Community‐Based Caregiver and Family Interventions to Support the Mental Health of Orphans and Vulnerable Children: Review and Future Directions

Orphan discipline and child neglect: An analysis from 48 countries

BACKGROUND

Orphans comprise a sizable sub-population of all children, and their status as orphans exposes them to many risk factors. Orphan exposure to violent discipline is poorly understood, as research on parents' disciplinary practices largely focuses on biological families. The little research that exists has found that orphans are at reduced risk of harsh discipline but fails to explain why.

OBJECTIVE

To assess, from a global perspective, orphans' odds of experiencing physical, psychologically aggressive, and nonviolent discipline, compared to non-orphans, and to investigate why discipline of orphans differs from other children.

PARTICIPANTS AND SETTINGS

This study uses 56 UNICEF Multiple Indicator Cluster Survey samples from 48 countries to assess the disciplinary experiences of 5- to 14-year-old children. Separate analyses on a subset of single and double orphans identify their risk factors for violent discipline.

METHODS

Multilevel logistic regressions were used to estimate odds of experiencing each type of discipline in the last thirty days.

RESULTS

All categories of orphans (maternal, paternal, and double) are at reduced odds of experiencing any form of discipline relative to non-orphans. In the case of physical discipline, this disparity appears to be due to caregiver neglect rather than sensitivity toward orphans.

CONCLUSIONS

Orphan caregivers should be given strategies and support to reduce their stress and alleviate their risk of becoming neglectful of their charges, alongside family education about healthy disciplinary practices.

Approaches for psychosocial support towards orphans and vulnerable children by community-based workers in the Vhembe district, South Africa

INTRODUCTION

The orphan and vulnerable children crisis has raised the need for alternative solutions to their problems. These new alternatives gave prominence to the growth of community-based organisations and their interventions. Community-based interventions are a crucial component of the response to ensure that the demands of orphans and vulnerable children are mitigated as they offer initial support and act as well-being nets.

METHODS

A qualitative exploratory-descriptive and contextual design was used to explore possible approaches to psychosocial support for orphans and vulnerable childen from community-based workers. This study was conducted in four municipalities in the Vhembe district: Thulamela, Makhado, Collins Chabane, and Musina. The population consisted of community-based workers working with vulnerable and orphaned children in the Vhembe district. Data were collected in focus group discussions with the community-based workers using a focus group discussion guide with open-ended questions. The data were analysed according to Tesch's open analysis guide to analyse qualitative data. The measures to ensure trustworthiness included transferability, conformability, credibility, and dependability.

RESULTS

Data analysis generated the following theme and subthemes: Psychosocial interventions provided included Physical support, educational support, psycho-educational support, activities and socialisation, caregivers support and involvement and inter-professional referral.

CONCLUSION

These findings provide an insight into the types of psychosocial support interventions provided by Community-based organisations to orphans and vulnerable children. Conversely, the study also revealed that community-based organisations are experiencing challenges when delivering those services to orphans and vulnerable children.

Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan African countries

BACKGROUND

Adverse childhood experiences (ACEs) include forms of abuse, neglect, and household stressors that are potentially early life traumatic experiences. A summed integer count of ACEs is often used to examine cumulative childhood adversity (CCA) but has limitations.

OBJECTIVES

The current study tests two additional methods for measuring CCA using large samples of youth in low- and middle-income countries.

PARTICIPANTS AND SETTING

Pooled data were analyzed from a multi-country, nationally representative sample of youth aged 18-24 years (N = 11,498) who completed the Violence Against Children and Youth Surveys (VACS) in Lesotho, Cote d'Ivoire, Kenya, Namibia, and Mozambique.

METHODS

ACE exposures included: physical, sexual, and emotional violence; witnessing interparental violence; witnessing community violence; orphanhood. CCA was operationalized using an ACE score, ACE impact (standardized regression coefficients from outcome severity), and ACE exposure context (household; intimate partner; peer; community). Associations between CCA with mental distress (MD) were examined by sex using p ≤ 0.05 as the significance level.

RESULTS

Exposure to ≥3 ACEs was associated with MD (p < 0.05) for both sexes. Among females, all contexts contributed to MD except peer ACEs (p < 0.05). Among males, household and community ACEs contributed to MD. High-impact ACEs were associated with MD both sexes. ACE context was the best-fitting model for these data.

CONCLUSIONS

The challenges operationalizing CCA warrant continued research to ensure adversity type, severity, and context lead to validly assessing ACEs impact on child wellbeing.

In utero/peripartum antiretroviral therapy exposure and mental health outcomes at 8-18 years old: A longitudinal comparative study of children with perinatally acquired HIV, children perinatally HIV exposed but uninfected, and children unexposed uninfected from Uganda

