Tài liệu A baseline study on psychosocial support of orphans and vulnerable children in two villages in Botswana docx

Tables and figures ivAcronyms and abbreviations v Acknowledgements vi Executive summary vii ฀฀฀฀฀ The situation of orphans in sub-Saharan Africa 1 Overview of the OVC situation in Botswa

A baseline study on psychosocial support

of orphans and vulnerable children in two

Compiled by the Masiela Trust Fund’s OVC Research Unit, Botswana, in collaboration with the Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, South Africa

© 2007 Human Sciences Research Council and Masiela Trust Fund

Copyedited by David Le Page

Typeset by Simon van Gend

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Tables and figures iv

Acronyms and abbreviations v

Acknowledgements vi

Executive summary vii

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The situation of orphans in sub-Saharan Africa 1

Overview of the OVC situation in Botswana 1

Government response to the plight of orphans 2

Background to the OVC project 4

Objectives of the study 5

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Description of study sites 6

Populations and samples 8

Orphans and vulnerable children ages 6–14: Survey findings 12

Discussion of findings: OVC ages 6–14 in Palapye 15

OVC ages 15–18 in Palapye: Survey findings 18

Discussion of findings: OVC ages 15–18 in Palapye 24

Parents/guardians of OVC in Palapye: Survey findings 27

Perceptions of HIV/AIDS and other health-related issues 29

Discussion of findings: Parents/guardians of OVC in Palapye 30

Orphans and vulnerable children ages 6–14: Survey findings 32

Discussion of findings: OVC ages 6–14 in Letlhakeng 35

OVC ages 15–18 in Letlhakeng: Survey findings 36

Discussion of findings: OVC ages 15–18 in Letlhakeng 42

Parents/guardians of OVC in Letlhakeng: Survey findings 43

Perceptions of HIV/AIDS and other health-related issues 45

Discussion of findings: Parents/guardians of OVC in Letlhakeng 46

Table 3.1: What OVC 15–18 in Palapye miss about their late mothers – percentage

distribution by gender 21Table 3.2: Quality of relationships between OVC 15–18 and their guardians, in

Palapye 21Table 3.3: Primary confidants of OVC ages 15–18 in Palapye 23

Table 3.4: Most common health problems mentioned by OVC 15–18 in

Palapye 24Table 3.5: Employment status categories of parents and guardians of OVC in

Palapye 28Table 3.6: Key needs of OVC in Palapye, as identified by parents/guardians 28Table 4.1: OVC 15–18 in Letlhakeng: Household resources 38

Table 4.2: Primary confidants of OVC ages 15–18 in Letlhakeng 39

Table 4.3: Factors leading OVC in Letlhakeng to feel hopeful about life 40

Table 4.4: Employment status of parents and guardians in Letlhakeng 44

Table 4.5: Key OVC needs described by parents and guardians in Letlhakeng 45

Figure 1.1: Trends and patterns of registered orphans from 1999–2004 2

Figure 1.2: Specific needs of orphans and vulnerable children 4

Figure 2.1: Map of Botswana 6

Figure 3.1: OVC 15–18 in Palapye: Reasons for not attending school, by gender 19 Figure 4.1: OVC 15–18 in Letlhakeng: Reasons for not attending school, by gender 37

CBO community-based organisations

FBO faith-based organisation

HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

HSRC Human Sciences Research Council

IEC information, education and communication

OVC orphans and vulnerable children

PMTCT prevention of mother to child transmission (of HIV/AIDS)

SADC Southern African Development Community

SPSS Statistical Package for Social Sciences

STI sexually transmitted infection

VCT voluntary counselling and testing (for HIV/AIDS)

The researchers and authors of the document, Dr GN Tsheko, Mr K Bainame, Ms M Segwabe and Dr LW Odirile would like to thank all those who made it possible for this work to be completed This study was supported by the Kellogg Foundation and undertaken by Masiela Trust Fund OVC Research-Botswana under the umbrella of the HSRC in South Africa The researchers are indebted to the field assistants, all respondents, and community leaders in Palapye and Letlhakane who participated in this study

A special thanks goes to Dr K Solo and Ms G Moalosi who were involved with the original drafting of the report

We cannot stop thanking the staff at Masiela Trust Fund for the support they provided during the study period

This study describes a baseline psychosocial survey conducted in two communities in

Botswana, in preparation for a five-year intervention project intended to help orphans

and vulnerable children (OVC) in these communities

The Human Sciences Research Council (HSRC), together with its research partners within

the Southern African Development Community (SADC) region (the University of Botswana

and the Botswana Harvard Partnership in Botswana as well as the National Institute

of Health Research [formerly Blair Research Institute] and the Biomedical Research &

Training Institute‘s Centre for International Health and Policy in Zimbabwe) have been

commissioned by the WK Kellogg Foundation (WKKF) to develop and implement a

five-year intervention project for OVC commencing in 2003 The project is intended to assist

families and households coping with an increased burden of care for affected children

in Botswana, South Africa and Zimbabwe The HSRC chose the Masiela Trust Fund as a

grant maker to work with researchers from the University of Botswana The Masiela Trust

Fund in turn selected various community-based organisations (CBOs) and faith-based

organisations (FBOs) to implement the appropriate interventions at all the identified sites

