanation of the earlier literature. Thereby, the section leads the significance of this quantitative and qualitative research. I do not know what you are trying to say here 4 Research Methodology this is in the wrong place and needs to be before the review itself This chapter would highlight s the philosophical stance of the research. In any kind of research, evidence is very important. Martinic et al. (2019) states that research became valuable based on the authenticity of the data, facts, and examples. Systematic reviews are the simple process of bringing many studies together to see what has been researched. Gathering process of studies is called research mapping. There is another perspective that summarises many studies to answer the research question that is called research synthesis. PICO and SPIDER are two main tools used to conduct a systematic review. PICO observes research in four divisions, Patients, Intervention, Comparison, and Outcome. SPIDER is the Sample, Phenomenon of Interest, Design, Evaluation, and Research type (Eriksen & Frandsen 2018). Thereby, the earlier studies have been mapped and synthesised. So where have you applie d PICO or SPIDER detail what you did and the words used. The formation of literature review chapters is constructed on the critical appraisal type. In health-related research critical appraisal and research is very important to decide the intervention of the people in pain . why are you discussing pain? So, the methodology chapter of understanding the impact of HIV on children of Uganda, Nigeria, and Eswatini would identify the philosophical stance to assure the authenticity and effectiveness of the study. There are two types of methodologies used in systematic review, qualitative and quantitative (Guetterman & Fetters 2018). Siddaway et al. (2019) stated that qualitative research has evolved later from numeric data collection methods. Qualitative method tries to find the meaning and interpretation of the outcome. This chapter would discuss both types of methodology and justify the reason for choosing one. Research paradigm is the direct philosophical discussion. In four divisions, Positivism, Anti Positivism, Realism, and Pragmatism, the paradigm section would express the cause of the choice. In addition, Ontology, Epistemology, and Axiology would demonstrate the study’s relation to the truth, nature of truth, and value. Thereby, the chapter would elucidate justification of the choices of authentic and ethical methods. Please re read the differences between quantitative and qualitative research and write this section more clearly.

31 4.1 Methodology The methodology of a systematic literature review for health-related exploration motifs ? is veritably important. Stiglic & Viner (2019) states that experimenters try to use effective substantiation when working with people in pain. According to the study, health related motifs need to go beyond bare data collection styles. How people come to the pain point, how they witness the pain, and what they suppose about the unborn possibilities are veritably useful aspects to consider. Nothing to do with your lit review? Understanding the demography is veritably vital for intervention. Thereby, a systematic literature review can find the elaboration of the pain and range of effect (Mehta & Pandit, 2018). This exploration ?? Do you mean systematic review? shall produce the impact of HIV on children of Uganda, Nigeria, and Eswatini. So, the study would need some further than bare data collection styles . I do not understand what you are trying to say here Baumgartner & Thiem, (2020) explained two well- known processes of systematic literature reviews, quantitative and qualitative. The comparison of two data collection processes would help to know about the extensively used methodologies. In addition, the significance of each methodology in exploration work would pop up from the relative exploration. Thus, choosing the stylish system according to the exploration type would be easier. Quantitative is the data collection process, which leads experimenters to collect as important as possible. The scholars must find authentic spots, case studies, clinical trials, and literature to gather the numeric data on the content whereas qualitative is beyond the bare data collection. The qualitative methodology suggests experimenters to find earlier literature on the content. Mehta & Pandit (2018) by agreeing with Baumgartner & Thiem (2020) states that the overview or review of the former studies would be summarized to produce the earlier conclusion. Thus, the study can lead to an opinion. Face-to- face interviews and observing several clinical trials are two other processes that lead the scholars to observe how the earlier studies had been conducted. Therefore, the qualitative methodology leads to digging deep into the process of the study to understand the success point and the limitations. The process would help to reach at the source of the problem. In addition, the qualitative methodology would help experimenters to know whether the earlier studies could produce real data and numeric data or not. Please rewrite and give a clear explanation of both paradigms Justification for choosing the qualitative methodology is all of you literature qualitative?

32 This research aims at answering the impact ?? Considering the impact of HIV on children of Uganda, Nigeria and Eswatini, the percentage of impact on children and adolescents, the factors of the disease, screening range, and government’s intervention policies. The questions did not demand data. Explain more fully The data collection would not help to understand the deep route of HIV in the focused countries. Why expand The country's socioeconomic condition, demography, lifestyle, habits, and tendency are equally significant aspects to know the start and rise of HIV. The qualitative methodology would allow this study to look at several aspects of HIV in the countries. For example, one of the studies captured in the literature review chapter, explained that Mother to child transmission or MTCT is a major factor of growing numbers of HIV among children (Yah & Tambo 2019). So, the quantitative methodology would not allow the study to cultivate the factor. why it could measure the transmission? The point is to find the impact of a virus that is growing like an epidemic and taking many people’s lives in the mentioned countries . So, it is important to find the deep route of the factors and other aspects to prevent the disease. The qualitative methodology is more effective to understand how the disease came into its present state and how it causes pain. Thereby, the most penetrating intervention plan can be recommended. Please make sure you proof read before submission, your writing is very hard to follow. Please read as many systematic reviews as you can to understand how you should be formulating your chapters. 3.2 Paradigm Research paradigm is the philosophy of the research that guides the framework. Philosophy is very important for any research work says who reference? . This systematic review work aims to highlight at disclosing the facts of the impact of HIV on children of three developing African countries. So, the philosophical stance is vital for discussing the soft issue I have no idea what you mean by this . Clear understanding of the philosophy would lead to the ideal way to reach the conclusion. The paradigm includes the process of investigation, analysis, and conclusion. In other words, how the study collected the data, analysed, and reached its conclusion belongs to the paradigm ( Martinic, et al. 2019). The logical representation based on the events and the calculation must be constructed upon a suitable philosophy. The parameter of deciding the most suitable stance depends on the outcome and effectiveness. this is very hard to follow and again no references In other words, how much the philosophical stance is effective for the outcomes would fix the level of suitability. Four elements of the research paradigm are widely accepted, positivism, anti positivism, realism, and pragmatism. Davies & Fisher (2018) explained

