Tag: orphan

AIDS-Orphanhood and Caregiver HIV/AIDS Sickness Status: Effects on Psychological Symptoms in South African Youth

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Title: AIDS-Orphanhood and Caregiver HIV/AIDS Sickness Status: Effects on Psychological Symptoms in South African Youth

Authors: Lucie Cluver, Mark Orkin, Mark E Boyes, Frances Gardner, Joy Nikelo

Date: Feb, 7, 2012

Abstract: 

OBJECTIVE:

Research has established that AIDS-orphaned youth are at high risk of internalizing psychological distress. However, little is known about youth living with caregivers who are unwell with AIDS or youth simultaneously affected by AIDS-orphanhood and caregiver AIDS sickness.

METHODS:

1025 South African youth were interviewed in 2005 and followed up in 2009 (71% retention). Participants completed standardized measures of anxiety, depression, and posttraumatic stress. Comparison groups were youth who were AIDS-orphaned, other-orphaned, and nonorphaned, and those whose caregivers were sick with AIDS, sick with another disease, or healthy.

RESULTS:

Longitudinal analyses showed that both AIDS-orphanhood and caregiver AIDS sickness predicted increased depression, anxiety, and posttraumatic stress symptoms over a 4-year period, independently of sociodemographic cofactors and of each other. Caregiver sickness or death by non-AIDS causes, and having a healthy or living caregiver, did not predict youth symptomatology. Youths simultaneously affected by caregiver AIDS sickness and AIDS-orphanhood showed cumulative negative effects.

CONCLUSIONS:

Findings suggest that policy and interventions, currently focused on orphanhood, should include youth whose caregivers are unwell with AIDS.

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Persisting mental health problems among AIDS-orphaned children in South Africa

Written by matthew on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Title: Persisting mental health problems among AIDS-orphaned children in South Africa

Authors: Lucie Cluver, Mark Orkin, Frances Gardner, Mark E Boyes

Date: 2011

Abstract:

BACKGROUND:

By 2008, 12 million children in sub-Saharan Africa were orphaned by AIDS. Cross-sectional studies show psychological problems for AIDS-orphaned children, but until now no longitudinal study has explored enduring psychological effects of AIDS-orphanhood in low-income countries.

METHODS:

A 4-year longitudinal follow-up of AIDS-orphaned children with control groups of other-orphans and non-orphans. 1021 children (M = 13.4 years, 50% female, 98% isiXhosa-speaking) were interviewed in 2005 and followed up in 2009 with 71% retention (49% female, M = 16.9 years), in poor urban South African settlements. Children were interviewed using sociodemographic questionnaires and well-validated standardised scales for assessing depression, anxiety, and post-traumatic stress. Data were analysed using mixed-design ANOVA and backward-stepping regression.

RESULTS:

AIDS-orphaned children showed higher depression, anxiety, and post-traumatic stress disorder (PTSD) scores in both 2005 and 2009 when compared with other-orphans and non-orphans. Backward-stepping regression, controlling for baseline mental health, and sociodemographic cofactors such as age, gender, and type of bereavement, revealed that being AIDS-orphaned in 2005 was associated with depression, anxiety, and PTSD scores in 2009. This was not the case for other-orphaned or non-orphaned children. Age interacted with orphan status, such that there was a steep rise in psychological distress in the AIDS-orphaned group, but no rise with age amongst other-orphans and non-orphans.

CONCLUSIONS:

Negative mental health outcomes amongst AIDS-orphaned children are maintained and worsen over a 4-year period. It is important that psychosocial support programmes are sustained, and focus on youth as well as young children.

Multimedia:

httpv://www.youtube.com/watch?v=ttDinnYOoiM

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Effects of stigma on the mental health of adolescents orphaned by AIDS

Written by matthew on . Posted in Psychological Effects of Orphanhood. Leave a Comment

Title: Effects of stigma on the mental health of adolescents orphaned by AIDS

Authors: Lucie Cluver, Frances Gardner, Don Operario

Date: 2008

Abstract:

PURPOSE:

By 2010, an estimated 18.4 million children in Sub-Saharan Africa will be orphaned by AIDS. Research in South Africa shows that AIDS orphanhood is independently associated with heightened levels of psychological problems. This study is the first to explore the mediating effects of stigma and other factors operating on a community level, on associations between AIDS orphanhood and mental health. We assessed the associations of four risk factors that can potentially be addressed at a community level (bullying, stigma, community violence, and lack of positive activities) with psychological problems and orphanhood status.

METHOD:

One thousand twenty-five participants aged 10-19 were recruited from deprived urban settlements in South Africa. The sample included adolescents orphaned by AIDS (n = 425), adolescents orphaned by non-AIDS causes (n = 241), and nonorphaned adolescents (n = 278). Participants were interviewed using standardized psychological measures of depression, anxiety, posttraumatic stress, peer problems, delinquency, and conduct problems. Information on risk factors and demographic characteristics were also assessed.

RESULTS:

AIDS-orphaned adolescents reported higher levels of stigma and fewer positive activities than other groups. There were no reported differences on bullying or community violence. All community-level risk factors were associated with poorer psychological outcomes. Multivariate analyses controlling for age and gender showed that experience of stigma significantly mediated associations between AIDS orphanhood and poor psychological outcomes.

CONCLUSIONS:

Reduction of AIDS-related stigma could potentially reduce adverse psychological outcomes among AIDS-orphaned adolescents.

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School support as structural HIV prevention for adolescent orphans in Western Kenya

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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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Are orphans at increased risk of malnutrition in Malawi?

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Title: Are orphans at increased risk of malnutrition in Malawi?

