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Kizito S, Nabayinda J, Kiyingi J, Neilands TB, Namuwonge F, Namatovu P, Nabunya P, Bahar OS, Ssentumbwe V, Magorokosho N, Ssewamala FM. The Impact of an Economic Strengthening Intervention on Academic Achievement Among Adolescents Living with HIV: Findings from the Suubi + Adherence Cluster-Randomized Trial in Uganda (2012-2018). AIDS Behav 2023; 27:1013-1023. [PMID: 36048290 PMCID: PMC9974578 DOI: 10.1007/s10461-022-03838-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
We examined the impact of a family-based economic strengthening intervention on school dropout and repeating a class among ALWHIV in Uganda. In this cluster-randomized trial (2012-2018) conducted in 39 clinics, we recruited adolescents aged 10-16 years living with HIV. We included data from 613 adolescents. We plotted a Kaplan Meier survival curve and fitted Cox proportional hazards models to test the effect of the economic strengthening intervention on school dropout. The incidence of school dropout was 13.0% and 9.6% in the control and intervention groups, respectively. Also, economic empowerment reduced the risk of school dropout, aHR = 0.68 (95% CI 0.52-0.88), p-value 0.004. In other words, participants in the intervention group had 32% reduced hazards of dropping out of school. Also, increasing age aHR = 1.54 (95% CI 1.42-1.66), p-value < 0.001 and double orphanhood aHR = 0.67 (95% CI 0.47-0.96) p-value 0.030 increased the risks for dropping out of school. The intervention was not efficacious in reducing the rates of repeating a class. The intervention offered the ALWHIV an opportunity to live a productive adult life. More research is required on these kinds of interventions intended to keep ALWHIV and those impacted by HIV in school.
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Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Torsten B. Neilands
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Vicent Ssentumbwe
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Natasja Magorokosho
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Fred M. Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
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Earning their keep? Fostering, children's education, and work in north-western Tanzania. DEMOGRAPHIC RESEARCH 2019. [DOI: 10.4054/demres.2019.41.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Raymond JM, Zolnikov TR. AIDS-Affected Orphans in Sub-Saharan Africa: A Scoping Review on Outcome Differences in Rural and Urban Environments. AIDS Behav 2018; 22:3429-3441. [PMID: 29721717 DOI: 10.1007/s10461-018-2134-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Currently, there are more than 11 million AIDS-affected orphans that suffer from various adverse effects, most of whom reside in sub-Saharan Africa. The difference between whether a child resides in a rural or urban environment can have a significant role in a child's education, health status and access to healthcare, and social or family relationships. A scoping review was conducted in order to understand any possible environment-based differences on orphans directly affected by HIV/AIDS in sub-Saharan Africa. There were 233 sources used for this review; however, 164 manuscripts focused more so on a general review of orphans within a rural or urban environment. Thus, after eliminating for various factors, 69 manuscripts were removed, which focused primarily on the social aspect of orphans due to HIV/AIDS. Rural environments provided more family support, while urban environments generally had more resources available to orphans (e.g. school fees). Unfortunately, both rural and urban environments were found to be fairly non-supportive of orphans and their development. This scoping review found, in general, that orphans in both urban and rural environments continue to suffer from the consequential effects of low parental support due to AIDS mortality. These conclusions suggest that specific support to orphans through school and social relationships encourage better development outcomes in sub-Saharan Africa.