33 the four elements of the research paradigm in a comparative format. The study produced examples on each paradigm and demonstrated the effectiveness according to the type of research. The study explained that positivism is a systematic process of examining the research problems on mathematical principle. The aim of positivism is to derive the positive facts mathematically. Anti Positivism is the extension of positivism, which deals with the sociological aspects. The paradigm examines variations and describes each element in the proper way. The aim is to derive positive facts based on wide mathematical calculation. Realism or Naturalism is the other type of paradigm used by many studies, especially health related research. The paradigm focuses on observing facts as they are in nature. The aim is to produce the true scenario without any fabrication. make sure this is all in your own words otherwise you will breach the AI policy Pragmatism is another widely accepted research paradigm. Many scholars have used pragmatism, because of its ability to deal with the complexity between social aspects and logical deduction. Sociological research and few health researchers have used the paradigm to understand the matters politically. Mitchell (2018) states that the four elements of research paradigm have widely discussed but most of the research either follow naturalism or positivism. According to the study, inter positivism and pragmatism can be easily merged with positivism. It is hard to distinguish between the three elements, because those have similar aims. The spirit of anti positivism, pragmatism, and positivism are the same. So, there are two separate paradigms, naturalism, and positivism. Positivism examines the aspects and derives the positive facts based on mathematical logic. Naturalism examines the facts and events and depicts all the elements. Naturalism focuses on eliminating any kind of artificiality and producing the exact facts and events. Thereby, Mitchell, (2018) stated that health related issues that focus on exploring the people’s pain must rely on finding and describing the exact facts.

34 Figure 1: Research Paradigm (Source: Bauer, 2017) Justification for choosing Naturalism This research shall aim at finding the impact reword of HIV on children of Uganda, Nigeria, and Eswatini. So, the study must describe the true events and facts on the issue. Naturalism paradigm refers to finding the data of several aspects and describing them in a true manner. Any kind of fabrication or artificiality is denied by the stance (Weber, et al. 2018). The paradigm does not use any methods to derive the positive or negative effects from the research. The aim of this research is to observe how HIV is impacting the life of the children. Whether HIV impact has a low trajectory or n up, ??/ must be demonstrated exactly. So, there is no need to find the complexity in the issue. I have no idea what you mean by this? The simple requirement from the research is to observe the level of impact to reach the range of pain again you make reference to pain, this is not the title of your literature review?? among children. In case HIV has low impact, then the research must show the declined impact. Otherwise, the upward trajectory should be mentioned. Therefore, true depiction of the facts and events are necessary for perfect recommendation. this makes no sense at all. All you need to do is justify why you consider naturalism appropriate ie to gain rich data 3.3 Ontology Research philosophies Positivism Interpositiv sm Realism Pragmatis m

35 Ontological position defines the researchers’ relationship with the reality of the study. In other words, ontology refers to the nature of reality of the study reference . The term is not newly invented. Kamal (2019) states that ontology is a philosophical term that has a broad historical background. The cultivation should start from at least the Aristotelian period. The father of philosophy proposed ontology to observe what exists. There are two major types in ontology, objective and constructed. The way researchers think that reality should be independent of the earlier knowledge is the objective position. The stance allows researchers to go beyond the existing realities and establish a new theory based on logic. The constructed reality is based on the existing knowledge. In constructed reality researchers review earlier findings and reveal a new answer (Sanfilippo, 2018). Hathcoat et al. 2019 states that Ontology is the study based on the nature of existence and structure of reality. The aim of the stance is ‘being’ and the consideration is, ‘what is.’ Ontology generates the researchers to assess what exists in the world and what is possible. (Al-Ababneh, 2020) defines ontology is a concept of determining existence and relationship between various aspects of society. The social actors, cultural norms, and social structures are the aspects to assess the relationship. So, the ontological methodology questions the existence from different aspects to establish the reality. (Hathcoat, et al. 2019) and (Al-Ababneh, 2020) agrees that ontology has two aspects, one is to assess what exists and second is assessing relationship between what exists and what is possible. (Guyon, et al. 2018) introduced a new term, ‘social ontology.’ According to the study, ontology is a philosophical stance that considers the nature of reality in the social entities. There are two perspectives. One way is based upon existing reality that is established earlier. Individual actors made the reality according to their perception and interpretation. In other words, the research conclusion based on earlier knowledge is the constructed reality. Other way leads to establish individual perception and interpretation on the social entity. In other word, this is the objective stance. So how does this relate to your study, you must explain the ontological fit. 3.3.1 Objective nature of reality Advantage Objective ontological stance allows researchers to question the existing reality, which leads to the primary benefit of it. The researcher can create a new theory that can lead to a better outcome (Kamal, 2019). For example, the research on Impact of HIV among children of three developing countries of Africa has many earlier findings. According to, X the existing intervention plans have declined the range of impact. Yet, if the research can initiate a

