Title: Academic Achievement of Students in Foster Care: Impeded or Improved?

Author(s): Larry Evans

Date: 2004

Abstract: Foster care’s impact on academic development was investigated for 392 students reentering foster care. Psychoeducational evaluation was performed at initial and return placements. Average achievement increased .22 points between placements. Students reentering care did not show differences in achievement or IQ compared to control students with a single placement. Although average achievement showed a small increase between placements, some students showed large changes. Declining achievement was directly related to above-average initial achievement ( p < .001), and indirectly related to not being in special education ( p < .001) and nonminority race ( p < .02). Results provide evidence that overall academic development appears neither enhanced nor hindered by foster care placement, but specific groups may be at risk for poor gains.

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Title: Orphans and schooling in Africa: A longitudinal analysis

Author: David Evans and Edward Miguel

Date: 2007

Abstract: AIDS deaths could have a major impact on economic development by affecting the human capital accumulation of the next generation. We estimate the impact of parent death on primary school participation using an unusual five-year panel data set of over 20,000 Kenyan children. There is a substantial decrease in school participation following a parent death and a smaller drop before the death (presumably due to pre-death morbidity). Estimated impacts are smaller in specifications without individual fixed effects, suggesting that estimates based on cross-sectional data are biased toward zero. Effects are largest for children whose mothers died and, in a novel finding, for those with low baseline academic performance.

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Title: AIDS epidemic and the psychological well-being and school participation of Ethiopian orphans

Author: Bhargava, A.

Date: 2005

Abstract: This paper modeled the proximate determinants of the scores on 60 items from Minnesota Multiphasic Personality Inventory-2 (MMPI) and of school participation of approximately 1,000 children who had lost their mothers due to AIDS and from other causes using the data from a survey in Ethiopia. The scores on MMPI items reflecting emotional and social adjustment, and school participation before and after maternal deaths were modeled in a multi-disciplinary framework incorporating the time sequence of events. The main findings were that while AIDS orphans scored lower on MMPI items, variables such as presence of the father, household income, feeding and clothing conditions, and attitude of the fostering family were significant predictors of children’s scores. Secondly, girls were at a disadvantage in terms of the scores on MMPI items. Third, variables such as income and good feeding and clothing conditions were significant predictors of school participation. Fourth, school participation before maternal death was an important predictor of subsequent school participation probabilities. An ordinal regression model was estimated to address certain methodological problems. Overall, the results indicated that economic subsidies to fostering households would enhance child welfare in Ethiopia.


Citation: Bhargava, A. (2005). “AIDS epidemic and the psychological well-being and school participation of Ethiopian orphans.” Psychology, Health & Medicine 10(3): 263-275.

Title: The impact of the AIDS epidemic on the schooling of orphans and other directly affected children in sub-Saharan Africa

Author: Bennell, P.

Date: 2005

Abstract:  This report examines the three groups of schoolchildren that are directly affected by the AIDS epidemic, namely children who are HIV positive or have AIDS, children who are orphaned by parents or guardians suffering from the disease, and children taking care of sick family members. The impact so far, of the epidemic on the schooling of these children, likely effects on them over the next 10-15 years, and the school-based support and national policies and strategies needed to reduce their education-loss, are discussed.

Citation: Bennell, P. (2005). “The impact of the AIDS epidemic on the schooling of orphans and other directly affected children in sub-Saharan Africa.” Journal of Development Studies 41(3): 467(422).


Study Title: The Impact of Adult Mortality and Parental Deaths on Primary Schooling in North-Western Tanzania

Author(s): Ainsworth, M., K. Beegle, et al.

Date: 2005

Abstract: Mortality of parents and other adults due to the African AIDS epidemic could reduce children’s primary schooling by reducing households’ ability to pay fees, raising the opportunity cost of children’s time, and leaving orphaned children with guardians who care less about their education than would their parents. This study measures the impact of adult deaths and orphan status on primary school attendance and hours spent at school using a panel household survey from north-western Tanzania, an area hard-hit by the AIDS epidemic. Attendance was delayed for maternal orphans and children in poor households with a recent adult death; there was no evidence that children 7-14 dropped out of primary school due to orphan status or adult deaths. However, among children already attending, school hours were significantly lower in the months prior to an adult death in the household and seemed to recover following the death. In addition, girls sharply reduced their hours in school immediately after losing a parent. Improvements in school quality and better access to secondary education would improve outcomes for all children, including those affected by adult AIDS mortality. Beyond that, public policy needs to focus on the special schooling constraints faced by children affected by adult deaths, both in terms of increased opportunity costs of their time and the psychological impacts, with an eye to how they might be mitigated and at what cost.

