Title: Orphanhood and Completion of Compulsory School Education Among Young People in South Africa: Findings From a National Representative Survey
Authors: Don Operario, Lucie Cluver, Helen Rees, Catherine MacPhail, Audrey Pettifor
Date: Feb. 21, 2008
Abstract: We examined the association of orphanhood and completion of compulsory school education among young people in South Africa. In South Africa, school attendance is compulsory through grade 9, which should be completed before age 16. However, family and social factors such as orphanhood and poverty can hinder educational attainment. Participants were 10,452 16–24-year-olds who completed a South African national representative household survey. Overall, 23% had not completed compulsory school levels. In univariate analyses, school completion was lower among those who had experienced orphanhood during school-age years, males, and those who reported household poverty. In multivariate analyses controlling for household poverty, females who had experienced maternal or paternal orphanhood were less likely to have completed school; orphanhood was not independently associated with males’ school completion. Findings highlight the need for evidence-informed policies to address the education and social welfare needs of orphans and vulnerable youth, particularly females, in South Africa.
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Study Title: Neuropsychological benefits of cognitive training in Ugandan HIV children
Context: Over 110,000 HIV Ugandan children are at risk for neurocognitive disorders due to the progressive encephalopathy of CNS HIV infection. Even if clinically stable, these children can have motor, attention, memory, visual-spatial processing, and other executive function impairment.
Study Aims: Study Aim 1: To compare the neuropsychological benefit of 24 training sessions of Captain’s Log CCRT to the active and passive control groups over a 8-week period, and at 3-month follow-up. Study Aim 2: To compare the psychiatric benefit of 24 training sessions of Captain’s Log CCRT to the active and passive control groups over an 8-week period, and at 3-month follow-up. Study Aim 3: To evaluate how HIV subtype, ART treatment status, and the corresponding clinical stability of the child modifies CCRT neuropsychological performance gains and psychiatric symptom reduction.
Methods: One-hundred and fifty school-age children with HIV in Kayunga District, Uganda, will serve as our participants. Fifty of these children will be randomly selected to receive 24 training sessions of a computerized cognitive rehabilitation therapy (CCRT) program called Captain’s Log, marketed mostly for American children with attention or learning problems. A locked version of Captain’s Log which does not direct the child’s training in a progressive manner will be administered to a second “active control” group; while a third group will be a passive control group not receiving any computer training intervention. Outcome Assessments: The Kaufman Assessment Battery for Children, 2nd ed. (KABC-2), Tests of Variables of Attention (TOVA) visual and auditory tests, CogState computerized neuropsychological screening test, Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and Achenbach Child Behavior Checklist (CBCL) will be administered before and after the 8-week training period and at 3-month follow-up. We have previously used all these assessments with Ugandan children with HIV to effectively evaluate neuropsychological and psychiatric problems. Captain’s Log has an internal evaluator feature which will help us monitor the specific training tasks to which the children best respond. Based on our prior research with Kayunga children with HIV, we anticipate that about 40% of our sample will be on ART at study enrollment, and about 20% will be Subtype D while 60% will be subtype A. We also observed that children with HIV Subtype A are at greater risk for neurocognitive deficits. Analyses: We will compare neuropsychological and psychiatric gains over the 8-week training period and at 3-mo follow-up for our three study groups, anticipating that they will be significantly greater for the CCRT intervention children (Study Aims 1 & 2). These neuropsychological gains will be associated with improved school performance over the long-term. Intervention children on ART will have greater gains than those not on ART, and HIV subtype D children will have lower viral loads and higher lymphocyte activation levels, resulting in greater gains from CCRT (Study Aim 3). Conclusion: CCRT will prove effective and sustainable in potentiating the neurocognitive benefit of ART in HIV children. It will prove viable for assessing and treating children in resource-poor settings.
Public Health Relevance: Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV children and orphans globally is monumental when considering how it further compromises quality of home environment and educational opportunity for children already impoverished. If computerized cognitive training proves practical and effective for enhancing neuropsychological function and psychiatric well-being in HIV children, then this would support the second of the UN Millennium Development Goals, which is to ensure that all children have the best opportunity to complete primary schooling. Computerized cognitive training and assessment might also allow for cost/effective interventions in resource poor settings in low-income countries, where special education or medical rehabilitative care by trained professionals are not available.
Principal Investigator: Michael J. Boivin (Michigan State University)
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Study Title: Cognitive and psychosocial benefit of caregiver training for Ugandan HIV children
Context: A decade after the end of apartheid, the well-being of South African children is still in a precarious state. Nearly 70% of the nation’s Black African children live in households with incomes less than $2000 per year. The HIV/AIDS prevalence rate for pregnant women attending public antenatal services is over 30%. And, by 2010, 19% of South African children will have experienced the death of one or both parents, half due to AIDS.