36 process that would erase HIV from the countries, then that would help the people in pain. please take out There is scope in the objective stance to go beyond the existing reality. so again there is no relation to your literature review here Disadvantage The tendency of questioning the existing reality leads the stance towards the drawback . makes no sense The new theory might not show an effective way to the solution. So, the research can turn into a total waste of time please use academic terms do you mean the research would be fruitless or unethical (Bakker, 2019). The theories based on theories would need peer review. So, the time and cost would increase. Moreover, there is a possibility of not reaching any fruitful position. I do not think any of the above is needed you just need to be clear what you have done for your literature review. 3.3.2 Constructed nature of reality Advantage The constructed reality is based on observing the existing findings. So, there is less possibility to produce a hypothetical result. The conclusion would be drawn upon the existing elements, which would help researchers to keenly examine the gaps of the earlier studies. Thereby, the research can lead to a better way to fill the gap of the earlier findings (Sanfilippo, 2018). The reason of playing a predominant role of the constructed nature of reality is its multi-dimensional approach reference . The way refers to observe subjects from a broader point of view and connect the human cognition with the pursued knowledge reference . The earlier scientific researches followed the impact of object on subject and demonstrate the knowledge gained from examining the peculiarities. On the contrary, the constructive realism refers to add more perspectives to create the scientific rationality. For example, the constructive realism recommends following the socio-cultural values and purposes to gather knowledge (Al-Ababneh, 2020). Thus, the type of reality helps in determining multiple dimensions of a research. So is this applicable to your review? Disadvantage Constructed reality would not allow the researchers to go beyond existing findings. The researcher can fall into the trap where earlier studies fell. Thus, the unsolved matter may remain unsolved. The constructed nature of reality does not allow researchers to observe from a complete hypothetical perspective, which increases the possibility to stay in limitation (Bakker, 2019). Is any of this relevant for your review?

37 Justification for choosing the constructed reality This research aims at answering the range of impact of HIV among children of three developing countries, comparative percentage of impact, the existing screening process, and government intervention policies. Based on the answers, the research it’s a literature review shall lead to an effective procedure to decrease the effect I do not think a lit review does this it enhances knowledge on a particular subject area. . So, the point is to find the gaps from earlier studies and highlight the exact point of failure. ??? Thus, the research can successfully produce a report to express what to do to decrease HIV in Uganda, Nigeria, and Eswatini . This is not the ai m of a litewrature review it can make recommendations The constructed reality would help to look at the real condition of the countries (Sanfilippo, 2018). The objective reality would aim at establishing new facts beyond existing knowledge, which is unnecessary in the context. Instead, the study needs to look at the real condition and produce facts and events without any artificiality. So, the constructed reality shall make a more effective outcome. 3.4 Epistemology Epistemology refers to the theory of knowledge in the sense that it gauges the perception of reality and the truth (Richards, 2003). It involves certain ways of looking at the world and deriving meaning out of it (Crotty, 1998). It concerns itself with the study of knowledge in terms of its origin, nature, and parameters. Researchers examine the justification and rationality of the ‘truth’ or evidence through epistemological foundations. In doing so, epistemology also evaluates the sources of belief and knowledge. Since the concept of ‘knowledge’ has a central bearing in epistemology, the debate and discussion on the various forms of ‘knowing’ is well fleshed out ??? within epistemology (Bengson and Moffett, 2001). Epistemology carries significant weight in the way research is undertaken on the conclusions that are arrived at. As such among the various schools of thought of epistemology such as rationalism, empiricism, pragmatism, feminist epistemology, epistemic relativism, epistemic idealism, for the purpose of the current study of a systematic review of the impact of HIV on children and adolescents in Uganda, Nigeria and Eswatini, the schools of epistemic constructivism and epistemic skepticism were considered. narrowed down on . 3.4.1 Epistemic Constructivism Constructivism is a view in philosophy which considers knowledge as an amalgamation of human constructions (Raskin, 2002), rather than the objectivist discovery of said knowledge through neutral means. Meaning deems to be constructed rather than discovered (Jonassen,

38 1991). Different people might have different constructions or interpretations of the same event or phenomena according to their own worldview. Constructivism builds on new meanings of knowledge by posing open-ended questions which demand a descriptive explanation of the subject’s own ‘truth’. The understanding of the subject bestows meaning on the phenomenon and thus truth is constructed. Unlike in positivist approaches, the researchers also construct meanings out of the explanations of their research participants. so how does this relate to you review Advantage Since constructivism is a reflection of events rather than a factual recall of them, it allows us to better understand the social realities of the subjects being studied. This is important as our study of the impact of HIV in children and adolescents aims to examine how they are impacted by the disease. Disadvantage A major disadvantage of the epistemic constructivist approach is that research devoid of values is impossible. Facts are not distinctly objective in this approach as the researchers happen to become personally engaged and their own values might have a disruptive influence on the findings of the study and thus ruin the sanctity of the research methodology. 3.4.2 Epistemic Skepticism Epistemic skepticism poses the question of the possibility of knowledge, both on general and specific grounds (Klein, 2015). This approach argues that since knowledge should be factual and that our beliefs are not objective, this knowledge is thus not verifiable (Garrett and Barbanell, 1997). Here, knowledge is judged on the basis of a person’s views and their subsequent idea of knowledge. Rather than being a single school of epistemology, skepticism appears as a key element in many different schools of thought in epistemology. Skepticism began in ancient Greece and over the years spread to be practiced among philosophers in India. The most well-known work in skepticism,must be in Rene Descartes’ work, in which he questions all the alleged forms of knowledge or truth (Popkin, 1972). Advantages To validate facts from fiction and to distinguish substance from appearance, a method is needed to maintain the sanctity of research (Montaigne, 1580). It questions the reliability of superfluous evidence, thus turning its attention on objective and verifiable sources of knowledge. This also allows an investigation into our cognitive processes and social factors that lead to particular trends of knowledge formation.