The general aim of the project is to ease the increased burden of care for OVC The

purpose of the psychosocial survey (PSS) was to gather baseline OVC data to facilitate the

introduction and evaluation of the effectiveness of orphan care intervention programmes

for strengthening community participation and empowerment of OVC in two research

sites in Botswana This information will be used in evaluating the effectiveness of the

new OVC interventions that will be implemented in the two sites in Botswana as part of

the overall OVC project

The two research sites are Palapye in the Serowe/Palapye sub-district and Letlhakeng in

the Kweneng West district The sample for the study was randomly selected using the

census data that was collected prior to the PSS survey Instruments for data collection

were questionnaires for 6–14 years, 15–18 years and one for parents/ guardians All

instruments were adapted from the generic one compiled by HSRC

A total of 828 parents/guardians of OVC were interviewed, 505 in Palapye and 323 in

Letlhakeng The pattern of responses in Palapye and Letlhakeng were very similar The

majority of parents/guardians for OVC were mostly females This means that the majority

of caregivers are females and it is possible that the majority of these households are

female headed Female-headed households are generally characterised by poverty The

findings of the study also show high levels of illiteracy among the study population with

only a few of the respondents reaching tertiary level This reflected in the fact that most

of the guardians do not have proper jobs and depend on temporary jobs, farm work and

other jobs that do not bring enough income for the caregivers to cater for all the children

in their care Having insufficient money, caregivers are not always able to provide for the

basic things that are needed for survival

A majority of the parents/guardians reported that they had heard about HIV/AIDS

Both parents and guardians reported an increase in the number of both orphans and

vulnerable children living in their neighbourhood HIV/AIDS was cited as the main reason

for the increase of OVC Misconceptions about HIV/AIDS obviously persist, as some

claimed they could tell whether someone is infected just by looking at them

In Palapye, a total of 258 children aged 6–14 years were interviewed and in Letlhakeng,

84 Most of the children are in school (90% in Palapye and 70% in Letlhakeng) Reasons

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commonly given for not being in school included lack of funds, having completed school

or being under age The claims of some of those respondents to have completed school were questionable, as most people do not finish at 14 years This probably means the OVC in question did not do well during their Junior Certificate Examinations, and they needed to be supported to continue beyond Junior Certificate The underlying causes

of non-school attendance need to be investigated in an effort to promote access to education for all children of school-going age

The study revealed both the negative and positive aspects of the respondents’ emotional wellbeing Feelings of happiness, of being hopeful about the future and good relations between respondents and their guardians where guardians encourage OVC positively have all been noted All these reported positive feelings play an important role in the respondents’ over emotional wellbeing

For the age group 15–18 years, 139 children were interviewed in Palapye while 77 were interviewed in Letlhakeng A majority of these children were in school (77% in Palapye and 55% in Letlhakeng) A large majority of those who were not in school explained this

by saying that they had failed

Despite the positives noted, the study showed that OVC’s go through a lot of negative emotional phases in their everyday lives Feelings of unhappiness, worry, trouble falling asleep, frustration and anger were all noted at high percentages (exceeding 40 per cent) The study concludes that conditions under which children live in the households

surveyed are mostly conducive to well-being, save for those children who live in

households that are headed by elderly females – where there are inadequate resources and children are often short of food and money The study further concludes that the cultural and traditional norms of inheritance are entrenched and work to the disadvantage

of children who have lost parents This is particularly common in those cases where children are still young and there is no consultation

The situation of orphans in sub-Saharan Africa

The AIDS epidemic has created an estimated 15 million orphans worldwide Eighty per

cent of these orphans live in Sub-Saharan Africa (Kanabus & Fredriksson 2004) Tragically,

the number of orphans in Sub-Saharan Africa will continue to rise in the years ahead

This is partly due to the high proportion of adults in the region already living with HIV/

AIDS, and the continuing difficulties in expanding access to life-prolonging antiretroviral

treatment (UNICEF 2003) In Zambia, one of the countries hardest hit by the HIV/AIDS

epidemic, the traditional mechanism for the care of vulnerable children, the extended

family, has started to break down under the twin pressures of poverty and disease

(Fleshman 2001: 3) The estimated number of children orphaned because of AIDS in

Zambia is 630 000 The HIV/AIDS epidemic has deepened poverty and exacerbated a

myriad of existing deprivations The responsibility of caring for orphaned children is a

major factor in pushing many extended families beyond their ability to cope (UNICEF

2003)

Furthermore, orphans may grow up without basic material resources and may lack the

love and support that more emotionally-invested caregivers usually provide They may

be discriminated because of the sero-status of their parents, or they may be forced to

discontinue their education because of lack of money or the need to take care of their

siblings (HSRC 2003)

Children orphaned by HIV/AIDS are disadvantaged in numerous and often devastating

ways For instance, in addition to the trauma of witnessing the sickness and death of

one or both parents, they are likely to be poorer and less healthy than non-orphans

They are more likely to suffer damage in their cognitive and emotional development, to

have reduced access to education, and to be subjected to the worst forms of child labour

(UNICEF 2003) This is particularly true in Sub-Saharan Africa where few social support

systems exist outside of families and where basic social services are largely inadequate

(Kanabus & Fredriksson 2004)

There is a general consensus in the literature that help for orphans should be targeted

at supporting families and improving their capacity to cope, rather than at setting up

institutions for children, as orphanages are not a sustainable long-term solution (UNAIDS

2002) In addition, institutional care can cause permanent setbacks in the lives of children:

those sent away from their villages may lose their rights to their parents’ land and other

property, as well as their sense of belonging to a family and a community

Overview of the OVC situation in Botswana

The number of orphans in Botswana has increased tremendously in recent years and

HIV/AIDS is the main contributing factor to this increase In 1999, the number of

registered orphans was 21 209, and this number has more than doubled in five years to

47 964 by 2004 (Social Welfare Division Database 2004)

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Figure 1.1: Trends and patterns of registered orphans from 1999–2004

Source: Ministry of Local Government (Department of Social Services, 1999–2004)

