Title: More than the loss of a parent: Potentially traumatic events among orphaned and abandoned children
Authors: Kathryn Whetten, Jan Ostermann, Rachel Whetten, Karen O’Donnell, Nathan Thielman, and The Positive Outcomes for Orphans Research Team
Date: March 25, 2011
Abstract: This study examines rates of potentially traumatic events and associated anxiety and emotional/behavioral difficulties among 1,258 orphaned and abandoned children in 5 low- and middle-income countries. The study quantifies the types of events the children experienced and demonstrates that anxiety and emotional/behavioral difficulties increase with additional exposure. As policies for orphaned and abandoned children are being implemented, this study helps policy makers and care providers recognize that (a) children and caregivers are willing to report experiences of potentially traumatic events, (b) those who report such events are at higher risk for experiencing additional events, (c) resulting symptomatology indicates a need for appropriate mental health services, and (d) boys are as vulnerable as girls, indicating an equal need for protection.
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Title: Psychological distress amongst AIDS-orphaned children in urban South Africa
Authors: Lucie Cluver, Frances Gardner, Don Operario
Abstract: BACKGROUND: South Africa is predicted to have 2.3 million children orphaned by Acquired Immune Deficiency Syndrome (AIDS) by 2020 (Actuarial Society of South Africa, 2005). There is little knowledge about impacts of AIDS-related bereavement on children, to aid planning of services. This study aimed to investigate psychological consequences of AIDS orphanhood in urban township areas of Cape Town, South Africa, compared to control groups of children and adolescents orphaned by other causes, and non-orphans. METHOD: One thousand and twenty-five children and adolescents (aged 10-19) were interviewed using socio-demographic questionnaires and standardised scales for assessing depression, anxiety, post-traumatic stress, peer problems, delinquency and conduct problems. RESULTS: Controlling for socio-demographic factors such as age, gender, formal/informal dwelling and age at orphanhood, children orphaned by AIDS were more likely to report symptoms of depression, peer relationship problems, post-traumatic stress, delinquency and conduct problems than both children orphaned by other causes and non-orphaned children. Anxiety showed no differences. AIDS-orphaned children were more likely to report suicidal ideation. Compared to Western norms, AIDS-orphaned children showed higher levels of internalizing problems and delinquency, but lower levels of conduct problems. CONCLUSIONS: Children orphaned by AIDS may be a particularly vulnerable group in terms of emotional and, to a lesser extent, behavioural problems. Intervention programs are necessary to ameliorate the psychological sequelae of losing a parent to AIDS.
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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: Cognitive and Psychosocial Benefit of caregiver training for Ugandan HIV children
Context: 110,000 Ugandan HIV children and 1 million non-infected AIDS orphans will have poor or inconsistent caregiving because one or both parents are ill or dead from AIDS (UNAIDS 2006). Consequently, the cognitive and social development of these children may be stunted in early childhood, and eventually they will perform more poorly in school. Mediational intervention for sensitizing caregivers (MISC) has a structured curriculum and training program to teach HIV mothers/caregivers the skills for enhancing their child’s cognitive and social development in the home each day. This is done by teaching mothers/caregivers how to focus a child’s attention, excite a child’s interest, expand her cognitive awareness, encourage her sense of competence, and regulate behavior during play, feeding, bathing and working.
Study Aims: To adapt MISC to the Ugandan context and demonstrate its effectiveness for enhancing the cognitive and social development of HIV children and orphans, we will use a four-part protocol for evaluating parent training programs: context evaluation, input evaluation, process evaluation, and product evaluation (CIPP Model of Evaluation). Study Aim 1 is the context evaluation of MISC through the use of focus groups of local community leaders, teachers, and caregivers, partnering with us to adapt MISC to the Ugandan context. Study Aim 2 involves the input evaluation of appropriateness and acceptability of MISC training for the caregivers and household through interviews and training compliance. Study Aim 3 is the process evaluation of the fidelity of intervention though home observation and evaluation of HOME quality, and videotape evaluation of caregiving interactions between mother/caregiver and child, as well as changes in the caregivers own attitudes and approach throughout the year-long training period. Study Aim 4 evaluates the product or benefit of the MISC training; in terms of the child’s gains on the Mullen Scales of Early Learning, the Early Childhood Vigilance Test (ECVT) of attention, the Color-Object Association Test (COAT) for memory, and the Child Behavior Checklist (CBCL) for psychosocial adjustment.
Methods: Mothers/caregivers of half of 120 HIV-infected and 120 non-infected preschool AIDS orphans in Kayunga District, Uganda, will be assigned to monthly home-based MISC training for one year. The remaining children and caregivers will continue to receive the regular monthly home health care visits. MISC for both the HIV infected and non-infected orphans will lead to greater gains on the Mullen learning, ECVT attention, and COAT memory scores compared to non- intervention children. These gains will be mediated by improved scores on monthly videotaped caregiving samples evaluated for MISC features, HOME scale quality of home environment, and child/caregiver quality interactions (CCQI) scores from home-based observations. These gains will be moderated by clinical stability of the HIV children.
Implications: Establishing the feasibility and effectiveness of MISC caregiving training will provide a strategic and sustainable means of cognitive enhancement for millions of HIV-affected children in resource-poor settings. Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV orphans globally is monumental when considering how it further compromises quality of home environment and caregiving for children already impoverished. In the African context, home-based caregiver training interventions to enhance the developmental milieu of HIV-affected children may be the single most developmentally strategic, culturally relevant, and resource sustainable means of buffering them from this impact of HIV disease. More broadly, caregiver training interventions may also enhance the cognitive ability and psychosocial adjustment of all children at risk from poverty and other public health challenges to the second of the UN Millennium Development Goals, which is to ensure that all children are able to complete primary schooling.
Principal Investigator: Michael Joseph Boivin (Michigan State 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: 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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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: 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: The impact of parental death on school outcomes: longitudinal evidence from South Africa
Author: Anne Case and Cally Ardington
Abstract: We analyze longitudinal data from a demographic surveillance area (DSA) in KwaZulu-Natal to examine the impact of parental death on children’s outcomes. The results show significant differences in the impact of mothers’ and fathers’ deaths. The loss of a child’s mother is a strong predictor of poor schooling outcomes. Maternal orphans are significantly less likely to be enrolled in school and have completed significantly fewer years of schooling, conditional on age, than children whose mothers are alive. Less money is spent on maternal orphans’ educations, on average, conditional on enrollment. Moreover, children whose mothers have died appear to be at an educational disadvantage when compared with non-orphaned children with whom they live. We use the timing of mothers’ deaths relative to children’s educational shortfalls to argue that mothers’ deaths have a causal effect on children’s educations. The loss of a child’s father is a significant correlate of poor household socioeconomic status. However, the death of a father between waves of the survey has no significant effect on subsequent asset ownership. Evidence from the South African 2001 Census suggests that the estimated effects of maternal deaths on children’s outcomes in the Africa Centre DSA reflect the reality for orphans throughout South Africa.
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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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