39 Disadvantages In the quest of seeking indisputable knowledge and verifiable truth, skepticism misses out on the experiences and perceptions of human subjects and social actors, around whom the phenomenon of research is most likely to be centered. Absolute skepticism is at the end of the day untenable because almost all knowledge in some way or the other is supposed reference . Justification for choosing Epistemic Constructivism Since the aim of the research is to study the range of impacts of HIV on children and adolescents in Nigeria, Uganda and Eswatini, we need an epistemology needs to that allow s for human factors to be noted, studied, and compared. Now, a A ccording to the skeptical approach human beings’ belief forming functions are heavily colored through the lens of perception and thus inadmissible as reliable sources of data reference . But, in a systematic review that examines HIV patients’ access to diagnostic and screening options, medicines and treatment and subsequent improvement in their health and recovery, the experiences of said patients and the data offered by them is one of the principal bases of qualitative data collection. In addition, since the study aims to identify information gaps, a keyway to do so would be to involve the people who know best about the disease, its exposure, effects, and subsequent vulnerabilities. Hence, constructivism would be the preferred choice while going for undertaking research with this kind of an aim. 3.5 Axiology Axiology refers to the philosophical examination of values, in terms of its nature, scope and types reference . Axiology attempts to include ethics, morality as well as aesthetics in the examination of value reference . Axiological arguments refer to those principles and values which are considered essentially universal, such as beauty, truth, justice etc. Axiology considers the goodness and the worthiness of a phenomenon. Unlike ontology and epistemology, axiology is not used that often. I would disagree where is your justification for this statement But the use of axiology allows good research in so far as it allows the researcher to be impartial and diligent, as well as allows the science to be worthwhile by focusing on the hypothesis and being problem oriented. It further allows the research to examine paradigm influences and guides the objective of the study by focusing on the study aims. Axiology is a more recent avenue in the subject of research methodology. While there are a few axiology’s of major research philosophies, for the purposes of the study of the

40 impact of HIV in children and adolescents in the mentioned countries, two were narrowed down upon, those being, realism and pragmatism. 3.5.1 Realism In the axiology of realism, research is normative in that it is value laden. The research takes into consideration cultural perceptions, social upbringing and socio-economic factors affecting worldviews as well. Hence, these factors heavily affect research findings. However, the researchers try their best to minimize any errors that might occur due to biases and try to remain as objective as can be. Advantage As the effectiveness of research findings are heavily influenced by social and cultural phenomenon, it is important to keep these in mind while formulating the methods of research, while interpreting data and finally while drawing conclusions from the findings. As realism allows and encourages the researcher to do so it is particularly useful especially if the research requires the examination and study of a particular and section of the population. There is a growing consensus on the viability of realism as a method that allows researchers to capture the bigger picture, rather than focusing on distinct phenomenon. Disadvantage However, the realist philosophy might often have difficulty with adjusting social phenomenon and institutions in the framework of research (Albritton 2008). In addition, there may arrive a point that in the pursuit of value-laden data, it compromises on the objectivity and veracity of the data. Critical realists even agree that our senses and perceptions may cause a hindrance in path of arriving at accurate research findings ( Hammersley 1995 ). 3.5.2 Pragmatism In the axiological approach of pragmatism also, value plays an extremely significant role in interpreting the results. In contrast, though the researcher attempts to adopt both the subjective and the objective point of view and tries to achieve a balance as he carries out his research. According to pragmatism, the research aim is the single most important factor when it comes to considering the research philosophy. Pragmatism endorses only those concepts which support action.

41 Advantage Pragmatism can combine both the positivist and constructivist philosophies within the framework of one systematic review to deal with a specific research question. In doing so, there arises the possibility of working on both qualitative and quantitative types of data, which would otherwise be characterized as irreconcilable, hence allowing researchers to look for important points of connection. Disadvantage Pragmatists use whatever blend of methods that they need, to arrive at answers that have already been decided by them beforehand, at the commencement of the research, is the claim of some (Wilson, 2010). They use the methods in such a combination that it advances a specific finding to a specific research question the best possible way. Also, this axiology might be too complicated in that it involves resolving findings from mixed methods which can be unnecessarily time consuming. This can be really summarized down to exactly what axology you have focused on for this literature review.You have stated previously you are using qualitative and constructivist approaches. Justification for choosing Realism The role of axiology is to examine the aim(s) of the research work. It enquires into the research methodology in terms of whether the researcher is simply trying to understand a phenomenon or trying to explain and predict it. As axiology focuses on what is valued in research, which in turn affects how the entire process of research is carried out. As , we who is we ask ourselves these same questions with reference to our this is your literature review research into the impact of HIV on children and adolescents in the specific regions and countries of Nigeria, Uganda and Eswatini it is of extreme importance to have cultural and social factors included in the axiology. For example, while examining the institutional response the epidemic of HIV, the examination of cultural factors might prove important. Similarly, to tackle the problem of risk of exposure to HIV for a certain age group, knowledge of their specific habits, behaviors and perspectives in necessary to bridge the existing research gap, which realism encourages.