Botswana’s registered orphans are cared for under the orphan care programme and they are supplied with a food basket that contains the main basic food and toiletry items on

a monthly basis The programme also supplies school uniforms, clothes and blankets as and when needed Findings from the Rapid Assessment on the situation of orphans in Botswana (Muchiru 1998) indicated that many orphans still do not have access to basic necessities such as food, clothing, shelter and toiletries The assessment also established that these children’s basic fundamental human rights were being violated both by society and by caregivers, including relatives In some cases for example, orphans’ food rations are sold or shared among relatives There are instances of orphans being used as cheap labour by the business community The problem is further aggravated by many caregivers being aged grandparents who live in abject poverty and are themselves in many cases dependent on the destitute programme or on old-age pensions (Ministry of Local

Government 1999)

The advent of HIV/AIDS has not only increased the problem of orphans but also

compounded the phenomenon of vulnerable children The long-term sickness and eventual death of a parent or both to HIV/AIDS exposes their children to all kinds of abuse For instance, it is frequently mentioned that many vulnerable children end up leaving their homes to join the ranks of ‘street children’ while some remain in poverty in their homes According to Solani (2002), the main underlying reason why children go to the streets is poverty

Government response to the plight of orphans

In view of the rapid increase of the number of orphans, the government of Botswana, through the Ministry of Local Government which has sectoral responsibility for protecting,

1999 2000 2001 2002 2003 20040

caring for and mitigating the impact of HIV/AIDS on children, developed a Short-Term

Plan of Action on the care of orphans in 1999 Some of the key activities/projects of the

programme are discussed below

National orphan care programme

The government of Botswana initiated a national orphan-care programme in 1999

to coordinate, through the Social Welfare Department under the Ministry of Local

Government, all efforts addressing the orphan problem Since the start of the programme

in 1999, all districts have the responsibility to assess, register and support orphans

The Botswana orphan care programme is guided by a Plan of Action (Ministry of Local

Government 1999), which has the following stated objectives:

The orphan care Plan of Action has implemented the following:

Provision of basic needs

Given that many of the orphans are without adequate food, clothing, decent shelter and

toiletries, provision of these basic needs was perceived as the most urgent and immediate

focus of the orphan care programme In collaboration with the Ministry of Health a ‘food

basket’ was established for orphans and other children in need of nutritional care The

food basket contains all the necessary food items for example maize-meal, rice, meat,

vegetables, toiletries and others These are issued on a monthly basis to all registered

orphans nationwide (Ministry of Local Government 1999)

Access to education

Primary education in Botswana used to be absolutely free, but this changed at the

beginning of 2006 To ensure that orphans remain in schools and get appropriate

education, orphans are provided with appropriate school uniform, shoes and other

miscellaneous school costs

Security

To ensure sustained/continued protection of orphans from abuse, the orphan care

programme is mandated with the responsibility of the well-being and security of orphans

Alternative care

Given the complexity of the orphan problem, the government has since identified the

need to establish alternative care for orphans guided by the ‘Regulations governing

alternative arrangements for children in need for care’ (Ministry of Local Government

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The response of the government of Botswana is in line with the Millennium Development Goals, which were adopted by 189 United Nations member states in the year 2000 to combat poverty, hunger, disease, discrimination against women, degradation of land and illiteracy (Government of Botswana/United Nations 2004)

Figure 1.2: Specific needs of orphans and vulnerable children

Adapted from a workshop on Capacity Building for Community-Based Organisations on OVC, Botswana

The Government of Botswana and its partners provide material support for OVC as shown in Figure 1.2 above Some of the overlapping needs are provided to a limited extent The non-material needs, which are mainly psychosocial, are not adequately provided for, if at all

Background to the OVC project

The Human Sciences Research Council (HSRC), together with its research partners within Southern African Development Community (SADC) region (the University of Botswana and the Botswana Harvard Partnership in Botswana, the National Institute of Health Research, and the Biomedical Research & Training Institute’s Centre for International Health and Policy in Zimbabwe) was commissioned by the WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention project for orphans and vulnerable children (OVC), and families and households coping with an increased burden

of care for affected children This project is to run initially in Botswana, South Africa and Zimbabwe, commencing in 2003 The Masiela Trust Fund was selected as a grant maker,

to work with researchers from the University of Botswana The Masiela Trust Fund in turn selected community-based organisations (CBOs) and faith-based organisations (FBOs) to implement the appropriate intervention programme at all the sites that are identified

SpiritualGuidanceIdentitySense of BelongingLife Skills

AcceptanceFreedom of expressionPlaying

LoveSupportCounsellingInteractionParental loveSurvival skillsRight to Religion

HealthSupportLeisureEducationProtectionEntertainment

ClothingSupportBooksLegalAdviceShelterFoodMATERIAL

The project is expected to assist some of those families and households coping with an

increased burden of care for affected children at the sites selected in Botswana, South

Africa and Zimbabwe The specific objectives of the project are as follows:

support programmes for the benefit of vulnerable children families and communities

The overall philosophy behind the project will be to empower communities to help

themselves, with a very strong emphasis on sustainability of the project after funding from

donors ceases

Purpose of the OVC Psychosocial Survey (PSS)

The purpose of the study described in this monograph was to gather baseline data to

facilitate the introduction and evaluation of the effectiveness of orphan care intervention

programmes for strengthening community participation and empowerment of OVC at

the two project sites in Botswana This information will be used to evaluate the OVC

interventions that will be implemented in the two sites as part of the overall

(three-country) OVC project

Objectives of the study

The specific objectives of the study were to gather information that:

฀ Methodology

Description of study sites

A cross-sectional survey design was adopted The two study sites in Botswana are Palapye in the Serowe/Palapye sub-district and Letlhakeng in the Kweneng West district (see Figure 2.1)

Figure 2.1: Map of Botswana

Palapye site

Palapye village is located 315 kilometers from the capital city of Botswana, Gaborone Its population is estimated at 26 086, of which 57.3 per cent is female (Central Statistics Office 2001) There are 6 200 households in Palapye, 3 229 are female-headed and 2 971 male-headed The average household size in Palapye is 4.2

Consistent with the typical system of government in rural Botswana, there are four local authorities in Palapye The Department of District Administration is responsible for local economic planning and development in collaboration with a number of committees and civil society These range from District Land Use Planning Committees to Village

Development Committees Land Boards are another authority found in Palapye The

mandate of the Land Board is to administer land applications and allocations The District

Council, which is composed of the local political leadership and local civil servants, is

responsible for the provision of basic physical infrastructure, and management of local

essential services such as health clinics, school classrooms, collection of refuse and

bylaw promulgation and enforcement The Department of Tribal Administration is the

fourth local authority It is responsible for customary matters, the administration of the

ethnic group and delivery of customary justice through the customary court commonly

known as the Kgotla A Senior Chief Representative helped by a Deputy Senior Chief

Representative traditionally heads the village In the national context, Palapye is a

parliamentary constituency and it has an elected member of Parliament and a number of

elected councillors representing the wards in the village Members of the Land Board are

also elected for a term of duty at the Kgotla

There are two hospitals and six clinics in the sub-district Palapye, which is the capital

of the sub-district, is the main hub of economic activities The major economic activities

in Palapye are mining and quarrying, manufacturing (including repair of machinery and

equipment), construction, wholesale and retail trade (including repair of motor vehicles

and personal household items), hotels and restaurants, and real estate business In the

Serowe/Palapye sub-district, the unemployment rate is 23.5%–27.5% for adult women and

20.5% for adult males (Central Statistics Office 2001)

The types of housing found in Palapye are traditional and mixed houses (n = 1 962),

detached and semi-detached (n = 2 689) and town house/terraced housing (n = 187)

Some households have piped water indoors (n = 2 033), some get piped water outdoors

(n = 2 900) and some access communal taps (n = 1 138) (Central Statistics Office 2001)

Palapye is situated mid-way on the main highway from Gaborone to Francistown It is

a major stopover for truckers, people travelling and government officials on duty It is a

major conference centre Palapye is said to have the largest number of guesthouses (n =

17) outside of Gaborone and Francistown (Muchiru 1998)

Over 500 truckers stop over in Palapye each month Between 19–23 buses en route to

other parts of Botswana and to Zimbabwe pass through Palapye each day It is estimated

that there are approximately 200 commercial sex workers, 140 migrant workers, and

over 1 000 informal traders (Muchiru, 1998) Some 120 commercial sex workers are

semi-resident in Palapye; others come from as far as Francistown, Selibe-Phikwe, Maun,

Gaborone, Kasane and Serowe (Muchiru 1998)

There is an abundance of transport; a number of taxis and combis provide transport

within the village The numbers of households owning some kind of transport are as

follows: van bakkies (n = 741), cars (n = 777), tractor trailers (n = 152) and donkey carts

(n = 662) (Central Statistics Office 2001)

According to the Botswana 2003 Second Generation HIV Surveillance Report (December

2003), Serowe/Palapye has an HIV prevalence rate of 43.3 per cent among pregnant

women This is one of the highest prevalences in the country, according to currently

available statistics

In Serowe/Palapye sub-district there were 5 697 registered orphans as at December 2004

and of these, 1 743 were registered in Palapye (Social Welfare Division Database 2004)

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Letlhakeng site

Letlhakeng village is situated 120 kilometers west of the capital city of Botswana,

Gaborone, in the Kweneng West District The population of Letlhakeng is estimated at

6 032 and females make 55% of the population (Central Statistics Office 2001) There are about 1 297 households of size 4.6 Of these households 481 (37.1%) are headed by males while 816 (62.9%) are headed by females Letlhakeng is a rural area, with very little economic activity In the village, 62 people are engaged in agriculture, hunting and forestry and 57 in manufacturing, including the repair of machinery and equipment

A total of 80 are in construction activity, 84 are in wholesale and retail trade including repair of motor vehicles Public administration employs 351 people and 92 work in education

In the Kweneng West sub-district, the unemployment rate is 17.4%, with 27% of women being unemployed and 13.4% men being unemployed (Central Statistics Office 2001) This sub-district remains one of the poorest in the country, with a greater section of the population living in poverty The types of housing found in Letlhakeng are traditional houses, mixed detached and semi-detached houses There are 883 households with traditional and mixed houses; 138 have piped water indoors, and 246 have piped water outdoors, while 894 have access to communal taps (Central Statistics Office 2001)

Modes of transport in Letlhakeng are van bakkies (n = 152 households), cars (n = 67 households), tractor trailers (n = 41 households) and donkeys (n = 181 households) According to the Botswana 2003 Second-Generation HIV Surveillance Report (December 2003), Kweneng West had an HIV prevalence of 27.0 per cent – one of the lowest in the country In Kweneng West sub-district, there were 1 160 registered orphans as at December 2004 and in Letlhakeng alone there were 542 registered orphans in the same period (Ministry of Local Government: Department of Social Service 2004)

Populations and samples

For this study, the target population was OVC aged 6–14 and 15–18 years, and their parents/guardians in Palapye and Letlhakeng Skinner et al (2004), define a vulnerable child as someone who has no or restricted access to basic needs and their rights are denied even if they have both parents A vulnerable child is a child who is either

orphaned or is living in crisis situations due to multiple causes Such situations may result

in prostitution or street life These are children who belong to high risk groups and lack access to basic social facilities Risk can be identified in terms of malnutrition, morbidity, death and loss of education (World Bank and UNICEF 2002)

