How later adolescents with adult responsibilities experience HIV bereavement in Nigeria: application of a bereavement model

Responding to Maternal Loss: A Phenomenological Study of Older Orphans in Youth-Headed Households in Impoverished Areas of South Africa

The aim of this study was to explore how older orphans in youth-headed households (YHHs) experience and respond to maternal death and to examine the strategies they employ to care for their younger siblings. We interviewed 18 older orphans who were purposively selected from YHHs located in informal settlements in the City of Tshwane, South Africa. After the death of their mothers, the orphans lost the family home, lost support from their relatives, lost friendships, lost educational opportunities, and lost childhood. The orphans experienced prolonged pain, sadness, anxieties, fear, loneliness despondency, and deep-rooted and persistent anger towards their mother for dying. They suffered from prolonged bereavement because they had been denied the opportunity to mourn the loss of their parents and yearned persistently but silently for their dead mothers. Dropping out of school to seek employment in order to care for their siblings was one of the main coping strategies that older orphans used. However, dropping out of school early robbed them of their future goals of getting an educational qualification. The orphans had not been prepared for taking on an adult role and were given no support or counselling to help them recover from their parents' death. Continuous grief counselling should form an integral component of the psychosocial support services that are provided to orphans soon after the death of a parent.

Improving psychological outcomes for orphans living with HIV in Tanzania through a novel intervention to improve resilience: findings from a pilot RCT

Parental death and HIV are associated with poor mental health for orphans in sub-Saharan Africa. This study aimed to evaluate a theory-based intervention for orphaned children on treatment in Tanzania, in terms of feasibility, acceptability and preliminary outcomes. A pilot RCT with nested focus group (FGD) allocated 48 children to usual care or residential "Memory Work Therapy". Children completed outcome measures at T0 (baseline), T1 (2 weeks following intervention) and T2 (9 weeks from T0). Forty percent of eligible children assented. T1 intervention effects were found on all total measures: Brief Symptom Inventory d = 0.99, p < .001; Rosenberg Self Esteem Scale d = 0.65, p = .001; Strengths and Difficulties Questionnaire d = 0.64, p = .002; Self-efficacy questionnaire for children both "social" and "emotional" subscales, d = 0.54, p = .008 and d = 0.63, p = .002, respectively. At T2, significant effects remained for all measures and SES effect increased from medium to large (T1 = 0.65, T2 = 1.33). FGD data found children valued a calm environment that met their basic needs, enabling them to reflect, highlight support resources, and strengthen ability to recognize personal skills. The intervention has strong feasibility and acceptability, with no attrition or missing data. Memory Work Therapy has high potential effect size and should be tested in a fully powered trial. Clinical trials.gov NCT02180750.