42 3.6 chapter Summary The chapter on research methodology delves into the philosophical stance of the research, to assure the authenticity and effectiveness of the study. The methodology of a systematic review for health related research topics is very important, which need to go beyond mere data collection methods; how people come to the pain point, how they experience the pain, irrelevant stick to you r title and what they think about the future possibilities need to be considered, to find the evolution of the pain and range of effect. Among the two types of methodologies used in systematic review, qualitative and quantitative, for the purposes of this specific study the former process would be suitable. Intensive numerical ? data collection would not help to understand the deep route of HIV in the focused countries, whereas socioeconomic conditions, demography, lifestyle and habits are more significant aspects. The qualitative methodology is more effective to understand how the disease came into its present state and how it causes pain , in addition to the review to previous studies resulting in a relevant opinion. The research paradigm which guides the framework of the research, includes the process of investigation, analysis, and conclusion. Thus, health related issues that focus on exploring the people’s pain must rely on finding and describing the exact facts, which is why the paradigm of naturalism is chosen over positivism. This paradigm does not use any methods to derive the positive or negative effects from the research. In addition, Ontology, Epistemology, and Axiology demonstrate the study’s relation to the truth, nature of truth, and value, thereby justifying the choices of authentic and ethical methods. Ontology refers to the nature of reality of the study. Of the two major types in ontology, constructed reality is given preference over objective reality as the study aims to answer the range of impact of HIV among children of three developing countries, comparative percentage of impact, the existing screening process, and government intervention policies. The objective reality would aim at establishing new facts beyond existing knowledge, which is unnecessary in the context. For epistemology, constructivism was opted for, since the aim of the research is to study the range of impacts of HIV on children and adolescents in Nigeria, Uganda and Eswatini, we are in need of an epistemology that allows for human factors to be noted, studied and compared, rather than skepticism which questions this kind of data. In looking for a method of axiology, realism is chosen as it allows us to look at the bigger picture in terms of social and cultural context, as opposed to pragmatism which would be unnecessarily complicated for the purpose of this study. This is a very long chapter summary please shorten and make more succinct

43 4. Methods None of this is relevant to the methods section take out Now a day’s immune deficiencies are a very common disorder. It is occurred when body is unable to produce sufficient amount of insulin. Immune deficiencies causes various illness in our body. These are HIV Aids, nerve damage, kidney damage, eye damage, foot damage, hearing impairment, Alzheimer’s disorder. Two types of immune deficiencies have been distinguished till date. 4.1. Background 3000 thousand years ago a Egyptians mentioned a condition of a patient which may be appear as people of uk and Uganda, Nigeria, and Eswatini area. The symptoms were excessive urination, thirst and weight loss. In ancient time HIV Aids was recognized. The term 'HIV Aids' was mentioned by Apollonius of Memphis in third century BCE. It was discovered later that HIV Aids is caused due to less production of insulin in body. Greek physicians distinguished between HIV Aids insipidus and mellitus. Furthermore, medical scientists described two types of immune deficiencies, type 1 and type 2. In this report we will discuss about infection, and contamination problems as a risk factor of HIV Aids ( Balakumar, Maung & Jagadeesh, 2016 ). 4.2. Research proposal The research proposes to search what are the areas where the infection, and contamination problems are a risk factor of HIV Aids. This is not the title of your literature review be consistent 4.3. Research aims and Objectives make sure these are exactly the same the chapters before This research aims at: a) Critically evaluating the symptoms of infection, and contamination disorder which is occurred due to immune deficiencies type 1. b) Reflect on the path which will help us to detect infection, and contamination problems. c) Investigate and enumerate possible schemes to reduce the infection, and contamination disorder, when patient is already affected by infection, and contamination problems. d) Recommend some measures to alleviate the consequences of infection, and contamination disorder.

44 4.4. Research questions a) What are the symptoms of infection, and contamination disorder which is occurred due to immune deficiencies type 1? b) What are the common paths which will help us to detect infection, and contamination problems? c) What are the possible schemes to reduce the infection, and contamination disorder, when patient is already affected by infection, and contamination problems? d) What are some recommendations which shall help in evading some measures to alleviate the consequences of infection, and contamination disorder? This is all different to page 8 4.5. Research rationale From the above discussion we have come to know about the types of HIV Aids (mellitus and insipidus) and the types of immune deficiencies also (type 1 and type 2). It is also known to us that immune deficiencies is also reason of various disorders like kidney damage, foot damage, eye damage, Alzheimer’s besides infection, and contamination disorder ( Low Wang et al 2016 ). This research shall help the learners to locate the risk factor of infection, and contamination disorder due to infection, and contamination problems. 4.6. Research limitations The research shall not be able to state the way that how the infection, and contamination disorder causes due to infection, and contamination problems can be eradicated. The learners will get to know risk factors as well as the processes to reduce the risk factors of infection, and contamination disorder due to infection, and contamination problems. Still the research shall not be able to state the way that how the infection, and contamination disorder can be eradicated. This should no be here 4.7 Ethical Consideration Plagiarism, figure manipulation, indistinguishable representation, and spare publication. Plagiarism refers to the process of dupe paste from another study or composition. The action reflects that the experimenter didn't or couldn't perceive the reading and dupe- paste the material. This study ensures zero presence of such a notion. Although, many names, scientific terms, expressions, and organization’s

