Tag: South Africa

Title: The motor development of children with and without HIV: pilot exploration of foster care and residential placement

Authors:  Jennifer Jelsma, Naliah Davids, Gillian Ferguson

Date: 2011

Abstract: Background: The AIDS epidemic has lead to an increase in orphaned children who need residential care. It is known that HIV leads to delayed motor development. However, the impact of place of residence on motor function has not been investigated in the South African context. The aim of the study was therefore to establish if children in institutionalised settings performed better or worse in terms of gross motor function than their counterparts in foster care. A secondary objective was to compare the performance of children with HIV in these two settings with those of children who were HIV negative. Methods: Forty-four children both with and without HIV, were recruited from institutions and foster care families in Cape Town. The Peabody Development Motor Scale (PDMS II) was used to calculate the total motor quotient (TMQ) at baseline and six months later. Comparisons of TMQ were made between residential settings and between children with and without HIV. Results: Twenty-one children were infected with HIV and were significantly delayed compared to their healthy counterparts. Antiretroviral therapy was well managed among the group but did not appear to result in restoration of TMQ to normal over the study period. HIV status and place of residence emerged as a predictor of TMQ with children in residential care performing better than their counterparts in foster care. All children showed improvement over the six months of study. Conclusions: Foster parents were well supported administratively in the community by social welfare services but their children might have lacked stimulation in comparison to those in institutional settings. This could have been due to a lack of resources and knowledge regarding child development. The assumption that foster homes provide a better alternative to institutions may not be correct in a resource poor community and needs to be examined further.

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Title:  Health of adults caring for orphaned children in an HIV-endemic community in South Africa

Authors: Caroline Kuo, Don Operario

Date: 2011

Abstract: Abstract In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV-endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic Studies-Depression scale), anxiety (using Kessler-10 scale), and post-traumatic stress (using the Harvard Trauma Questionnaire) among a representative community sample of adults caring for children in Umlazi Township, an HIV-endemic community in South Africa. Of 1599 respondents, 33% (n=530) were carers of orphaned children. Results showed that, overall, carers reported poor general health and functioning and elevated levels of depression, anxiety, and post-traumatic stress. Carers of orphaned children reported significantly poorer general health and functioning and higher rates of depression and post-traumatic stress compared with carers of non-orphaned children. In multivariate analyses, orphan carer and non-orphan carer differences in general health were accounted for by age, gender, education, economic assets, and source of income, but differences in depression were independent of these cofactors. Interventions are needed to address physical and mental health of carers in general. Greater health problems among orphan carers appeared to be fully explained by socioeconomic characteristics, which offer opportunities for targeting of programs. More research is needed to understand determinants of mental health disparities among orphan carers, which were not explained by socioeconomic characteristics.

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Title: Depression among carers of AIDS-orphaned and other-orphaned children in Umlazi Township, South Africa

Authors: Kuo Caroline, Operario Don, Cluver Lucie

Date:  2012

Abstract: South Africa faces the challenge of supporting the well-being of adults caring for growing numbers of AIDS-orphaned children. These adults play a critical role in responses to the epidemic, but little information exists in regard to their mental health needs. This paper reports on findings from n=1599 adults, recruited through representative household sampling, who serve as primary carers for children in Umlazi Township, an HIV-endemic community. Overall, 22% of participants were carers of AIDS-orphaned children, 11% were carers of other-orphaned children and 67% were carers of non-orphaned children. Prevalence of depression was 30.3%. Orphan carers, regardless of whether they cared for AIDS-orphaned or other-orphaned children, were significantly more likely than carers of non-orphaned children to meet the clinical threshold for depression (35.2% vs. 27.9%, p < 0.01). In multivariate logistic regressions, food insecurity and being a female carer were identified as additional risk factors for greater depression. In contrast, households with access to running water and households dependent on salaries as the main source of income were identified as protective factors for disparities in depression. Mental health interventions are urgently needed to address an increased risk for depression among all orphan carers, not just those caring for AIDS-orphaned children. 2012 Copyright Taylor and Francis Group, LLC.

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Title: Psychological distress amongst AIDS-orphaned children in urban South Africa

Authors: Lucie Cluver, Frances Gardner, Don Operario

Date: 2007

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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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



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.


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.


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.


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

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

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

Date: 2011



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.


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.


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.


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.



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Study Title: Cognitive and psychosocial benefit of caregiver training for Ugandan HIV children

Context: A decade after the end of apartheid, the well-being of South African children is still in a precarious state. Nearly 70% of the nation’s Black African children live in households with incomes less than $2000 per year. The HIV/AIDS prevalence rate for pregnant women attending public antenatal services is over 30%. And, by 2010, 19% of South African children will have experienced the death of one or both parents, half due to AIDS.

Study Aims: In response to this crisis, the overarching objective of the proposed project is to conduct a short-term, longitudinal, multi-level study of 6000 7- to 10-year-olds and their parents/parent surrogates in 60 urban and rural South African communities in KwaZulu-Natal. We posit three specific aims. AIM 1. Examine the associations between a) a set of major household risk factors and a set of adverse childhood experiences; and between b) the occurrence and nature of adverse childhood experiences and child psychosocial, health and educational outcomes. AIM 2. Explore the degree to which selected factors at multiple levels moderate the influence of major household risk factors on adverse childhood experiences, and adverse childhood experiences on key child outcomes. AIM 3. Test the effects of a major social policy innovation Conditional Cash Transfers on household and childhood risk factors (directly) and children’s well-being (indirectly). This project is a collaboration of researchers at New York University in the U.S. and the Human Sciences Research Council in South Africa in cooperation with the South African government and the World Bank. PUBLIC HEALTH RELEVANCE The results of this study have two main implications for public health. First, one set of results will indicate whether Conditional Cash Transfers can improve the health, education and well-being of poor South African children in high HIV/AIDS prevalence communities. Second, another set of results can inform the design of new public health and social policy strategies to support households in AIDS-affected communities.

Prinicipal Investigator: J. Lawrence Aber (New York University)

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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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Title: The impact of parental death on school outcomes: longitudinal evidence from South Africa

Author: Anne Case and Cally Ardington

Date: 2006

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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