Title: Building orphan competent communities: experiences from a community-based capital cash transfer initiative in Kenya
Authors: Morten Skovdal, Winnie Mwasiaji, Albert Webale, Andrew Tomkins
Abstract: As a result of the increasing number of orphans in sub-Saharan Africa, numerous programmes have been initiated to facilitate the care and support of orphaned and vulnerable children. This paper reports on a community-based capital cash transfer initiative in Kenya and explores its role in building orphan competent and supportive communities through its participatory project cycle. Using a mixture of individual and group interviews, 300 orphaned children and 110 adults involved in this initiative were interviewed using open-ended questions. A thematic analysis of the data revealed that many of the communities participating in this programme had become more united and active in the support of orphaned children following the mobilization of much needed economic, political and social support resources. Despite many difficulties, largely due to the complexity of communities, we conclude that community-based capital cash transfer initiatives can facilitate the building of orphan competent communities.
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Title: Child work and labour among orphaned and abandoned children in five low and middle income countries
Authors: Rachel Whetten, Lynne Messer, Jan Ostermann, Kathryn Whetten, Brian Pence, Megan Buckner, Nathan Thielman, Karen O’Donnell, and The Positive Outcomes for Orphans (POFO) Research Team
Date: Jan. 13, 2011
The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC) worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs), yet little is known about rates of child labour among OAC, what child and caregiver characteristics predict child engagement in work and labour, or when such work infers with schooling. This study examines rates and correlates of child labour among OAC and associations of child labour with schooling in a cohort of OAC in 5 LMICs.
The Positive Outcomes for Orphans (POFO) study employed a two-stage random sampling survey methodology to identify 1480 single and double orphans and children abandoned by both parents ages 6-12 living in family settings in five LMICs: Cambodia, Ethiopia, India, Kenya, and Tanzania. Regression models examined child and caregiver associations with: any work versus no work; and with working <21, 21-27, and 28+ hours during the past week, and child labour (UNICEF definition).
The majority of OAC (60.7%) engaged in work during the past week, and of those who worked, 17.8% (10.5% of the total sample) worked 28 or more hours. More than one-fifth (21.9%; 13% of the total sample) met UNICEF’s child labour definition. Female OAC and those in good health had increased odds of working. OAC living in rural areas, lower household wealth and caregivers not earning an income were associated with increased child labour. Child labour, but not working fewer than 28 hours per week, was associated with decreased school attendance.
One in seven OAC in this study were reported to be engaged in child labour. Policy makers and social service providers need to pay close attention to the demands being placed on female OAC, particularly in rural areas and poor households with limited income sources. Programs to promote OAC school attendance may need to focus on the needs of families as well as the OAC.
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Study Title: School support as structural HIV prevention for adolescent orphans in Western Kenya
Context: The HIV/AIDS pandemic has led to illness and early death for millions of adults, and this, in turn, has left many millions of orphans in sub-Saharan Africa. In Kenya, alone, there are more than 2.4 million orphans who are at great risk for school dropout, early sexual debut, and HIV infection. Approaching the fourth decade of the AIDS epidemic, many in the field have called for a paradigm shift in HIV prevention, to address structural, as well as individual-level, factors.
Study Aims: This study examines the impact of school support as a structural intervention, tested among adolescent Luo orphans in Nyanza Province, Kenya. The Luos have the highest HIV prevalence and largest orphan prevalence of all ethnic groups in the country. The study uses a rigorous randomized controlled trial design to test whether school support can retain adolescent orphans in school through the transition to high school, delay sexual debut, and reduce the likelihood of HIV and herpes simplex virus type 2 (HSV-2) infections. Specific aims for the proposed study are: 1) To experimentally test whether providing comprehensive school support to Luo orphaned boys and girls will reduce school dropout, reduce sexual risk behaviors, and prevent HIV/HSV-2 infection; 2) To conduct a process evaluation of the implementation of the program; and 3) To conduct comparative cost effectiveness analyses, specifying the intervention’s cost and return on investment as evidenced by cost per unit improvement in the primary outcomes of school enrollment, delay of sexual debut and prevention of risk behaviors and HIV/HSV-2 infection, as well as by gains in health- related quality of life.
Methods: The design randomizes 24 primary schools to intervention or control condition. All youth in grades 7 and 8 who have lost one or both parents, regardless of cause of death, will be invited to participate; the total number of participants to be recruited into the study is approximately 840 students, 420 in each condition. Youth in intervention schools will receive five years of school support, including tuition, fees, uniforms, and a school-based adult “helper.” Data will comprise annual ACASI surveys, school data (attendance, grades), and HIV/HSV-2 bio-specimens. Analyses will test posited mediators and gender moderation in causal pathways and program effects. Cost effectiveness analyses will add much needed policy-relevant information.
Public Health Relevance: Although millions of children have been orphaned as a result of the AIDS pandemic, few studies have considered the particular vulnerability of young orphaned adolescents for school dropout, risky sexual behaviors, and HIV infection. The Luo people of Nyanza Province have the highest proportion of orphans, highest HIV prevalence, and earliest sexual debut among all ethnic groups in Kenya. This structural intervention trial uses a strong conceptual framework and rigorous experimental design to test whether school support can keep adolescent Luo orphans in school, reduce sexual risk behaviors, and prevent HIV /HSV-2 infection. Process evaluation and cost effectiveness analyses add further relevance for policy development.