45 names can be analogous. The names, scientific terms, and expressions haven't been replaced for compendiums’ understanding. In addition, the study has not tried to manipulate through numbers and supplements. For illustration, frequently experimenters try to find some cites and sources that demonstrate docket or propaganda grounded data. There are many government-supported cites or governmental cites that try to show progress . This is not related to your study The study has either cross-checked the authenticity by transnational healthcare organization’s websites or plant similarity from several scholarly sources how did you do this? . The study rechecked the numbers what numbers how? . Thereby, the exploration ensures zero presence of manipulative data how . Duplicate representation refers to the process of fake data, data, and claims reference . The experimenter what is an experimentor? either purposely or reluctantly falls into the trap of fake websites. The knowledge about similar possibilities has helped the exploration to stay out of similar traps. What do you mean by this? In addition, the study took information, data, and data from peer reviewed papers, scholarly studies, and public and transnational healthcare organizations. Peer reviewed papers are the inquiries that are checked by numerous other scientists and approved for authenticity reference . A study becomes scholarly after critically appreciated or tested and the public or transnational healthcare organizations are out of electoral politics and liable to promote mortal health I do not understand what you are saying here? (Navalta, etal. 2019). Thus, the mentioned coffers What are you referring to here? give further precious and independent data. Secondly, the study has checked the information to validate its probity. again what do you mesn by this and how is it relevant to your study? Thereby, this exploration could deny the fake cites to add any argument and figure. The value of word doesn't calculate on fake coffers only. Spare publication means the data and claims of the publication are no longer applicable in the ultramodern world or environment. I do not know what you are saying here. For illustration, data from the once century cannot give a stronger lead to find the reason or impact of HIV. The script has changed by the time. The countries have executed numerous intervention programs, which converted the goods. So, in mortal health related subjects most recent numbers are necessary. The once papers and sources can come in case of agitating frame, propositions, principles, or background information. For illustration, the exploration wants to demonstrate a once intervention program to emphasize its positive impact or the exploration wants to bandy a once fact that's connected with the ultramodern line. In similar mentioned issues, the exploration can find some information from earlier decades or ahead. This study claims conscious use of the rearmost publication. Utmost of the coffers are published after 2018. Especially, the numbers and arguments that explained the impact of the complaint, reasons for the complaint, and intervention programs are published after 2018. In addition, the script

46 has not changed till 2022. Therefore, the study has covered several aspects of probity or honesty and declared acceptable consideration of the principle. I am afraid this section does not demonstrate your understanding of ethics applied to literature rev iewing. You need to evidence the ethical considerations you adopted, gaining ethical approval, supervision, demonstrating a clear aud it trail, quality appraisal of articles etc etc. Results thi sis in the wrong place- see template please proof read and put after the review itself Infection, and contamination disorder is one of the major causes of mortality from immune deficiencies. There are innumerable evidence which connote the multifaceted race often extrapolated from HIV Aids. I do not know what you are trying to say here Several types of tests show for HIV Aids patients show symptoms of HIV Aids at a very early age of their life. HIV Aids patients are exposed to risk factors involved with HIV Aids. On aging the prevalence of IMMUNO DEFICIENCIES is pound maximum again makes no sense among the patients who have been diagnosed with People of Uk and Uganda, Nigeria, and Eswatini area ( Katakami, 2017). A search was conducted among various literatures present in this field from 1946 to 2021. Why these dates and this should be in your search strategy section. The statistics proposed by Statistical Institute in Uganda also covered up a major part of the methods which were utilized to formulate this research work do you mean you also utilized this policy document? ( Newman et al 2017). The research took up exploratory methods of data collection what do you mean by this? without eliminating other disorders of circulatory system like coronary artery disorder, heart failure, infarction congenital heart disorder and HIV Aids. The most popular search terms what do you mean by popular, what exact terms did you use? Boolean operato rs etc which were used while doing this research were infection, and contamination disorder. It was narrowed by People of Uganda, Nigeria, and Eswatini area population. Which search engines were used. More than thousand papers were identified, and it was seen that 461 of the papers were duplicate. The Other manuscripts present were screened how what criteria did you use? . Most of the manuscripts were review articles titled manuscripts and conference abstracts. The elimination method was used to remove titles which did not deal with both HIV Aids and People of Uganda, Nigeria, and Eswatini area. The focus of the research department what department? the objective and the articles were analyzed by descriptive methods so that the qualitative and quantitative analysis is achieved so you did a mixed review not qualitative? ( Oberoi et al 2016). Among the common methods of qualitative analysis survey was a very important aspect. The survey what survey are you talking about? was conducted among patients who were diagnosed with HIV Aids and who were also carrying infection, and contamination

47 discrepancies with them. Special questionnaire session was conducted with doctors from various hospitals who treated patients with HIV Aids and People of Uganda, Nigeria, and Eswatini area. The main motive of the methodology used in this research work was to understand the mortality of HIV Aids and the frequency of happening. A close connection was shot out ??? between HIV Aids and People of Uganda, Nigeria, and Eswatini area. In this research the primary research was done among patients and doctors who had been acquiring credibility in treating HIV Aids patients. The data collection ??? The secondary research was mainly done with Peer reviewed journal articles. It has been already mentioned that the Peer reviewed journal articles were narrowed based on title and content. The statistics proposed by the government health department were also used as a very important literature piece to understand how much the HIV Aids can facilitate HIV Aids and what were the rate of infection. In the past the methodology formulated in this research is largely exploratory in nature with a descriptive format of collecting data because of the large-scale expansion in the infection, and contamination disorder among aging population ( Strain & Paldánius, 2018). The study design of this research project was systematic analysis based on qualitative methods. In this meta-analysis , so are you doing a meta analysis using statistical data or a qualitative review the Prisma flow chart put in appendix was used to guide the checklist of studies which were reviewed for the research and also guide this meta-analysis study are you definitely doing a meta analysis if so say in the title and if so why are you doing qua litative research? Please read the resources concerning systematic review and meta analysis carefully . This full information and explanation of full text of potentially relevant study was done by only one investigator who independently assess and gathered all the information of this meta-analysis search. 5.1 Inclusion/Eligibility Criteria. There were some criteria has been done during the selection of the study for this meta- analysis . The criteria were like, if any study has only abstract and title but does not publish full explanation study with fully -data, then this type of articles was not considered. Medical reports, medical letters, case series and only theory-based articles with no data analysis or statistics were not reviewed. Fully articles which included non-randomized control studies which were prospective cohort or retro prospective cohort studies were reviewed in this criterion. Systematic reviews, meta-analysis-studies or reviews, interviews and surveys were also considered in the selection of the study. Then other thing was the a A rticles were should be in the English language . apart from the English no other language should be considered in this