Sampling procedures and sample

Prior to this survey, an OVC census survey was conducted to estimate the size of the OVC population in the research sites; Palapye and Letlhakeng The sampling for this psychosocial survey was to be drawn from this estimate of the OVC population An inclusion criterion was developed to serve the purpose of reaching households in the sample which had at least one orphan and/or a sick member, as identified through the OVC census held in each site prior to this survey In a household, three types of people were targeted; OVC aged 6–14 years, 15–18 years and OVC parents/guardians In Palapye,

471 OVC were interviewed, of which 258 were aged 6–14 years and 139 were aged 15–18 years In addition, a separate sample of 505 parents and guardians in households with

OVC were selected to participate in the study In Letlhakeng, 164 OVC were interviewed,

of which 84 were aged 6–14 years and 77 were aged 15–18 years Furthermore, a

separate sample of 323 parents and guardians in households with OVC were selected to

participate in the study An alternating selection schedule was used so that both sexes

would be equally represented in the sub-sample

Study instruments

The questionnaires for all three categories of respondents (OVC aged 6–14 years; OVC

aged 15–18 years; parents/guardians) were adapted from the OVC generic protocol

compiled by the HSRC These comprised three sets of OVC PSS baseline questionnaires,

which were originally developed by two organisations, Strengthening Community

Participation for the Empowerment of Orphans and Vulnerable Children (SCOPE) and

Family Health International (FHI) for a similar project in Zambia, 1 and were adapted for

use in this study The questionnaires concerned measured various issues such as food

intake, psychosocial issues, risk taking, decision-making processes and emotional

well-being All questionnaires were translated into Setswana, the local national language

PSS questionnaire for 6–14 year olds

This questionnaire was used to measure various issues such as background, information

on father, mother and OVC, food intake, psychosocial issues such as coping with the

loss of a mother and /or father, child/guardian relationships, relationship in household,

child’s feelings on the late mother/father/guardian, displaced and non-displaced OVC,

eligible orphans, eligible vulnerable children and sexual involvement and abuse The

questionnaire also measured the response, decision-making processes, cultural modes

of caring and inheritance, risk taking, emotional well-being, experiences of stigma and

health and HIV/AIDS-related issues

PSS questionnaire for 15–18 year olds

This questionnaire was used to measure various issues such as background information

on father, mother and OVC; food intake; psychosocial issues such as coping with

the loss of a mother and/or father; child/guardian/teacher relationships; relationships

in household; the child’s feelings towards a late mother/father/guardian; and sexual

involvement and abuse The questionnaire also measured the responses and support

offered by NGOs, CBOs, FBOs and the state, decision-making processes and inheritance,

cultural modes of caring, risk taking, emotional well-being and health, and HIV/AIDS

related issues

Parents/guardians PSS issues questionnaire

The questionnaire for guardians measured demographic details of the child and that of

the guardian The questionnaire also measured their perceptions and experiences of HIV/

AIDS and related issues, as well as general livelihood issues

Validation of instruments

The research teams in Botswana, South Africa and Zimbabwe scrutinised the instruments

and checked the content validity during a consensus workshop There was general

agreement that the questionnaires measured constructs that were important for the

1 See the http://www.popcouncil.org/horizons/AIDSQuest/summaries/ssSCOPE.html for details of the SCOPE survey in

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project, and some core questions that needed to be included in the surveys done in all three countries were identified Each country added questions that were specific to their environments, taking into account the unique social contexts found in each country.Ethical considerations

Ethical approval of the OVC project was granted by the HSRC Research Ethics Committee Further, the project proposal was submitted to the Health Research and Development Committee (HRDC) in the Ministry of Health, Botswana for ethical and scientific review approval Obtaining informed consent from possible research participants is an essential aspect of the overall research process Informed consent entails informing the research subjects about the overall purpose of the study, possible benefits of the study, and explaining voluntary participation and the right to withdraw from the study at any time (Kvale 1996).This was done prior to administering the questionnaires in the field The consent forms were translated into Setswana

Data collection procedures

Access to the community

Sensitisation workshops were held in each research site prior to the survey, with leaders

of the community The workshops aimed to communicate the goals and objectives of the survey to the community, and appear to have succeeded, as the study was well received.Recruitment and training of field workers

A team of interviewers and supervisors was recruited from the two research sites These included retired nurses, teachers and high school leavers The reason for recruiting from the sites were to ensure community ownership and empowerment

Three-day training workshops for interviewers and supervisors were conducted Manuals were developed specifically for supervisors and interviewers The manuals focused

on conducting interviews during data collection, as well as understanding the survey instrument The training was designed to impart a clear understanding of the ethical issues involved, and of the survey questions, and to ensure appropriate words would

be used in interviews Time was also set aside for practice, to ensure understanding of the content of the instrument and to provide a chance to conduct interviews using the instrument Feedback from interviewers undergoing training was obtained, and integrated where appropriate A consensus on ethical considerations, style of questioning and appropriate words to use was also reached

Data collection started shortly after the training Once in the field, the enumerators worked closely with their supervisors, area community liaison officers and the research team Fieldwork lasted for two weeks

Quality assurance

Training manuals for supervisors and interviewers were used as the key training

instruments Training sessions for supervisors and interviewers were conducted

concurrently for three days The areas of focus during the training were: interviewing skills, research ethics and quality control checks during and after interviews During training, participants engaged in role-plays in groups and then made presentations in plenary sessions