Authors: Ratana Panpanich, Bernard Brabin, Andrew Gonani, Stephen Graham

Date: 1999

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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Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study

Written by matthew on . Posted in Longterm Consequences of Orphanhood, Psychological Effects of Orphanhood. 1 Comment

Title: Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study

Authors: Laura Murray, Alan Haworth, Katherine Semrau, Mini Singh, Grace Aldrovandi, Moses Sinkala, Donald Thea, Paul Bolton

Date: 2006

Abstract: HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in low-income countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study. Two qualitative methods resulted in the identification of three major problems for women: domestic violence (DV), depression-like syndrome, and alcohol abuse; and children: defilement, DV, and behavior problems. DV and sexual abuse were found to be closely linked to HIV and alcohol abuse. This study shows the local perspective of the overlap between violence and HIV. Results are discussed in relation to the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa.

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Depressive symptoms in youth heads of household in Rwanda – Correlates and implications for intervention

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Title: Depressive symptoms in youth heads of household in Rwanda – Correlates and implications for intervention

Authors: Neil Boris, Lisanne Brown, Tonya Thurman, Janet Rice, Leslie Snider, Joseph Ntaganira, Laetitia Nyirazinyoye

Abstract: Objective: To examine the level of depressive symptoms and their predictors in youth from one region of Rwanda who function as heads of household (ie, those responsible for caring for other children) and care for younger orphans. Design: Cross-sectional survey Setting: Four adjoining districts in Gigonkoro, an impoverished rural province in southwestern Rwanda. Participants: Trained interviewers met with the eldest member of each household (n=539) in which a youth 24 years old or younger was caring for 1 child or more. Main Exposure: Serving as a youth head of household. Main Outcome Measures: Rates and severity of depressive symptoms using the Center for Epidemiologic Studies Depression scale; measures of grief, adult support, social marginalization, and sociodemographic factors using scales developed for this study. Results: Of the 539 youth heads of household, 77% were subsistence farmers and only 7% had attended school for 6 years or more. Almost half (44%) reported eating only 1 meal a day in the last week, and 80% rated their health as fair or poor. The mean score on the Center for Epidemiologic Studies Depression scale was 24.4, exceeding the most conservative published cutoff score for adolescents. Multivariate analysis revealed that reports of depressive symptoms that exceeded the clinical cutoff were associated with having 3 basic household assets or fewer, such as a mattress and a spare set of clothes (odds ratio [OR], 1.69; 95% confidence inter-vat [CI], 1.06-2.70), eating less than 1 meal per day (OR, 1.68; 95% CI, 1.092.60), reporting fair health (OR, 1.32; 95% CI, 0.762.29) or poor health (OR, 2.33; 95% CI, 1.17-4.64), endorsing high levels of grief (OR, 2.67; 95% CI, 1.734.13), having at least 1 parent die in the genocide as opposed to all other causes of parental death (OR, 1.83; 95% CI, 1.10-3.04), and not having a close friend (OR, 1.91; 95% CI, 1.1.7-3.1.2). There was an interaction between marginalization from the community and alcohol use; youth who were highly marginalized and did not drink alcohol were more than 3 times more likely to report symptoms of depression (OR, 3.07-1 95% CI, 1.73-5.42). When models were constructed by grouping theoretically related variables into blocks and controlling for other blocks, the emotional status block of variables (grief and marginalization) accounted for the most variance in depressive symptoms. Conclusions: Orphaned youth who head households in rural Rwanda face many challenges and report high rates of depressive symptoms. Interventions designed to go beyond improving food security and increasing household assets may be needed to reduce social isolation of youth heads of household. The effect of head-of-household depressive symptoms on other children living in youth-headed households is unknown.

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Psychological Distress in Orphan, Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities

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Title: Psychological Distress in Orphan, Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities

Authors: Killian, B. and K. Durrheim.

Date: 2008

Abstract: The degree of psychological distress and access social support is investigated in children (n = 741) living in nine high prevalence HIV/AIDS communities. They comprised (1) vulnerable, maternally-orphaned (n = 319); (ii) vulnerable and not orphaned (n = 276); and (iii) typically developing (n = 146). The following psychometric tests were administered: The Trauma Symptom Checklist for Children (Townsend, 2002); the Reynolds Depression Scale for Children (Reynolds, 1989); and the Social Support Scale (Beale Spencer, Cole, Jones & Phillips Swanson, 1997). Primary caregivers completed the Conners’ Parent Rating Scale (Conners, Parker, Sitarenios, & Epstein, 1998) and an Adversity Index (Killian, 2004a) to establish the vulnerability status of each child. The data were analysed to distinguish the groups from each other regarding profiles of distress. The findings suggest that vulnerable children, be they orphaned or not, manifest similar degrees of emotional distress and perceived themselves as unable to access social support. Interventions should address the needs of both orphans and other vulnerable children, without prioritising the needs of orphans over other vulnerable children.

Citation: Killian, B. and K. Durrheim (2008). “Psychological Distress in Orphan, Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities.” Journal of Psychology in Africa 18(3): 421-429.

The educational and psychological experiences of children orphaned by AIDS in Western Kenya

Written by matthew on . Posted in Educational Impact, Psychological Effects of Orphanhood. Leave a Comment

Title: The educational and psychological experiences of children orphaned by AIDS in Western Kenya

Author: Grace Jepkemboi

Date: 2007

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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Experiences of Children Heading Households

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Title: Experiences of Children Heading Households in Hammarsdale, KwaZulu-Natal, South Africa

Author: Nomlindo Dlungwana, Reshmna Sathiparsad

Date: 2008

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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