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Olanrewaju AD, Jeffery C, Crossland N, Valadez JJ. Access to Education for Orphans and Vulnerable Children in Uganda: A Multi-District, Cross-Sectional Study Using Lot Quality Assurance Sampling from 2011 to 2013. PLoS One 2015; 10:e0132905. [PMID: 26181056 PMCID: PMC4504478 DOI: 10.1371/journal.pone.0132905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study estimates the proportion of Orphans and Vulnerable Children (OVC) attending school in 89 districts of Uganda from 2011 - 2013 and investigates the factors influencing OVC access to education among this population. METHODS This study used secondary survey data from OVCs aged 5 - 17 years, collected using Lot Quality Assurance Sampling in 87 Ugandan districts over a 3-year period (2011 - 2013). Estimates of OVC school attendance were determined for the yearly time periods. Logistic regression was used to investigate the factors influencing OVC access to education. RESULTS 19,354 children aged 5-17 were included in the analysis. We estimated that 79.1% (95% CI: 78.5% - 79.7%) of OVCs attended school during the 3-year period. Logistic regression revealed the odds of attending school were lower among OVCs from Western (OR 0.88; 95% CI: 0.79 - 0.99) and Northern (OR 0.64; 95% CI: 0.56 - 0.73) regions compared to the Central region. Female OVCs had a significantly higher odds of attending school (OR 1.09; 95% CI: 1.02 - 1.17) compared to their male counterparts. When adjusting for all variables simultaneously, we found the odds of school attendance reduced by 12% between 2011 and 2012 among all OVCs (OR 0.88; 95% CI: 0.81 - 0.97). CONCLUSION Our findings reinforce the need to provide continuing support to OVC in Uganda, ensuring they have the opportunity to attain an education. The data indicate important regional and gender variation that needs to be considered for support strategies and in social policy. The results suggest the need for greater local empowerment to address the needs of OVCs. We recommend further research to understand why OVC access to education and attendance varies between regions and improvement of district level mapping of OVC access to education, and further study to understand the particular factors impacting the lower school attendance of male OVCs.
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Affiliation(s)
- Ayobami D. Olanrewaju
- Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Caroline Jeffery
- Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Nadine Crossland
- Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joseph J. Valadez
- Department of International Public Health, Monitoring and Evaluation Technical assistance and Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ssewamala FM, Nabunya P, Ilic V, Mukasa MN, Ddamulira C. Relationship Between Family Economic Resources, Psychosocial Well-being, and Educational Preferences of AIDS-Orphaned Children in Southern Uganda: Baseline Findings. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2015; 2:75-86. [PMID: 26146601 PMCID: PMC4486644 DOI: 10.1007/s40609-015-0027-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examines the relationship between economic resources, psychosocial well-being, and educational preferences of AIDS-orphaned children in southern Uganda. We use baseline data from a sample of 1410 AIDS-orphaned children (defined as children who have lost one or both biological parents to AIDS) enrolled in the Bridges to the Future study, a National Institute of Child Health and Human Development (NICHD) funded study. Analyses from both bivariate and multiple regression analyses indicate the following: 1) despite the well-documented economic and psychosocial challenges AIDS-orphaned children face, many of these children have high educational plans and aspirations; 2) educational aspirations differ by orphanhood status (double orphan vs. single orphan); 3) regardless of orphanhood status, children report similar levels of psychosocial well-being; 4) high levels of family cohesion, positive perceptions of the future, school satisfaction, and lower levels of hopelessness (hopefulness) are associated with high educational aspirations; and 5) reported family economic resources at baseline, all seem to play a role in predicting children's educational preferences and psychosocial well-being. These findings suggest that the focus for care and support of orphaned children should not be limited to addressing their psychosocial needs. Addressing the economic needs of the households in which orphaned children live is equally important. Indeed, in the context of extreme poverty-in which most of the children represented in this study live-addressing structural factors, including poverty, may be a key driver in addressing their psychosocial functioning.
