Anne Skalicky

Exploring the Cinderella myth: intrahousehold differences in child wellbeing between orphans and non-orphans in Amajuba District, South Africa.

Objective:To determine whether differences in wellbeing (defined by a variety of education and health outcomes) exist between recent school-aged orphans and non-orphans who live in the same household in a context of high HIV/AIDS mortality in KwaZulu Natal, South Africa. Design:The data come from the first 2 years (2004–2006) of an ongoing 3-year longitudinal cohort study in a district in KwaZulu-Natal, the Amajuba Child Health and Well-being Research Project. Using stratified cluster sampling based on school and age, we constructed a cohort of 197 recent orphans and 528 non-orphans aged 9–16 years and their households and caregivers. Household heads, caregivers, and children were interviewed regarding five domains of child wellbeing: demographic, economic, educational, health/nutrition/lifestyle, and psychosocial status. Methods:The analytical sample consists of 174 children (87 orphans and 87 comparable non-orphans who live together) at baseline and 124 children in round 2. We estimated a linear regression model using household fixed effects for continuous outcomes (grade adjusted for age, annual expenditure on schooling and body mass index) and a logit model using household fixed effects for categorical variables (malnutrition) to compare co-resident orphans and non-orphans. Results:We found no statistically significant differences in most education, health and labour outcomes between orphans and the non-orphans with whom they live. Paternal orphans are more likely to be behind in school, and recent mobility has a positive effect on schooling outcomes.

Vulnerability of orphan caregivers vs. non-orphan caregivers in KwaZulu-Natal

Abstract Using data from a cohort of schoolgoing children, their households and caregivers (the Amajuba Child Health and Wellbeing Project, ACHWRP) in KwaZulu-Natal, South Africa, we compared demographic characteristics, care burden, health, physical function and social capital of caregivers of orphans (n = 300) with those of non-orphans (n = 298). This analysis presents cross-sectional findings from questions for caregivers that were added for the studys second round, conducted between September 2005 and June 2006. Caregivers of all children were overwhelmingly women (87%). Compared to non-orphan caregivers, caregivers of orphans were on average older (49.5 vs. 45.2 years, p = 0.0002), had fewer years of education (6.7 vs. 7.8 years, p = 0.0042) and were less likely to be married or cohabiting (29% vs. 46%; p < 0.0001). Caregivers of orphans reported caring for more children than those of non-orphans (4.8 vs. 3.8 children, p < 0.0001). A larger proportion of orphan caregivers reported having cared for an ill adult in the previous year (28% vs. 19%), and for that adult to have been a biological child (p = 0.0531). There was a high prevalence (55%) of self-reported poor health among all caregivers; caregivers of orphans were more likely to report poor general health and chronic illness. Although there was a high prevalence of functional impairment (self-reported inability to perform primary activity) among all caregivers (59%), there was no difference between groups. In terms of social capital, although similar proportions of orphan and non-orphan caregivers reported having friends outside the household, orphan caregivers were less likely to have a source of a small emergency loan [51% vs. 63%; adjusted odds ratio: 0.60 (0.41–0.88)]. Our results suggest that orphan caregivers are indeed more vulnerable, and that their particular limitations and needs must be considered when developing strategies for assisting vulnerable households to ensure better support for both caregivers and the children in their care.

Longitudinal evaluation of the psychosocial well-being of recent orphans compared with non-orphans in a school-attending cohort in KwaZulu-Natal, South Africa

To assess differences in psychosocial well-being between recent orphans and non-orphans, we followed a cohort of 157 school-going orphans and 480 non-orphans ages 9–15 in a context of high HIV/AIDS mortality in South Africa from 2004 to 2007. Several findings were contrary to the published evidence to date, as we found no difference between orphans and non-orphans in anxiety/depression symptoms, oppositional behavior, self-esteem, or resilience. Female gender, self-reported poor health, and food insecurity were the most important predictors of childrens psychosocial well-being. Notably, girls had greater odds of reporting anxiety/depression symptoms than boys, and scored lower on self-esteem and resilience scales. Food insecurity predicted greater anxiety/depression symptoms and lower resilience. Perceived social support was a protective factor, as it was associated with lower odds of anxiety/depression symptoms, lower oppositional scores, and greater self-esteem and resilience. Our findings suggest a need to identify and strengthen psychosocial supports for girls, and for all children in contexts of AIDS-affected and economic adversity.