Ten supervisors and 20 interviewers worked to cover each site Supervisors were in

contact with interviewers at all times They collected interviewers’ work and helped

them solve problems encountered doing the fieldwork The research team conducted

training to enable the researchers and fieldworkers to understand the contents of the

questionnaire and how it should be filled out, the various activities and stages involved

in the study, as well as the fieldworkers’ own role in data collection Members of the

research team oversaw all fieldwork

Data management

After data were collected from the field, it was brought to the research office at the

Masiela Trust Fund Offices in Gaborone for data editing, coding, entry, cleaning and

analysis Data entry was done using the Statistical Package for Social Sciences (SPSS)

by well-trained data entry clerks who were oriented to the tool that was used for data

collection prior to starting data entry There were some data entry quality checks done

during data entry, such as re-entering of cases Once data entry was completed, the

project researchers cleaned the data For data analysis SPSS was used to perform simple

cross-tabulations and descriptive statistics

The sample from Palapye site consisted of 258 (121 males and 137 females) respondents

A large majority of the respondents in this age bracket were Batswana comprising of 98.8% of the sample Out of the 258 respondents, 253 (97.3%) indicated Setswana as their home language The remaining indicated ChiZezuru (a Shona dialect), English and Kalanga

Education

Ninety-four per cent of the respondents attended school; 93.8% of all females and 92.6%

of all males For those not in school, reasons cited for not attending school were financial constraints (14.3%), not liking school (21.4%), being too young to start school (21.4%), and having completed school (42.9 %)

Religion

Sixty-four per cent of the respondents indicated that they belonged to a religious

organisation; of these respondents, 45% were males and 53% females Of the 36% that did not belong to any religion, 51% were males and 49% were females

Food intake issues

Most of the respondents (97.6%) reported having their meals at home, while only 2% had their meals at school Forty-one per cent of the respondents reported that they usually have three meals a day Another 40% reported that they usually have two meals a day while 16.8% indicated having one meal a day, and 2.5% reported having four meals a day

Psychosocial issues

Background information on father

Among the 258 respondents, 45.2% indicated that their fathers were dead while 26.3% of the respondents did not know whether their fathers were dead or alive Twenty per cent indicated that their fathers had been very sick over the past three months About 7% of the respondents whose fathers were alive reported that their fathers lived in the same household with them

Background information on mother

Of the 258 respondents, 38.8% reported that their mother was dead; 0.4% did not know the whereabouts of their mothers Among those whose mothers were alive, 20.5% of the respondents indicated that their mothers had been very sick in the past three months Many children whose mothers were alive (about 69% of the respondents) reported that their mothers lived in the same household with them

Household relationships

Displaced orphaned and vulnerable children

Forty-seven per cent (n = 128) of the respondents reported that they had had to move

into another household after their mother/father died Sixty-one per cent of these

displaced children (of whom 54.5% were male and 66.7% were female) moved with the

other children that they had lived with before their mother/father died Eighty-three per

cent of the children that they moved with were their siblings

Non-displaced orphaned and vulnerable children

Among the (n = 179) non-displaced children, 10% of the respondents indicated that a

guardian moved into their household after their mother/father died Asked how they

were related to their guardian, 28% said the guardian was their grandmother, while 12.8%

indicated that it was their aunt Ninety-three per cent of these non-displaced children

indicated that there were other children living with them in their parent’s home, and the

great majority of these other children (87%) were their siblings

Child/guardian relationship

A large percentage (80.8%) of the respondents knew their present guardian very well

before s/he began to take care of them Only 11.5% of them had known their present

guardians only a little, while 2.4% had not known them at all

Emotional well-being issues

Most of the respondents (90.3%) indicated that they sometimes feel happy Some of the

reasons advanced for their happiness included: playing with friends (21.2%), new clothing

bought by parents/guardian (10.6%), and the presence of siblings at home (6.2%) More

than half of the respondents (63.4%) indicated feeling unhappy at different times When

asked about what mostly caused their unhappiness, responses included having their

parents/guardians or caregiver’s anger directed at them (9.5%), being hurt or beaten by

other children (8.9%), being pressed to do home chores (5.1%), having parent/guardians/

caregivers who were sick (4.5%) and being ill-treated (4.5%) When they felt unhappy,

58.6% talked to other people other than those that are closely related to them, 21.6%

talked to their siblings and 13.6% talked to their friends

More than forty per cent (42%) of the respondents indicated that they sometimes felt

worried, with 34.8% indicating that it happened quite often and 58.8% reporting that they

sometimes get worried When the respondents were asked about what worries them,

12.5% indicated sickness of a family member, 10.7% indicated lack of adequate clothing

and school shoes while 9.8% said they worried about the prospect of being beaten When

respondents got worried, they were likely to talk to other persons other than those that

are closely related to the respondent (65.2%), their siblings (23%) or their friends (5.3%)

Asked whether they had trouble falling asleep, 39% said they did, and of these 57.9%

indicated that it happened sometimes, with 25.2% reporting it happened often Those

who had trouble falling asleep cited nightmares/bad dreams (20.4%) and thoughts

about parent/guardian death (7.1%) as reasons for their trouble falling asleep When

respondents struggled to fall asleep, they discussed it with other persons not of any

relationship to them (63.1%) and siblings (30.1%)

Seventy-three per cent of the respondents did feel frustrated while 48.9% reported

feelings of anger; however, a high percentage of the respondents (81.5%) mentioned that