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Affiliation(s)
- Fred M. Ssewamala
- International Center for Child Health and Asset Development, Columbia University School of Social Work, 1255 Amsterdam Avenue, Office 1122, New York, NY 10027, USA
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA
| | - Proscovia Nabunya
- School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, IL 60637, USA
| | - Vilma Ilic
- International Center for Child Health and Asset Development, Columbia University School of Social Work, 1255 Amsterdam Avenue, Office 1122, New York, NY 10027, USA
| | - Miriam N. Mukasa
- International Center for Child Health and Asset Development, Columbia University School of Social Work, 1255 Amsterdam Avenue, Office 1122, New York, NY 10027, USA
- McSilver Institute for Poverty Policy & Research, New York University, 1 Washington Square North, New York, NY 10003, USA
| | - Christopher Ddamulira
- International Center for Child Health and Asset Development, Columbia University School of Social Work, 1255 Amsterdam Avenue, Office 1122, New York, NY 10027, USA
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Hong Y, Chi P, Li X, Zhao G, Zhao J, Stanton B, Li L. Community-based family-style group homes for children orphaned by AIDS in rural China: an ethnographic investigation. Health Policy Plan 2014; 30:928-37. [PMID: 25124083 DOI: 10.1093/heapol/czu093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2014] [Indexed: 11/13/2022] Open
Abstract
As the number of children orphaned by AIDS (Acquired Immunodeficiency Syndrome) has reached 17.3 million, most living in resource-poor settings, interest has grown in identifying and evaluating appropriate care arrangements for them. In this study, we describe the community-based family-style group homes ('group homes') in rural China. Guided by an ecological framework of children's wellbeing, we conducted a series of ethnographic observations, in-depth interviews and group discussions in the rural areas of Henan Province, which has been severely impacted by the AIDS endemic through commercial blood collection. Based on our observations and discussions, group homes appear to provide stable and safe living environments for children orphaned by AIDS. Adequate financial support from non-government organizations (NGOs) as well as the central and provincial governments has ensured a low child-caregiver ratio and attention to the basic needs of the children at group homes. The foster parents were selected from the local community and appear to have adequate qualifications and dedication. They receive a monthly stipend, periodical evaluation and parenting consultation from supporting NGOs. The foster parents and children in the group homes have formed strong bonds. Both children and foster parents reported positively on health and education. Characteristics of community-based group homes can be replicated in other care arrangements for AIDS orphans in resource-poor settings for the optimal health outcomes of those vulnerable children. We also call for capacity building for caregivers and communities to provide sustainable and supportive living environment for these children.
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Affiliation(s)
- Yan Hong
- School of Public Health, Texas A&M University, TX, USA,
| | - Peilian Chi
- Pediatrics Prevention Research Center, School of Medicine, Wayne State University, Detroit, MI, USA, Department of Psychology, University of Macau, Macau Special Administrative Region, China
| | - Xiaoming Li
- Pediatrics Prevention Research Center, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Guoxiang Zhao
- International Research Center for Physical and Psychological Health of Vulnerable Populations, Henan University, Henan, China and
| | - Junfeng Zhao
- International Research Center for Physical and Psychological Health of Vulnerable Populations, Henan University, Henan, China and
| | - Bonita Stanton
- Pediatrics Prevention Research Center, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Li Li
- Center of Community Health, University of California, Los Angeles, CA, USA
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Juma M, Alaii J, Bartholomew LK, Askew I, Van den Born B. Understanding orphan and non-orphan adolescents' sexual risks in the context of poverty: a qualitative study in Nyanza Province, Kenya. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:32. [PMID: 23886019 PMCID: PMC3725178 DOI: 10.1186/1472-698x-13-32] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 07/19/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Some studies show orphanhood to be associated with increased sexual risk-taking while others have not established this relationship, but have found factors other than orphanhood as predictors of sexual risk behaviours and outcomes among adolescents. This study examines community members' perceptions of how poverty influences adolescent sexual behaviour and outcomes in four districts of Nyanza Province, Kenya. METHODS Eight study sites within the four districts were randomly selected. Focus group discussions were conducted with a purposive sample of adolescents, parents and caregivers. Key informant interviews were undertaken with a purposive sample of community leaders, child welfare and healthcare workers, and adolescents. The two methods elicited information on factors perceived to predispose adolescent orphans and non-orphans to sexual risks. Data were analysed through line-by-line coding, grouped into families and retrieved as themes and sub-themes. RESULTS Participants included 147 adolescents and parents/caregivers in 14 focus groups and 13 key informants. Poverty emerged as a key predisposing factor to sexual risk behaviour among orphans and non-orphans. Poverty was associated with lack of food, poor housing, school dropout, and engaging in income generating activities, all of which increase their vulnerability to transactional sex, early marriage, sexual experimentation, and the eventual consequences of increased risk of unintended pregnancies and STI/HIV. CONCLUSION Poverty was perceived to contribute to increasing sexual risks among orphan and non-orphan adolescents through survival strategies adopted to be able to meet their basic needs. Policies for prevention and intervention that target adolescents in a generalized poverty and HIV epidemic should integrate economic empowerment for caregivers and life skills for adolescents to reduce vulnerabilities of orphan and non-orphan adolescents to sexual risk behaviour.
