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The well-being of children affected by HIV/AIDS in Lusaka, Zambia, and Gitarama Province, Rwanda:
Findings from a study
Minki Chatterji, Leanne Dougherty, Tom Ventimiglia, Yvonne Mulenga, Andrew Jones, Antoinette Mukaneza, Nancy Murray, Kathy Buek, William Winfrey, and Joseph Amon
Futures Group
April 2005
SARPN acknowledges the www.futuresgroup.com website as the source of the document.
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Introduction
In sub-Saharan Africa an estimated 12 million children under the age of 18 have lost one or both parents to AIDS (UNAIDS, UNICEF, USAID, 2004). Many more children live with one or more chronically ill parent. Despite the recognition of the magnitude and significant health, economic, social, and psychological consequences of this problem, and increasing attention and resources devoted to these children, few evidence-based answers are available to such basic questions as “which children are in the greatest need of assistance?,” “what interventions are most effective?,” and “which approaches are most appropriate in the different settings in which AIDS epidemics are seen?” Thus, donors, policymakers, and program managers have often been forced to make decisions regarding allocation of scarce resources for orphans, children with chronically ill parents, and other children affected by HIV/AIDS using little evidence about which children are most in need of assistance and what types of interventions would be
most effective in helping them.
The Community REACH program is conducting an effectiveness study of selected interventions targeting orphans and children ages 6–19 with chronically ill caregivers.1 This research is being implemented in collaboration with Community REACH grantees CARE Rwanda, Bwafwano, and PCI Zambia. Community REACH has also produced a companion report entitled, A Costing Analysis of Community Based OVC Programs: Results from Rwanda and Zambia, which provides information regarding the costs of these service delivery programs.
Objective of the report
The objective of this report is to analyze data from the first round of data collection in 2003 to compare differences in measures of educational, socioeconomic, health and nutritional, and psychological wellbeing among three groups of children in the comparison sample only: 1) orphans, 2) children who are not orphans, but have a chronically ill parent or caregiver, and 3) other children. This study does not use data relating to children from intervention households because these children were already exposed to interventions for 6–12 months prior to the survey and thus may have already derived positive benefits from the interventions.
As programs for orphans and children with chronically ill caregivers are designed in accordance with the belief that these groups of children are disadvantaged relative to other children, exploring differences among these groups is critical. Examining the variation in measures of well-being among these three groups of children will also suggest what types of children should be targeted and what criteria should be used by NGOs starting new programs or scaling up existing programs. Future research will examine the effectiveness of specific interventions.
The research questions examined in this report are:
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Do households with orphans and/or children ages 6–19 with a chronically ill caregiver have lower socioeconomic status than households that do not have orphans or children with a chronically ill caregiver in this age group?
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Do orphans and children with a chronically ill caregiver ages 6–19 have lower levels of educational, socioeconomic, health and nutritional, and psychological well-being as compared to other children in the same age group?
Methods
The research design used for the overall intervention effectiveness study is a modified quasi-experimental pre-test/post-test study design. In the design, which includes a baseline (reported here) and an endline survey, intervention group households with orphans or children with a chronically ill parent or caregiver receiving interventions (selected from project registers) will be compared to a comparison group of households selected using a “nearest neighbor” approach. The first round of data collection was
conducted in mid-2003, and the same respondents will be interviewed in mid-2005. This report is based on analysis of data from the first round of data collection and only includes the comparison sample respondents.
The Zambia data used for the analyses in this paper includes 496 primary caregivers, 504 children ages 6–12, and 563 adolescents ages 13–19. The Rwanda data used for this report has 570 primary caregivers, 656 children ages 6–12, and 402 adolescents ages 13–19. Data were cleaned and analyzed using SPSS software.
For the analyses of the education, socioeconomic, and health and nutrition data, bivariate analyses and Pearson chi-square tests were used to test associations among the groups of children and various measures of well-being. Household-level socioeconomic measures were also calculated using standard of living indices (SLI). Scales intended to measure various aspects of psychological well-being were constructed, and the reliability of these scales was assessed using the internal consistency method.
Footnote:
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The Community REACH program conducted the baseline survey, and the endline survey will be implemented by MEASURE
Evaluation.
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