Early impacts of orphaning: Health, nutrition, and food insecurity in a cohort of school-going adolescents in South Africa

We recruited a cohort of 157 recent orphans and 480 non-orphans aged 9–15 in a region of high HIV/AIDS mortality in South Africa using stratified cluster sampling to determine the impact of recent parental death on health and food insecurity of school-going orphans compared to non-orphans over time. Between September 2004 and June 2007, household heads, caregivers, and children were interviewed at three annual intervals. Bivariate associations and multivariate models were assessed using generalized estimating equations (GEE). In the health domain, compared to non-orphans, double orphans were more likely to report worse health status and being very ill in the previous 12 months. For those who reported being very ill, maternal or paternal orphans were more than twice as likely not to seek care than non-orphans; no differences were found for double orphans. For nutrition and food insecurity, maternal or paternal orphans were more likely not to have eaten dinner and to have gone to bed hungry the previous night compared to non-orphans; no differences were found for double orphans. Overall, recent school-aged orphans were disadvantaged in health and food insecurity within two years after the death of a parent, compared to their non-orphaned counterparts, but the disparities were smaller than expected. No changes in health, nutritional status, or food insecurity were apparent over the three study rounds. Longer term effects into adulthood may well be more pronounced and warrant careful longitudinal investigation.

Household dynamics and socioeconomic conditions in the context of incident adolescent orphaning in KwaZulu-Natal, South Africa

We compared demographics, socioeconomic status, and food insecurity between households with and without recent orphans in a region of high HIV/AIDS mortality in South Africa. We recruited a cohort of 197 recent orphans and 528 non-orphans aged 9–15 years and their households using stratified cluster sampling. Households were classified into three groups: orphan-only (N = 50), non-orphan-only (N = 377), and mixed (N = 210). Between September 2004 and May 2007, households were interviewed three times regarding demographics, income and assets, and food insecurity. Baseline bivariate associations were assessed using chi-square test and t-test. Longitudinal bivariate associations and multivariate models were tested using generalized estimating equations. At baseline, mixed households generally exhibited greater characteristics of vulnerability than orphan-only and non-orphan-only households. They were larger, had older, less-educated household heads, and reported a much smaller annual per capita income. Orphan households were more likely to report a death in the previous year and less likely to have an adult employed. These differences persisted over the study. Even non-orphan-only households exhibited characteristics of vulnerability, with 14% reporting a death one year before baseline, 45% of whom were prime-age adults. At baseline, a much smaller proportion of orphan households reported receiving the child support grant than the other household types, but notably, there were no differences among households in receipt of the grant by Round 3. Household food insecurity was highly prevalent: more than one in five orphan-only and mixed households reported being food insecure in the previous month. These findings suggest that the effects of HIV/AIDS only exacerbate existing high levels of poverty in the district, as virtually all households are vulnerable regardless of orphan status. Community-level programs must help families address a spectrum of needs, including food security, caregiving, and financial support, as well as better target social welfare grants and make them more accessible to vulnerable households.

Challenges of developing a district child welfare plan in South Africa: lessons from a community-engaged HIV/AIDS research project:

The Amajuba Child Health and Wellbeing Research Project measured the impact of orphaning due to HIV/AIDS on South African households between 2004 and 2007. Community engagement was a central component of the project and extended through 2010. We describe researcher engagement with the community to recruit participants, build local buy-in, stimulate interest in study findings, and promote integration of government social welfare services for families and children affected by HIV/AIDS. This narrative documents the experience of researchers, drawing also on project reports, public documents, and published articles, with the objective of documenting lessons learned in this collaboration between researchers from two universities and a community in South Africa during a period that spanned seven years. This experience is then analyzed within the context of an applied research, community-engagement framework.