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they often felt hopeful about the future The respondents indicated that the opportunity

to attend school makes them hopeful Ninety-three per cent (95.5% of males and 89.8%

of females) of the respondents indicated that their guardians encouraged them to talk freely when they are sick, feel bad, or down Fifty per cent (44.9% of males and 55.1%

of females) of the respondents indicated that their guardians put them on their laps and put their hands around them as a way of comforting them when they were sick or down Eighty-seven per cent (89.7% of males and 85% of females) indicated that their guardians did not look away when they are talking, but showed interest in what they said Furthermore, 89% of the respondents indicated that their guardians spoke kindly to them, as well as explaining things to them

Eighty-seven per cent of the respondents (89.9% of males and 84.7% of females) indicated that their guardians often encouraged them to live without fear, and to function as normal members of the society They reported that their guardians often told them to work hard

at school (18%), take good care of themselves (9.7%) and develop a sense of trust (9.7%) Special items

Forty per cent of the respondents who were orphans indicated that they had photos of their deceased parents When they were asked how they felt when they looked at the relics from their deceased parents, a little more than half (50.5%) reported that they were saddened, while on the other hand, 15.3% said doing so made them happy More than a fifth (22%) of the respondents reported looking at the relics when they felt lonely (12.7%) and when they felt like being close to their late parents (18.6%)

Sexual involvement and abuse

Three per cent (1.8% of males and 4% of females) of the respondents indicated that they have had sexual intercourse One per cent of the males indicated that they had sexual intercourse against their will A large percentage (96.9 %, or 95.4% of males and 98.3%

of females) of the respondents indicated that their guardians had never touched them

in a way that made them feel uncomfortable Similarly, 94.3% indicated that they had never had other children in the household touch them in a way that made them feel uncomfortable But 3.1% reported that they had been touched uncomfortably by other children Ninety-five per cent of the respondents indicated that no community member has ever touched them in a way that made them feel uncomfortable Only 2.7% indicated that they had been touched uncomfortably by community members

Issues of inheritance

Fifty-nine per cent of the respondents reported that they still lived in the same house/home as they did with their parents Fifty-three per cent reported that they still had ownership of the house In responding to the distribution of family goods and possession after death of their parent(s), 78.1% said their parents’ goods have been distributed and 56.6% of the respondents said they were consulted while 28.3% were not The goods that had been distributed included livestock, furniture, money and other valuables Respondents reported that they inherited the following from their dead parents; livestock (85.5%), furniture (80.4%), money (92%) and various other items (72.4%)

Experiences of stigma and discrimination

A high percentage (97.5%) of respondents indicated that other children in the community

do not have any problems playing with them Almost all (97.9%) of them agreed that

adults in the community communicated well with them Two children (1.7%, n = 237)

that reported that adults in the community did not talk to them cited reasons: ‘because

my parents died of AIDS’ and ‘they do not like me’ A majority of the respondents (91%)

reported that they have not been denied access to school because of their parent’s

sickness/illness/death, while only 3.8% indicated they had been denied access on such

grounds

HIV/AIDS and health-related issues

Ninety-one per cent (91.8% males and 98.4% females) of the respondents reported

that they did sometimes get sick The most common illnesses were: colds/flu (35.7%);

headache (28.2%) and coughs (6.2%) When sick, they were generally taken care of by

their guardian (54.3%), siblings (23.8%) and aunt (14.8%) Seventy-one per cent of the

respondents reported that when they were sick, they were always taken to the clinic/

hospital, mostly by their guardian (35.8%), an uncle (23.7%) or a sibling (15.8%)

Twenty-six per cent of the respondents (30.5% of males and 22.7% of females) were sometimes

taken to consult with traditional or faith healers Guardians were reported by 38.1% of the

respondents to be helpful in assisting them to take their medication

Fifty-six per cent (49.5% of males and 62.3% of females) of the respondents reported that

someone had talked to them about disease prevention Those who normally talked to

them about disease prevention included: guardians (27.7%), siblings (27.7%), neighbours

(15.4%) and aunts (13.8%)

Community involvement of guardians/parents

When asked about community meetings called by religious or traditional leaders, where

health promoters come to address people, 39.4% indicated that indeed such meetings

do take place Seventy-two per cent of the respondents indicated that their guardians

attended such meetings Sixty-three per cent of the respondents, who indicated that

parents/guardians attended such meetings, said that whenever their guardians/parents

came from such meetings they normally shared or discussed what was said in the

meetings with them Fifty-three per cent of the respondents felt that leaders were

sufficiently urging solidarity for HIV-affected people and protection for survivors from

discrimination and stigma, whereas 30.1% did not know if that was happening

Discussion of findings: OVC ages 6–14 in Palapye

Over 90% of the children were in school These figures compare favorably with the

National Net Enrolment Ratio of 95.3% of a similar age group category, 7–13-year-old

children (Education Statistics 2001) The figures show that OVC are not disadvantaged

as far as education is concerned However, the small percentage not in school cited

not liking school, lack of financial support, being underage and completion of school

as reasons for not being in school Children being under-age is to be expected, given

this age-group, as the minimum age at which children start school in Botswana public

schools is six years (and maximum is ten years) The number claiming to have completed

schooling is questionable, as most people do not finish at 14 years This probably means

the OVC in question did not do well during their Junior Certificate Examinations and

that they needed support in continuing beyond Junior Certificate The underlying causes

of non-school attendance need to be investigated further in an effort to promote access

to education for all children of school-going age Strategies that encourage and support

continuation of school need to be developed, to strengthen the educational support given

an important role in the respondent’s emotional well-being

Despite the positives noted, the study also showed that OVC experience a lot of negative emotional phases in their everyday lives Feelings of unhappiness, worry, trouble falling asleep, frustration and anger were all noted at high percentages exceeding 40% What also came out is that the feelings were experienced more often and sometimes than rarely This goes to show that OVC generally do not have a good life and their happiness

is constantly challenged by the factors that surround their everyday lives Such emotional conditions tend to traumatise children, leading them to experience emotional discomfort Emotional distress among OVC is a clear indication of psychosocial problems that need targeted responses