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Affiliation(s)
- Milka Juma
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
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Abstract
According to a growing body of literature, some orphans are at heightened risk of early sexual debut and early marriage. This study examines a rarely explored aspect of orphanhood: the timing and type of parental death and their relationship to these outcomes. The study also explores whether education mediates orphans' risk of early sexual initiation and early marriage. The data are drawn from the 2004 National Survey of Adolescents, which includes interviews with 12-19-year-old adolescents in Burkina Faso, Ghana, Malawi, and Uganda. Results from discrete-time event history analysis indicate that female double orphans, regardless of timing of orphanhood, have greater odds of early sexual debut than do nonorphans. Education explains little of their increased risk. In contrast, male orphans of any type reveal no increased vulnerability to early sexual debut. Uganda is the only country where female orphans, specifically double orphans and those who are paternal orphans before age 10, have greater odds of early marriage, with education accounting for a small portion of the risk.
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Affiliation(s)
- Sophia Chae
- University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
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Mathambo V, Gibbs A. Extended family childcare arrangements in a context of AIDS: collapse or adaptation? AIDS Care 2013; 21 Suppl 1:22-7. [PMID: 22380975 PMCID: PMC2903782 DOI: 10.1080/09540120902942949] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Families are subjected to a number of social, economic, political and demographic challenges. In recent years, the AIDSepidemic has constituted a major challenge for already poor families due to its wide reaching social, economic and health consequences. The devastating consequence of HIV and AIDSis being seen through the prolonged illness and death of family members of prime working age which impacts on family livelihoods and the ability to provide for and protect its members. This paper forms part of a review — commissioned by the Joint Learning Initiative on Children and HIV/AIDS — of qualitative studies of how families in southern Africa have changed, and are changing, as a result of the impact of HIV and AIDS. This paper presents results of how extended family childcare arrangements are changing as a result of the AIDSepidemic. In a southern African context, family denotes a wider array of relations than biological parents and their children — with children growing up amongst a multitude of relations sharing responsibility for their care and upbringing (Chirwa, 2002; Verhoef, 2005). Recently, there has been growing interest in the capacity of the extended family to care for the increasing number of children whose parents have died. However, literature on the role of the extended family in caring for orphaned children remains contradictory. One approach — the social rupture thesis (Chirwa, 2002) — suggests that the extended family network is collapsing under the strain of AIDS. On the other hand, families are portrayed as resilient and dynamic entities which are adapting their systems of childcare in response to the epidemic (Kuo, 2007). In line with Abebe and Aase (2007) and Adams, Cekan, and Sauerborn (1998), this paper proposes a continuum of survival rather than a polarisation of extended family childcare arrangements.
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Affiliation(s)
- Vuyiswa Mathambo
- Child, Youth, Family and Social Development, Human Sciences Research Council, Durban, South Africa.