Principal Investigator: Hyunsan Cho (Pacific Institute for Research and Evaluation)
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Title: The educational and psychological experiences of children orphaned by AIDS in Western Kenya
Author: Grace Jepkemboi
Abstract: The purpose of this study was to describe the perceptions of teachers and caregivers concerning the psychological and educational experiences of children orphaned by AIDS in Western Kenya. On the basis of qualitative inquiry, the design of the study focused on phenomenology inquiry. Audio-taped interviews were used as the primary source to gather data for this study. The questions that guided the study were “What are the psychological characteristics of children orphaned by AIDS in Kenya?” “What are the educational experiences of children orphaned by AIDS?” and “What strategies do the teachers and caregivers at the orphanages use to help the children orphaned by AIDS cope with the loss of the parent(s)?”
There were 20 participants, 12 teachers and 8 caregivers, in seven orphanages who volunteered to participate in the study. Findings of the study revealed that the children orphaned by AIDS went through a continuum of experiences. At one end of the continuum are the experiences that arise as the children see their parents develop signs of HIV/AIDS, become terminally ill, and eventually die. Children were most affected psychologically and educationally in their first year in the orphanages. Some of the emotions they expressed were feeling sad, rejected and unwanted, lonely, strange, in need of acceptance, gloomy, dull, cold, worried, desperate, afraid, hopeless, angry, annoyed, upset, feeling stigmatized, in panic, disturbed, frustrated, confused, tensed, angry, reserved, desperate, violent, stigmatized, emotional, and in grief.
At the other end of the continuum are the emotions, personalities, and attitudes of the orphaned children toward the end of the first year and in the second year, which included being happy, hopeful, trusting, confident, respectful, outgoing, cooperative, warm, complacent, and courageous. The techniques that teachers and caregivers used to help children cope with grief after the loss of the parent(s) are also described. The results of the study could provide information for early childhood educators, psychologists, administrators at orphanages, and policy makers, as they consider the psychological and educational needs of the children orphaned by AIDS.
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Title: Orphans and schooling in Africa: A longitudinal analysis
Author: David Evans and Edward Miguel
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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Study Title: Improving Outcomes for Orphaned Youth: Implementation of Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Grief
Context: Approximately 50 million orphaned and abandoned adolescents currently live in sub-Saharan Africa. Previous studies have indicated that many of these children and adolescents, who often have mental health problems associated with parental loss, have high rates of other traumatic experiences and ongoing trauma exposure. Because the gap in mental health care is large in sub-Saharan Africa, with few individuals in need of treatment receiving even minimal support, more information regarding how to best implement effective interventions, like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for orphaned and abandoned children (OAC) is needed. Cognitive behavioral therapy approaches have been shown to be effective in low- and middle-income countries with adults and in wealthier nations with children and adolescents. More research on the effectiveness of CBT approaches effect resource-poor settings is needed. It is also critical to identify what level of provider and supervisor support is needed for maximum effectiveness and local feasibility.
Study Aims: This research will examine the effectiveness of TF-CBT for treating unresolved grief and traumatic stress for OAC and adolescents in two East African countries, Tanzania and Kenya. The randomized trial will examine the effectiveness of TF-CBT compared to receipt of services as usual in these countries. The study involves collaboration with local organizations in Tanzania and Kenya, in which nine local counselors in each country will be trained by both a US-based TF-CBT expert and Tanzanian lay counselors who gained TF-CBT expertise in a previous feasibility study of TF-CBT for OAC, to deliver group-based TF-CBT for childhood traumatic grief to children ages 7-13. This study will evaluate the effectiveness of TF-CBT compared to existing services as usual orphan supports. The study will also examine the impact of implementation factors (e.g., intervention fidelity, lay counselor-supervisor relationship, child/guardian attendance) to study how enhanced local involvement and responsibility (i.e., Tanzanian lay counselor involvement in co-training and supervision) impacts outcomes.
Methods: This study build on previous work demonstrating that TF-CBT is a feasible and acceptable approach for OAC and adolescents by including a control group to properly examine the effectiveness of the TF-CBT approach. The 18 counselors who are trained in TF-CBT will deliver the treatment in 20 groups in each country, 10 rural and 10 urban, resulting in a total of 320 children and adolescents receiving the treatment (40 groups). TF-CBT and mental health experts will oversee the training of the lay counselors and the treatment given to the groups.
- The study will examine the effectiveness of TF-CBT treatment for OAC and adolescents, as compared to receipt of services as usual in two East African Countries.
- Incorporating experienced lay counselors in providing training and supervision in TF-CBT will inform future efforts to build local expertise and sustainability. This work will inform not only TF-CBT for CTG efforts but also efforts for scale up of other mental health interventions.
- Generate important recommendations for OAC treatment and training approaches that are effective in low- and middle-resource settings.
M-Principal Investigators: Shannon Dorsey (University of Washington) and Kathryn Whetten (Duke University)
Investigators: Dafrosa Itemba (TAWREF), Kevin King (University of Washington), Rachel Manongi (KCMC), Karen O’Donnell (Duke University), Augustine Wasonga (ACE Africa)
Contact Information: [email protected]