48 meta-analysis . However, some study used the same data or sample patients in their studies, so this duplication type of studies was also not included. However, studies which do not have sufficient information for extraction of data like (number of populations, comparison, and outcome) were excluded. The inclusion criteria consist of a full text study which is focus on the outcome of Infection, and contamination disorder in the INFECTION, AND CONTAMINATION PROBLEMS patients which should published between 2015 to 2021. So this is different to the dates previously presented The article which had control group were considered or reviewed, no control group articles were used in the discussion part. Additionally, the studies which used or prefer the pure tone cardio related testing were considered or reviewed in the inclusion criteria. Moreover, if any studies or articles have the patient who have other type of disorder apart from the INFECTION, AND CONTAMINATION PROBLEMS and already have heart related Infection, and contamination problem then this type of studies were excluded from this criterion. Only this study type of study included whose patient have the status of INFECTION, AND CONTAMINATION PROBLEMS or abnormal hemoglobin or ischemic heart disorder (IHD). The gender restriction was not considered in this criterion. Additionally, the studies which included the any type of chronic transfusion or transplantation, and any type of medication or antibiotic were restricted in the inclusion criteria. Why were these included were there not enough articles on HIV in children??? 5.2. selection of study In this research only full-text articles were included for the meta-analysis For, searching studies and articles some freely electronic databases were used. The electronic databases applied were PUB-MED, EMBASE, MEDLINE and COCHRANCE LIBRARY systematically records up to March 2021 for this meta-analysis. Moreover, to find the right and correct study some hand searching was used by adding some phrase like (AND, OR, between etc.). Some different keywords were applied like ‘’heart related Infection, and contamination and coronary heart disorder’’, ‘’hypertension Infection, and contamination problems in old age populace and HIV Aids”. “immuno deficiencies with coronary heart disorder’’,’’ link between immuno deficiencies and coronary heart disorder’’, ‘immuno deficiencies problem with HIV Aids in old age population”, “living with coronary heart disorder’’, ‘’HIV Aids problem in coronary heart disorder’’, ‘HIV Aids in united states”, “patient with coronary heart disorder’’ in the data collection.

49 Only clinical studies were included in the study selection. The database searches have been matched by the searches of reference from the list of publication which allow to enhance the number of studies in the meta-analysis. The data were extracted from the studies included, total number of patients which conducting the intervention (cardio related testing), patient’s age, In Addition, the type of cardio related testing used and what was its threshold and the primary outcome of testing. this is better but needs to be moved and amalgamated with the sections above. 5.3. Quality assessment. The q Q uality assessment is used to check quality the uncertainty of the selected study and also check how precise and accurate the data in the studies. In this meta-analysis, Quality assessment measured by using the New Castle Ottawa scale this is just for non randomized studies which were showing in the following table1. The prospective cohort study design table were used, and it was reviewed from the study. The maximum scores of quality assessment were (6). If the score in between 0-3 then it has low quality, if the score in between 4-5 then it has appropriate quality and it is between 5-6 then it has high quality ( Schmidt, 2019). you need to add in the appendix one study with this assessment tool completed 5.4. Analysis of Results 5.4.1 overall study analysis In the overall study analysis, there were total 586 patients with coronary heart disorder were examined why are you looking at this, your study is on Children and HIV. (Fig 2 :Forest plot), out of that 174 patients were carried out with IMMUNO DEFICIENCIES or heart related Infection, and contamination problem, on the other side, total 377 people with normal hemoglobin were analyzed, out of that only 25 people were carried out with IMMUNO DEFICIENCIES or heart related Infection, and contamination problem. Fig: 2 Forest plot shows the overall estimate of RR (relative risk) was 4.07% with 95% confidence interval of the (2.12 to 7.83). However, the total I 2 coming out was 47% , indicates there were low heterogeneity present among the studies. The P value of the overall effect was (P<0.0001) which means there were significantly difference between the two groups. In fig 2 forest plot, all the lines were going in the side of the experimental group and black colour diamond which indicated the overall effect size of the studies, was not overlap the CI line, it was totally present on the INFECTION, AND CONTAMINATION PROBLEMS group side. Without the figures