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Morantz G, Cole D, Vreeman R, Ayaya S, Ayuku D, Braitstein P. Child abuse and neglect among orphaned children and youth living in extended families in sub-Saharan Africa: What have we learned from qualitative inquiry? VULNERABLE CHILDREN AND YOUTH STUDIES 2013; 8:338-352. [PMID: 24563656 PMCID: PMC3929282 DOI: 10.1080/17450128.2013.764476] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Researchers and aid organizations have reported that orphans in sub-Saharan Africa (SSA) are particularly vulnerable to abuse and neglect. This article is a review of qualitative studies that address experiences of maltreatment among orphaned children and youth living in extended families in SSA. It aims to inform policy and programming by providing a better understanding of the types of maltreatment encountered and the perceived risk factors. A literature search was carried out using Google, PubMed, Scholars Portal Search and Scopus. Searches of relevant bibliographies and publications of authors were also undertaken. Studies from peer-reviewed journals and the grey literature were reviewed for relevance and quality. Eligible studies had to include orphans living with extended family in SSA as participants, explore their maltreatment experiences and employ a sound qualitative methodology. Findings were coded, extracted, compared and synthesized. Twenty articles, representing 15 studies, were selected. These studies, from diverse SSAn countries, reported similar forms of maltreatment among orphaned children and youth: experiences of intra-household discrimination; material and educational neglect; excessive child labour; exploitation by family members and psychological, sexual and physical abuse. The perceived risk factors were poverty, living with a non-biological caregiver, stigma and alcohol abuse. The findings of the included studies suggest that awareness, prevention and intervention initiatives aimed to curb child abuse and neglect within communities in SSA are needed and should be coupled with efforts to promote education and reduce poverty and stigma.
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Affiliation(s)
- Gillian Morantz
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Corresponding author.
| | - Donald Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Samuel Ayaya
- School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare Partnership, United States Agency for International Development, Eldoret, Kenya
- Regenstrief Institute, Indianapolis, IN, USA
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Ismayilova L, Ssewamala F, Mooers E, Nabunya P, Sheshadri S. Imagining the future: Community perceptions of a family-based economic empowerment intervention for AIDS-orphaned adolescents in Uganda. CHILDREN AND YOUTH SERVICES REVIEW 2012; 34:2042-2051. [PMID: 23543861 PMCID: PMC3611978 DOI: 10.1016/j.childyouth.2012.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIDS-orphaned children and adolescents in sub-Saharan Africa have inadequate access to basic services, including health and education. Using a qualitative approach, the study explores the meaning of education in rural Uganda, obstacles faced by AIDS-orphaned adolescents and their caregivers to access secondary education, and the potential of an economic empowerment intervention SEED in addressing the challenges of accessing educational opportunities for AIDS-orphaned adolescents. The findings come from 29 semi-structured interviews conducted with eleven adolescents study participants, four caregivers and fourteen community leaders involved in the pilot SEED intervention. Study participants and community members indicated that the savings accounts offer a unique opportunity for orphaned adolescents to stay in school and imagine the future with optimism.
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Affiliation(s)
- Leyla Ismayilova
- University of Chicago, School of Social Service Administration, Chicago, IL
| | - Fred Ssewamala
- Columbia University, School of Social Work, New York, NY
| | - Elizabeth Mooers
- Leitner Center for International Law and Justice, Fordham University School of Law, NY, NY
| | - Proscovia Nabunya
- University of Chicago, School of Social Service Administration, Chicago, IL
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Khanare F. Schoolchildren affected by HIV in rural South Africa: schools as environments that enable or limit coping. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2012; 11:251-9. [DOI: 10.2989/16085906.2012.734985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Guo Y, Li X, Sherr L. The impact of HIV/AIDS on children's educational outcome: a critical review of global literature. AIDS Care 2012; 24:993-1012. [PMID: 22519300 DOI: 10.1080/09540121.2012.668170] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The number of children losing one or both parents to HIV/AIDS has continued to rise in the past decade, with most of them being school-aged children. This study reviews global literature on the effects of HIV/AIDS (e.g., parental HIV-related illness or death) on children's schooling. Systematic review procedures generated 23 studies for examination. Existing studies show educational disadvantages among children affected by AIDS in various educational outcomes, including school enrollment and attendance, school behavior and performance, school completion, and educational attainment. A number of individual and contextual factors potentially moderate or mediate the effect of HIV/AIDS on children's education. These factors include gender of child, pattern of parental loss (maternal vs. paternal vs. dual), living arrangement (relationship with caregivers, gender of the household head), and household poverty. Current literature indicates limitations in number and scope of existing studies and in educational outcome measurements. There is a lack of studies with longitudinal design and data collection from multiple sources (e.g., students, teachers, caregivers), and a lack of studies on the relationship between psychosocial well-being of children affected by AIDS and their educational outcomes. Future studies need to employ more rigorous methodology and incorporate both individual and contextual factors for children affected by AIDS in various regions. More efforts are needed to design and implement culturally appropriate and context-specific approaches to improve the educational outcomes of children affected by AIDS.
