Title: The influence of orphan care and other household shocks on health status over time: a longitudinal study in rural Malawi
Author: Megan Littrell, Neil W Boris, Lisanne Brown, Michael Hill, Kate Macintyre
Abstract: In the context of rising rates of orphanhood in AIDS-affected settings, very little is understood about implications for caregiver well-being given increasing and intensifying responsibilities for the care of orphaned children. Emotional distress and self-reported health status as well as shifts in household orphan care, wealth, food security and recent illness and death among household members were measured among a panel of 1219 caregivers in rural Malawi between 2007 and 2009. Logistic regression was used to identify predictors of improved and diminished caregiver health and emotional distress. Results suggest that becoming an orphan caregiver is associated with a shift from good to poor health status (adjusted odds ratio AOR=2.29, 95% confidence interval CI=1.16-4.54), and that elevated levels of distress and poor health both persist over time in comparison with care for non-orphans only. Once engaged in orphan care, taking on additional orphans is associated with increased emotional distress in relation to not caring for orphans (AOR=3.16, 95% CI=1.30-7.73) as well as in relation to maintaining the same number of orphans in care over time (AOR=2.84, 95% CI=1.04-7.70). In addition, findings illustrate the strong influence of household wealth and food security on caregiver well-being. Food insecurity and poverty that persist or develop over time are associated with increasing distress. Conversely, maintenance or improvement in food security and household wealth are associated with decreases in distress. Providing all aspects of household maintenance and care for children, primary caregivers are key to the extended family solution for orphaned and vulnerable children. Bolstering the foundation of rural African families to ensure care and protection of these children involves targeting support to orphan caregivers but must also include addressing the issues of poverty and food insecurity that pose a wider threat to caregiving capacity.
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Title: Are orphans at increased risk of malnutrition in Malawi?
Authors: Ratana Panpanich, Bernard Brabin, Andrew Gonani, Stephen Graham
Abstract: The objective of this study was to compare the nutritional status and health problems of village orphans, non-orphans and orphanage children, and to identify factors associated with undernutrition. A cross-sectional study was conducted in three orphanages and two villages near Blantyre, Malawi. Seventy-six orphanage children, 137 village orphans and 80 village non-orphans were recruited. Anthropometric measurement was done and guardians were interviewed. In the group of children aged <5 years, the prevalence of undernutrition in orphanage children was 54.8% compared with 33.3% and 30% of village orphans and non-orphans, respectively. Sixty-four per cent of young orphanage children were stunted compared with 50% of village orphans and 46.4% of non-orphans. The mean (SD) Z-score of height/age was significantly lower in the orphanage group, -2.75 (1.29) compared with -2.20 (1.51) and -1.61 (1.57) in the village orphan and non-orphan groups (p<0.05). Conversely, older orphanage children (>5 years) were less stunted and wasted than orphans and non-orphans in villages. Illness of children in the last month was reported to be higher in the non-orphan group, especially diarrhoeal disease, which occurred in 30% compared with 10.8% of village orphans and 6.6% of orphanage children. More than three children in a family being cared for by guardians was significantly associated with undernutrition. Orphanage girls were more likely to be malnourished than orphanage boys. Children who had been admitted to an orphanage for more than a year were less malnourished. In village orphans, there was no association between undernutrition and duration of stay in extended families. Age and education of guardians were not associated with the nutritional status of children. We conclude that young orphanage children are more likely to be undernourished and more stunted than village children. Older orphanage children seem to have better nutrition than village orphans. There was no significant difference in nutritional status between village orphans and non-orphans.
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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.
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: [email protected]