50 this makes little sense and I cannot see how any of this relates to your subject of the impact of HOV on children. 5. Discussion 5.1. HIV Aids disorders increased in people Uganda, Nigeria, and Eswatini area A few cohorts which provide very important epidemiological data of HIV Aids prevalence in Infection, and contamination problems clearly indicate that this problem aggravates the chances of IMMUNO DEFICIENCIES. HIV Aids in stated ?? due to Immuno deficiencies is more common among the old age population. the European prospective of HIV Aids complications and the epidemiology of HIV Aids interventions and complications study mention that if HIV Aids is not controlled then the complications can lead to severe cases of HIV Aids ( Kaul et al 2015 ). What has this to do with your subject and children? The EDC cohort dated 1950 to 1980 reported that incidence of HIV Aids where 36% which means 36 of hundred people having HIV Aids are more prone to have HIV Aids I am unsure what you are saying here? . The baseline in this study was mentioned as 28 in the year 2009 following the median of five years and that changed to 239 in 2010 where have you discussed a baseline, I am completely lost I am afraid. . it was found that 49% of patients diagnosed with Infection, and contamination problems had incidence of HIV Aids in their life. The EDIC study mentions that 80% of people in the present Times prone to HIV Aids due to the prevalence of Infection, and contamination problems. Intensive and conventional HIV Aids treatment group mentions that people more than the age of 50 were the most vulnerable for being diagnosed with Infection, and contamination problems, there on creating problems of HIV Aids. In the last decade additional studies in this sector increased considerably and two of the largest of the vision of studies mention that the general population showed lesser rates of HIV Aids due to People of African Nations of Uganda, Nigeria, and Eswatini area than the older population. The Scottish registry linkage study or SRLS prepare data for infection, and contamination problems patients who are aged 20 and above and they were compared to non-HIV Aids people among the surveys of Scottish national. These studies also mention that women were more prone to type one Immuno deficiencies and HIV Aids than men are. different study which use the research database AND UGANDA, NIGERIA, AND ESWATINI AREA general practice compare the age and sex of Infection, and contamination problems patients and reported that one of the major reasons of HIV Aids in United Kingdom was Infection, and contamination problems and the mean for this study was 3.6 for men and 7.7 for

51 women who are 33 years of age or above and diagnosed with People of African Nations of Uganda, Nigeria, and Eswatini area. None of this has any relation to your literature search concerning children, why is it in here? The SRLS analysis also revealed that the mean age of HIV Aids events was 70 but that decrease in the present Times the large-scale prevalence of HIV Aids among Infection, and contamination problems patients has also been reported in other observational studies among worldwide populace in a cohort where 209 Chinese population were identified with young onset of Infection, and contamination problems in Hong Kong showed that 60% of the Hong Kong population we are prone to HIV Aids and thereby the chances of HIV Aids in this Nation was very high in comparison the Saudi Arabian patients who are also studied develop better chances of HIV Aids due to Infection, and contamination problems. These worldwide studies were largely observational in nature and reported about the different Rangers of Infection, and contamination problems in various Nations. Same again no discussion of the literature you have searched? 5.2. IMMUNO DEFICIENCIES mortality increased in infection, and contamination problems The mortality rate of patients due to HIV Aids was studied and reported it was seen that people diagnosed with Infection, and contamination problems at a larger chance of mortality due to HIV Aids than patients who were not diagnosed with Infection, and contamination problems. A recent study in Switzerland assessed the rate of mortality of patients with Infection, and contamination problems and compares the same to general sweet ?? population who were also patients of HIV Aids it was scene that the chances of mortality due to HIV Aids increase by 66% for Infection, and contaminate on problems patients makes no sense . the Norwegian childhood HIV Aids registry or ncdr compile the data for the childhood onset of Infection, and contamination problems in Norway and reported that 9 out of hundred male geriatric populace and 21 out of hundred female geriatric populace had an earlier onset of HIV Aids which further complicated towards HIV Aids. these studies revealed that HIV Aids happening below the age of 30 and diagnosed with a tertiary problem of Infection, and contamination problems were less in the mortality rate than people diagnosed with the same disorders above the age of 30. HIV Aids where the predominant cause of death among the adults who were diagnosed with Infection, and contamination problems. A multinational cohort conducted by the World Health Organization accountant that people with Infection, and contamination problems were more vulnerable to die due to HIV Aids and the rate was 44%. a similar study in the Danish nationality with 4821 patients diagnosed with

52 Infection, and contamination problems also proved that infection, and contamination disorder Death was facilitated due to People of uk and Uganda, Nigeria, and Eswatini area and 31% of men and 40% female patients died due to the prevalence of People of uk and Uganda, Nigeria, and Eswatini area and HIV Aids. Various studies also prove that acute complications of HIV Aids problems like ketosis and Hypoglycemia also instate death in young patients the HIV Aids are more predominant in the patients who are old. a Japanese nationwide population-based cohort 1385 type 1 HIV Aids patients were surveyed proved that 41% of Japanese populace died due to HIV Aids various studies have proved that circulatory disorders under the age of 40 were mainly happening due to Immuno deficiencies. acute HIV Aids complications have become one of the main causes of death due to HIV Aids within the past 10 years’ diagnosis. 73% of female and 40% of male died due to HIV Aids in Infection, and contamination problems within the first 10 years of the diagnosis. A focus on the ischemic heart disorder also showed that HIV Aids is a killer substance for any kind of infection, and contamination disorder the young women the most valuable having the highest mortality rate across all the age groups in the world female type of HIV Aids patients within the age of 20 to 29 at a mortality rate of 44 % while male HIV Aids patients at the mortality rate of 26%. Another study of Australian nation proved that infection, and contamination problems were highly the causes of death among the general populace. None of this is linked to your subject area. You have not discussed the key findings and made sense of the review you have undertaken Recommendations from your findings ? Limitations of your findings ? 5.3. Conclusion Thus, it can be concluded that the onset and the effect of immuno deficiencies is grave over the disorders of infection, and contamination problems. I do not know what you are trying to say here This study ensured that the infection, and contamination problems are spread all across the world and the discrepancy is aggravated by the advent of mellitus disorder . this makes no sense and why are you now considering diabetes This is an LTC and there is no absolute cure but the problems can be contained. This meta-analysis proves that there is a higher proportion of IMMUNO DEFICIENCIES or HIV Aids and ischemic heart in the Geriatric patient with Infection , your subject is children???? and contamination problems disorder compared to normal people from the different region and the possible reason for these arising issues is the pathophysiology of the HIV AIDS in the patient, and its future direction is to a regular check-up of audiometry

53 testing in Infection, and contamination problems patient mostly in geriatric populace. No link to your study

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