Ainsworth, M., K. Beegle, et al. (2005). “The Impact of Adult Mortality and Parental Deaths on Primary Schooling in North-Western Tanzania.” Journal of Development Studies 41(3): 412-439.

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Title: Malawi Orphans and Vulnerable Children Evaluation (MOVE) 

Context: Between 700,000 and 1.2 million children in Malawi have been orphaned by AIDS, and many others are vulnerable. The Funders’ Collaborative for Children (FCFC), a novel collaboration between 4 independent funding organizations, is funding an intervention that aims to establish a collaborative, replicable, and sustainable model of prevention, treatment, and care which will result in a “system of care” better able to support children and their families than the currently fragmented organization of agencies and groups.  The program is implemented in Salima District, Malawi, by Family Health International (FHI) in collaboration with XXX implementing partner organizations. Duke University and Malawi’s College of Medicine were contracted to jointly evaluate the effectiveness of the 5-year program. MOVE assesses the impact of the intervention on child outcomes in four domains: health; education; social welfare; and nutrition and livelihood. 

Study Aims: The FCFC intervention aims to improve the lives of 65 percent of vulnerable children in Salima District in terms of their education, health, livelihood, and social welfare. Researchers at Duke University and the College of Medicine will determine if the Funder’s Collaborative for Children achieved its objective.

Methods: The effectiveness of this intervention model is evaluated using qualitative and quantitative monitoring and evaluation methods. Repeated cross-sectional cluster surveys with a total of 1,260 vulnerable children and their caregivers assess district-level intervention coverage and changes in outcomes over time.  Repeat assessments with 200 of these children, half in intervention areas and half in non-intervention areas seek to attribute changes to the program.  Twice-annual surveys with implementing partners assess changes in scale and scope of service delivery.

Policy Implications:

This evaluation will determine if the FCFC intervention is effective in improving the wellbeing of orphans and other vulnerable children in Salima District, Malawi. If the evaluation demonstrates that the intervention is effective, it will help funders and national policymakers design more integrated and more effective care systems for orphans and vulnerable children.

Investigators: Karen O’Donnell (Duke University) Jan Ostermann (Duke University), Eric Umar (College of Medicine, Malawi), Kathryn Whetten (Duke University), Sara Legrand (Duke University)

Funding Source: Funders’ Collaborative for Children (Children’s Investment Fund Foundation, Comic Relief, Elton John AIDS Foundation and the Diana Princess of Wales Memorial Fund)

Contact: duke.ovcstudies@gmail.com

Study Title: Child Status Index (CSI)

Context: In past, programs for orphaned and vulnerable children (OVC) have been evaluated by reporting the numbers of children and the services that they received (outputs.) To measure more appropriately the needs of OVC and the effectiveness of the support these programs provide (outcomes), the President’s Emergency Plan for AIDS Relief (PEPFAR) requested a tool to assess vulnerabilities, needs, and outcomes of OVC. To fill this gap, the Child Status Index was developed to provide a framework for identifying a child’s needs, creating service plans, and assessing intervention outcomes.

Study aims: As it is currently designed, the Child Status Index provides an assessment strategy that addresses the areas of a child’s life that are most indicative of the child’s relative well-being or vulnerability in low- and middle-income countries (LMIC). The CSI was developed based on twelve child centered factors, including food security, growth and nutrition, abuse and exploitation, legal protection, wellness, healthcare services, emotional health, social behavior, performance, and education. These factors are rated on a high inference scale following interviews and specific observations in a home/community visit. Each factor is rated as “good”, “fair,”, “bad”, and “very bad” relative to local norms by community volunteers who work for local organizations and who may have varying degrees of literacy.

Methods: The development of the CSI involved a community participatory process that included community workers, OVC caregivers, and village leaders in Kenya and Tanzania. To derive the domains and the factors that comprise the CSI, researchers conducted a series of informal discussions with community workers, guardians, and other service providers in Kenya and Tanzania. The CSI was then successfully tested to ensure its reliability and validity, and it has been utilized in trials in other countries, such as Ethiopia, Rwanda, India and Cambodia to raise ongoing feedback about its applicability.

