Title: Exploring the relationship between caregiving and health: perceptions among orphaned and non-orphaned adolescents in Tanzania
Authors: Kristin Mmari
Abstract: The objectives of this study were to (1) explore the nature of caregiving for orphaned and non-orphaned adolescents; and (2), examine how changes in the caretaking roles, as a result of a parental loss, impact on an orphan’s sexual behaviors. A total of 52 in-depth interviews and 11 focus group discussions (n = 83) were conducted among adolescent orphans and non-orphans, as well as among 17 caregivers of orphans in Tanzania. Findings revealed three important caregiving roles that contributed to adolescent health: the provision of basic needs, advising and monitoring adolescent behaviors, and assigning household chores. Adolescent participants believed that when these roles are compromised, female orphans’ sexual behaviors are impacted. Consequently, they are perceived to be at greatest risk for HIV. Comprehensive programs are needed for orphans to ensure their basic needs are being met, and to assist caregivers find extra support to carry out their caregiving responsibilities.
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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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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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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]