In utero/peripartum antiretroviral therapy (IPA) exposure type was examined in relationship to mental health symptoms among 577 children with perinatally acquired HIV (CPHIV), children perinatally HIV exposed but uninfected (CHEU), and children HIV unexposed uninfected (CHUU). IPA exposure was categorized for CPHIV and CHEU as none, single-dose nevirapine with or without zidovudine (sdNVP±AZT), sdNVP+AZT+lamivudine (3TC), or combination antiretroviral therapy (cART). Anxiety and depressive symptoms were reported at baseline, 6-, and 12-month follow-up per behavioral assessment system for children. Multivariable linear mixed models were used to estimate differences (b) with 95% confidence intervals (95% CI) for IPA exposure types versus CHEU without IPA exposure. Depressive and anxiety symptoms were lower in CHUU relative to CHEU and CPHIV but did not differ between CPHIV and CHEU. CHEU with sdNVP±AZT exposure had greater anxiety (b = 0.51, 95% CI: [0.06, 0.96]) and depressive symptoms (b = 0.48, 95% CI: [0.07, 0.89]) than CHEU without IPA exposure. CHEU with sdNVP+AZT+3TC exposure had higher anxiety (b = 0.0.45, 95% CI: [0.03, 0.86]) and depressive symptoms (b = 0.72, 95% CI: [0.27, 1.17]) versus CHEU without IPA exposure. Depressive and anxiety symptoms were not different for CHEU and CPHIV exposed to cART (b = 0.12-0.60, 95% CI: [-0.41, 1.30]) and CHEU and CHUU (b = -0.04 to 0.08, 95% CI: [-0.24, 0.29]) without IPA exposure. Among CHEU, peripartum sdNVP±AZT and sdNVP+AZT+3TC but not cART compared to no IPA exposure was associated with clinically important elevations in anxiety and depressive symptoms. Monitoring of mental health trajectory of HIV-affected children considering IPA is needed to inform mental health interventions. Patient Contribution: Caregivers and their dependents provided consent for participation and collaborated with study team to identify mutually convenient times for protocol implementation.

Sexual Health Behaviors and Knowledge Among Ugandan Adolescent Girls: Implications for Advancing Comprehensive Sexual Health Education Technology

Background

Adolescent girls in Uganda have four-fold HIV infections than adolescent boys. Several barriers to accessing comprehensive sexual health education exist for adolescent girls in Uganda, including unequal, social, and economic statuses, limited access to education and health care services, discrimination, and violence.

Objective

This study qualitatively examines sexual health behaviors and literacy among Ugandan adolescent girls and explores how technology may be leveraged to improve sexual and reproductive health outcomes in this population.

Methods

Four focus group discussions (FGDs) were conducted among 32 adolescent girls aged 14-17 years enrolled in Suubi mHealth. Participants were randomly selected from four secondary schools participating in a randomized clinical trial known as Suubi4Her (N = 1260). FGDs were conducted in the local language, audio-recorded, transcribed verbatim, and translated. Translated transcripts were imported into Dedoose for data management and coding. Emerging themes included Influences for Sex/Relationships, HIV Knowledge, and Sources of Sexual Health Information.

Results

Participants reported common influences for sexual engagement included seeking resource security, limited parental communication, and peer influences. Participants also demonstrated knowledge gaps, requesting information such as how to prevent unplanned pregnancies and HIV, endorsing sexual health myths, and describing limitations to accessing sexual health information.

Conclusions

Noticeable inconsistencies and limited access to information and resources regarding basic sexual health knowledge were reported, which inevitably increases adolescent girls' risks for adverse sexual and reproductive health outcomes. Developing culturally appropriate interventions may help advance the sexual and reproductive health needs of Ugandan adolescent girls.

Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda

Background

Children in Sub-Saharan Africa are burdened by significant unmet mental health needs. Across the region, high rates of poverty, HIV/AIDS, food insecurity, stigma, and an inadequate health safety net system exacerbate serious child behavioral health needs and impede an effective response. Disruptive behavioral disorders are particularly concerning as they persist through adolescence and adulthood. Hence, addressing the context-specific social influences on child behavioral health is critical given that children in the region comprise more than half of the total regional population. Against this backdrop, this study protocol describes a randomized clinical trial that will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial, and context-specific drivers affect the mental health of children in Uganda.

Methods

The study uses an experimental, longitudinal design across 30 cluster-randomized primary schools to compare single and combination intervention options; influences of economic empowerment and family strengthening on economic, perceptual, and functioning mediators; and context-specific moderators. The study will be conducted with 900 Ugandan children in mid-upper primary school (10-14 years). The three study conditions (n = 300 each) are: (1) economic empowerment only (EE only), (2) multiple family group-based family strengthening only (MFG-based FS only), and (3) combined EE + MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24, and 36 months.

Conclusion

Children in Sub-Saharan Africa are burdened by significant unmet mental health needs, including disruptive behavior disorders that persist through adolescence and adulthood if left untreated. The proposed study will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial and context-specific drivers affect the mental health of children in mid-upper primary schools in Uganda. Findings from this study can inform group, community, and population approaches that are needed for scalable solutions to address the social drivers negatively impacting child behavioral health in low-resource settings, including in Sub-Saharan Africa.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT053 68714].

Intervention effect of group counseling on social support and post-stress growth of orphans and vulnerable children in China

Orphans and vulnerable children fall under the category of children who are at risk of exposure to more stressful circumstances and receive less social assistance compared to other children. This study aims to investigate the impact of group counseling based on social intervention and psychological therapy (SSGPC) on social support and the perceived stress growth of orphans and vulnerable children. In one special educational needs school in Nanning, China, the SSGPC was developed and implemented. Using the social support and post-stress growth scales, the researchers investigated the effects of SSGPC on orphans and vulnerable children. Twenty-seven orphans and vulnerable children between the ages of nine and 12 were arbitrarily assigned to the experimental and control groups. A pre-test post-test method of quasi-experimental design was applied, with 13 participants in the experimental group and 14 in the control group. The results revealed that the intervention group had significantly higher scores for social support and post-stress growth than the control group. The SSGPC had significantly improved the levels of social support for orphans. The findings indicated that the SSGPC provided an effective way to improve social support and post-stress growth of orphans and vulnerable children.