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Affiliation(s)
- Yan Guo
- Carman and Ann Adams Department of Pediatrics, Pediatric Prevention Research Center, Wayne State University School of Medicine, Detroit, MI, USA.
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Abstract
Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition-to-adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high-school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested.
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Affiliation(s)
- Sanyu A Mojola
- Department of Sociology, University of Colorado, Boulder, 219 Ketchum Hall, 327 UCB, Boulder, CO 80309, USA.
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Whetten R, Messer L, Ostermann J, Whetten K, Pence BW, Buckner M, Thielman N, O'Donnell K. Child work and labour among orphaned and abandoned children in five low and middle income countries. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11:1. [PMID: 21232140 PMCID: PMC3037885 DOI: 10.1186/1472-698x-11-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/13/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- Rachel Whetten
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Lynne Messer
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Jan Ostermann
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kathryn Whetten
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Brian Wells Pence
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA
| | - Megan Buckner
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nathan Thielman
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, USA
| | - Karen O'Donnell
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Departments of Psychiatry and Pediatrics, Duke University, Durham, NC, USA
- Center for Child and Family Health, Duke University, Durham, NC, USA
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16
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Abstract
Youths ( N = 57; mean age = 13.83 years) residing near Tororo, Uganda, were interviewed to obtain quantitative and qualitative data pertaining to negative life events, adjustment problems, coping, social support, self-worth, and hope. On average, they experienced nearly half of the 22 negative life events assessed. The experience of negative life events related positively to internalizing problems and negatively to social support and self-worth. Coping strategies (problem-focused, positive reframing, avoidance, and support-seeking) were positively associated with hope. Problem-focused coping was negatively related to externalizing problems. Furthermore, social support was positively associated with coping strategies, self-worth, and hope and was negatively related to adjustment problems. The qualitative data shed light on the difficult events the youths endured and what types of coping strategies they used. Ultimately, interviews suggested that youths experienced many negative events, but they remained optimistic.
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17
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Nyirenda M, McGrath N, Newell ML. Gender differentials in the impact of parental death: Adolescent's sexual behaviour and risk of HIV infection in rural South Africa. VULNERABLE CHILDREN AND YOUTH STUDIES 2010; 5:284-296. [PMID: 21270964 PMCID: PMC3024847 DOI: 10.1080/17450128.2010.507804] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 06/07/2010] [Indexed: 05/26/2023]
Abstract
Using data from a longitudinal surveillance study from rural South Africa, we investigated the odds of sexual debut, pregnancy and HIV infection of 15- to 19-year-old adolescents by parental survival. Using descriptive statistics and logistic regressions, we examine the relative risk of orphans compared with non-orphans to have ever had sex, being pregnant and being HIV infected, adjusting for age, sex, socio-economic status, education, being employed and residency. Of 8274 adolescents, 42% were orphaned (one or both parents died). Over 80% of adolescents remained in school, but orphans were significantly more likely to lag behind in grade for age. Female adolescent maternal (aOR 1.32, 95% CI 1.071.62), paternal (aOR 1.26, 95% CI 1.061.49) and dual (aOR 1.37, 95% CI 1.051.78) orphans were significantly more likely than non-orphaned females to have ever had sex; among males it was only paternal (aOR 1.27, 95% CI 1.051.53) orphans. Maternal (aOR 1.49, 95% CI 1.032.15) and dual (aOR 1.74, 95% CI 1.112.73) female orphans relative to non-orphaned females were significantly more likely to be HIV infected; male paternal (aOR 3.41, 95% CI 1.378.46) and dual (aOR 3.54, 95% CI 1.0611.86) orphans had over three-fold the odds of being infected. There was strong evidence that death of mother for girls was associated with increased vulnerability to earlier sexual debut and HIV infection, while fathers appeared to play a significant role in both their son's and daughter's lives.