Study Aims: In response to this crisis, the overarching objective of the proposed project is to conduct a short-term, longitudinal, multi-level study of 6000 7- to 10-year-olds and their parents/parent surrogates in 60 urban and rural South African communities in KwaZulu-Natal. We posit three specific aims. AIM 1. Examine the associations between a) a set of major household risk factors and a set of adverse childhood experiences; and between b) the occurrence and nature of adverse childhood experiences and child psychosocial, health and educational outcomes. AIM 2. Explore the degree to which selected factors at multiple levels moderate the influence of major household risk factors on adverse childhood experiences, and adverse childhood experiences on key child outcomes. AIM 3. Test the effects of a major social policy innovation Conditional Cash Transfers on household and childhood risk factors (directly) and children’s well-being (indirectly). This project is a collaboration of researchers at New York University in the U.S. and the Human Sciences Research Council in South Africa in cooperation with the South African government and the World Bank. PUBLIC HEALTH RELEVANCE The results of this study have two main implications for public health. First, one set of results will indicate whether Conditional Cash Transfers can improve the health, education and well-being of poor South African children in high HIV/AIDS prevalence communities. Second, another set of results can inform the design of new public health and social policy strategies to support households in AIDS-affected communities.
Prinicipal Investigator: J. Lawrence Aber (New York University)
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Title: Difference in psychosocial well-being between paternal and maternal AIDS orphans in rural China
Authors: Qun Zhao, Xiaoming Li, Xiaoyi Fang, Guoxiang Zhao, Junfeng Zhao, Xiuyun Lin, Bonita Stanton
Abstract: This study compares psychosocial well-being between paternal and maternal orphans in rural China in a sample (n = 459) of children who had lost one parent to HIV and who were in family-based care. Measures included academic marks, education expectation, trusting relationships with current caregivers, self-reported health status, depression, loneliness, posttraumatic stress, and social support. No significant differences were reported between maternal and paternal orphans, except that paternal orphans reported better trusting relationships with caregivers than maternal orphans. Children with a healthy surviving parent reported significantly better scores for depression, loneliness, posttraumatic stress, and social support than children with a sick parent. Analyses showed significance with regard to orphan status on academic marks and trusting relationships with caregivers while controlling for age, gender, surviving parent’s health status, and family socioeconomic status. Results underscore the importance of psychosocial support for children whose surviving parent is living with HIV or another illness.
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Title: Academic Achievement of Students in Foster Care: Impeded or Improved?
Authors: Larry Evans
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: The Potential for Successful Family Foster Care: Conceptualizing Competency Domains for Foster Parents
The potential to foster successfully starts with developing and supporting competency in 12 domains: (1) providing a safe and secure environment; (2) providing a nurturing environment; (3) promoting educational attainment and success; (4) meeting physical and mental healthcare needs; (5) promoting social and emotional development; (6) supporting diversity and children’s cultural needs; (7) supporting permanency planning; (8) managing ambiguity and loss for the foster child and family; (9) growing as a foster parent; (10) managing the demands of fostering on personal and familial well-being; (11) supporting relationships between children and their families; and (12) working as a team member. This article describes each domain and reviews relevant research to help guide the assessment of practicing and future foster parents.
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Title: Experiences of Children Heading Households in Hammarsdale, KwaZulu-Natal, South Africa
Author: Nomlindo Dlungwana, Reshmna Sathiparsad
Abstract: This study explored the experiences of children who are heads of households, particularly with regard to the psychological, emotional and social effects of heading a household, and access to schooling and support services. Fifteen children (females, n=9; males, n=6; age range 3 to 18) participated. Data were collected using in-depth interviews. Content analysis was employed in the qualitative analysis of the data. The findings revealed that many children from child-headed households lived in poverty, experienced psychological and emotional problems, received limited or no support from relatives and had irregular school attendance. Children heading households face ongoing challenges in relation to fulfilling their basic needs for food, clothing, shelter and security.
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Title: Orphanhood and the Long-Run Impact on Children
Author(s): Kathleen Beegle, Joachim De Weerdt, Stefan Dercon
Abstract: This paper presents unique evidence that orphanhood matters in the long-run for health and education outcomes, in a region of Northwestern Tanzania, an area deeply affected by HIV-AIDS in Africa. We use a sample of non-orphans surveyed in 1991-94, who were traced and reinterviewed in 2004. A large proportion, 23 percent, lost one or more parents before the age of 15 in this period, allowing us to identify the impact of orphanhood shocks. Since a substantial proportion reaches adulthood by 2004, we can also assess permanent health and education impacts of orphanhood. In the analysis, we can control for a wide range of child and adult characteristics before orphanhood, as well as community fixed effects. We find that maternal death causes a permanent height deficit of about 2 cm (or 22 percent of one standard deviation) and a persistent impact on years of education of almost 1 year (or 25 percent of one standard deviation). We also find that paternal orphanhood has an impact on educational outcomes, but only for particular groups. We show evidence that living arrangements and whether the child was in school at the time of losing a parent strongly influence the impact of maternal and paternal death. We also illustrate the problems of inference on the impact of orphanhood if only children who remained in their baseline communities by 2004 had been reinterviewed.
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