Policy Implications:

  • CSI results can be used for targeting children with needs and factors in which those needs appear, not by aggregating total scores, but rather by developing algorithms at a community level, such as: any score in the “very bad” range or more than a pre-specified number of scores in the “bad” range, and so forth. The targeting strategies are developed by community organizations depending on their funding priorities and resources.
  • The CSI is often used in case management for child and households cared for by community based organizations.
  • CSI information, when aggregated by factor, can inform program planning for identified organizations in a defined setting.
  • The CSI can help identify benefits children receive from services, preferably used in conjunction with other outcome measures.

Principal Investigator: Karen O’Donnell (Duke University)

Contact: duke.ovcstudies@gmail.com


Study Title: Cambodia Orphan Project Evaluation

Context: Save the Children Australia has established support services for more than 9,500 children in Cambodia, providing food, health services, educational support, shelter, psychosocial counseling and livelihood training to orphans in need. A unique feature of this program, funded by the Elton John AIDS Foundation, is that services are delivered through monks living in pagodas. Our role is to evaluate the effectiveness of this program.

Study Aims: This study evaluates the monk-led intervention by comparing orphans receiving their services with orphans not receiving any care and orphans who participated in the Positive Outcomes for Orphans study (POFO – see pofostudy.org for more information).

Methods: Over a three year period researchers are collecting quantitative and qualitative data from 200 orphans and caregivers in Siem Reap and Prey Veng who are receiving services and a total of 100 orphans and caregivers not receiving services in Siem Reap and Prey Veng to account for regional differences in care.

Policy Implications:

  1. If the monk-led intervention is shown to be effective, it will provide a model of care for children who are orphaned or abandoned in the region.

M-Principal Investigators: Sarah LeGrand (Duke University), Vanroth Vann (Homeland, Cambodia), Kathryn Whetten (Duke University)

Investigator: Jan Ostermann (Duke University)

Contact: duke.ovcstudies@gmail.com

Academic OVC Researchers Directory

Study Title: Pathways to health and well-being: social networks of orphans and abandoned youth 

Context: Globally, 153 million children are estimated to have been orphaned as defined by the death of one or both parents due to diseases such as malaria, tuberculosis, maternal mortality, unintentional injuries, natural disasters and armed conflict: AIDS accounts for 16.6 million of these children. Little is known, however, about the social networks that have been informally established that may assist orphaned and abandoned children (OAC) as they transition from structured family care or residential facility settings to their adult lives.

Study aims: The primary goal of this study is to determine key factors that may put youth at a disadvantage as they transition from structured care settings into their adult lives and those that support positive transitions. To accomplish this, researchers will study existing education and employment support networks as well as sexual communities. Researchers will then be able to determine how certain characteristics of these networks are associated with OAC health outcomes, including poor education, ability to generate income, and HIV risk-taking behaviors. Based on prior OAC-related research, this study expects to find that OAC networks are small and lack variability, leading to reduced access to education, fewer positive employment opportunities, and increased sexual-risk behavior. Findings will be used to construct potential interventions to promote OAC health and well-being.

Methods: This study will use a “network analysis approach” to identify major characteristics of OAC social and sexual networks. Researchers will then examine the association between network factors and OAC outcomes in two steps: examining the relationships between social network characteristics and education and income-generation outcomes, and between sexual network characteristics and HIV-risk outcomes. Researchers expect to learn which social and sexual network features are associated with poor outcomes, such as educational accomplishment, obtaining employment, and high sexual risk behavior. Such risk behaviors include an early age of sexual debut, a high number of sexual partners, and certain characteristics of the sexual partners themselves. This research will provide the basis for designing interventions to prevent disenfranchisement as OAC enter their adult lives. With this research, we will be able to learn how to effectively design community networks for OAC to prevent poor health and lifestyle outcomes.

Policy Implications:

  • To determine if OAC network features account for success in educational, income generation, and sexual risk-taking behaviors
  • To provide the basis for social network and sexual network interventions to reduce damage done to OAC to prevent disenfranchisement as OAC become adults.

Principal Investigator: Lynne Messer (Duke University)

Investigators: Bernard Agala (Duke University), Cyrilla Amanya (ACE Africa, Kenya), Misganaw Eticha (SVO Ethiopia), Amy Hobbie (Duke University) Dafrosa Itemba (TAWREF, Tanzania), Rachel Manongi (KCMC, Tanzania), Jim Moody (Duke University), Vanroth Vann (Homeland, Cambodia), Augustine Wasonga (ACE Africa, Kenya), Kathryn Whetten (Duke University), Rachel Whetten (Duke University)