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Affiliation(s)
- Makandwe Nyirenda
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, PO Box 198, Mtubatuba 3935, South Africa
| | - Nuala McGrath
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, PO Box 198, Mtubatuba 3935, South Africa
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Marie-Louise Newell
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, PO Box 198, Mtubatuba 3935, South Africa
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
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18
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Hong Y, Li X, Fang X, Zhao G, Zhao J, Zhao Q, Lin X, Zhang L, Stanton B. Care arrangements of AIDS orphans and their relationship with children's psychosocial well-being in rural China. Health Policy Plan 2010; 26:115-23. [PMID: 20587602 DOI: 10.1093/heapol/czq025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There is an estimated 100,000 children orphaned by AIDS in China, but data on the care arrangement of these orphans are limited. In this study, we examine the relationship between AIDS orphans' care arrangement and their psychosocial well-being among a sample of AIDS orphans in rural China. A total of 296 children who lost both parents to AIDS participated in the study, including 176 in orphanages, 90 in kinship care and 30 in community-based group homes. All participants completed a cross-sectional survey assessing their traumatic symptoms, physical health and schooling. Data reveal that the AIDS orphans in group homes reported the best outcomes in three domains of psychosocial well-being, followed by those in the orphanages and then the kinship care. The differences in psychosocial well-being among the three groups of children persist after controlling for key demographic characteristics. The findings suggest that the appropriate care arrangement for AIDS orphans should be evaluated within the specific social and cultural context where the orphans live. In resource-poor regions or areas stricken hardest by the AIDS epidemic, kinship care may not sufficiently serve the needs of AIDS orphans. Community-based care models, with appropriate government and community support preserving the family style and low child-to-caregiver ratio may constitute an effective and sustainable care model for the best interest of the AIDS orphans in developing countries.
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Affiliation(s)
- Yan Hong
- Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843, USA.
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19
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Delva W, Vercoutere A, Loua C, Lamah J, Vansteelandt S, De Koker P, Claeys P, Temmerman M, Annemans L. Psychological well-being and socio-economic hardship among AIDS orphans and other vulnerable children in Guinea. AIDS Care 2009; 21:1490-8. [DOI: 10.1080/09540120902887235] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Wim Delva
- a International Centre for Reproductive Health , Ghent University , Ghent , Belgium
- b South African Centre for Epidemiological Modelling and Analysis , Stellenbosch , South Africa
| | - An Vercoutere
- c Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
- d Fondation Elizabeth Cathy (FELICA) , Conakry , Guinea
| | | | - Jonas Lamah
- d Fondation Elizabeth Cathy (FELICA) , Conakry , Guinea
| | - Stijn Vansteelandt
- e Department of Applied Mathematics and Computer Science , Ghent University , Ghent , Belgium
| | - Petra De Koker
- a International Centre for Reproductive Health , Ghent University , Ghent , Belgium
| | - Patricia Claeys
- a International Centre for Reproductive Health , Ghent University , Ghent , Belgium
| | - Marleen Temmerman
- a International Centre for Reproductive Health , Ghent University , Ghent , Belgium
| | - Lieven Annemans
- f Department of Public Health , Ghent University , Ghent , Belgium
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20
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Abstract
There is a large amount of research into maternal health as a health issue, but maternal health as a development issue has been less explored. This Review analyses the evidence from the past 20 years on the links between maternal health and development to examine maternal health within a development framework. We note that although existing evidence suggests that these links are strong, further research is needed to definitively substantiate how and to what extent maternal health and development affect each other. Further, we find that progress and investment in maternal health have lagged far behind estimates of what is needed to achieve the Millennium Development Goals.
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Affiliation(s)
- Kirrin Gill
- International Center for Research on Women, Washington, DC 20036, USA
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