The study revealed that respondents were likely to talk to an unspecified other, sibling

or friends when experiencing some negative emotion This shows that OVC are able

to open up about what makes them uncomfortable however, it is worrying to note that they infrequently chose to talk to their guardian This could be a sign that the

positive relationship between the guardian and OVC being painted by the findings is not necessarily positive or OVC may not feel free to discuss some issues with someone older despite the solid relationship that exists Such issues suggest there is a need for the provision of psychosocial counselling

Nearly 40% of the respondents reported that their fathers were not alive, while 39% reported that their mother was not alive Grandmothers and aunts were the most common guardians of OVC The growing number of OVC under the care of grandmothers could

be a reflection of absenteeism of biological parents, partly as a result of HIV/AIDS Orphans have generally watched their parents get ill and eventually die As a result, they suffer extreme emotional pain, forcing them to deal with issues of loss and bereavement

at a very early age Additionally, being raised by grandmothers places orphans at an added disadvantage, as the quality of care they get is compromised Grandmothers are in most cases elderly, ailing and live in poor socio-economic conditions

A growing child requires well-balanced, nutritious meals to be healthy Getting such meals depends on household food security On average, 40% of the children reported eating two meals a day but there were those who ate one meal a day Many studies have shown that adequate access to food is critical for growing children If the frequency of eating is only once or twice a day, this is usually not sufficient to enable a young child’s food intake to meet minimum daily requirements for energy and vital nutrients (Kinabo 1998)

Most respondents ate carbohydrate-concentrated food with very little protein, minerals and vitamins Such inadequacy places great challenges to OVC’s nutritional security A number of factors may be contributing to these situations, which may include shortages of food due to unemployment and poverty in the household The other contributing factor for orphans registered under the national orphan care programme could be that the food

package provided by the programme contains mainly food that is rich in carbohydrates,

and little of other nutrients

Grandmothers were cited as guardians by 28% of these OVC This finding shows the

burden of care that women carry However what is more important to note is that in

most cases these grandmothers are elderly and ailing, making it difficult for them to cook

for these children In addition, their socioeconomic conditions are not always favourable,

making it difficult for them even to acquire enough food to feed all the children in their

care (Muchiru 1998)

In this study, almost 12% of the respondents hardly knew their guardians while just over

2% did not know them at all before the death of their parents It can be difficult for the

child to get to know the guardian, especially if the guardian does not understand that the

child is mourning the death of the parent

It is clear from this study that the core OVC caregivers are the extended family These

caregivers need support, and skills and knowledge to provide psychosocial support to

improve the quality of life of OVC and help OVC settle into the new family structure with

as little disruption as possible

Forty per cent of the respondents indicated that their deceased parents left some items for

them in the form of photos, letters, clothes, and jewelry and personal identification cards

Such items tend to have some sentimental value to the orphans The fact that a little more

than half of the respondents (50.5%) who had lost a parent indicated that they were sad

when looking at these items was an indication that they generally missed their parents

Nearly 20% of the respondents felt closer to their deceased parents when they looked

at these items The reactions of orphans towards these items was an indication that they

are grieving the loss of their parents, and this grief should not be ignored It is clear

that orphans need psychosocial support and meeting the need for this support demands

intervention from both the government and NGOs

The findings of the study showed that even though a good number of respondents

(78.1%) were consulted when their deceased parents’ belongings were distributed, not

all such property was inherited by the deceased children This is disturbing, as it is

evidence that property grabbing does take place, and the very young are especially

vulnerable to this because most of the time they would not know what their parents had

left behind, and neither know nor can fight for their rights They are not in a position to

seek legal assistance Laws protecting children need to be enforced to protect children’s

property, and parents need to be encouraged to write down wills Community members

including OVC need to be encouraged to visit existing structures such as the District

Commissioner’s office, Customary Court and others that can assist them in claiming their

birthrights

The findings of the study show that a small number (3%) of the respondents had had

sexual intercourse Even though the number is small, it cannot be ignored as it shows

that sexual activity starts at a very young age It is likely that sexual activity at this

age occurs without protection and sufficient knowledge or skills, thus exposing the

children to sexually transmitted infections (STI) including HIV/AIDS The findings also

show that there have been cases – such as the 3.1% and 2.7% reporting being touched

uncomfortably by other children and community members respectively – suggesting

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abuse In strengthening OVC intervention programmes, child sexual abuse needs to be addressed to ensure that children are protected

The experience of stigma and discrimination in the community and at school is reported

at 4% It is possible that this was due to the fact that the respondents came from

communities that are supportive to OVC or that the children are too young to pick up and understand acts of stigma and discrimination

Ninety-one per cent of the respondents reported that they do sometimes get sick, with common illnesses reported being colds/flu, headache and coughs The illnesses reported

by OVC are documented as stress-related illnesses (Madorin 1999) It should also be noted that younger children, who still have limited possibilities to express their grief and inner pain, might react to the loss with psychosomatic symptoms (Worden 1999) It should be noted that data collection for this study took place during the winter season, and this may have influenced the illnesses reported It is interesting to note that a small percentage (3.2%) of respondents who reported being sick at some point were not taken to any health facility despite the fact that in Botswana, children under twelve are exempted from paying fees at health facilities, and so one expects the guardians of such children to fully utilise the free health resources

Almost 50% of respondents reported that someone talked to them about disease

prevention More girls than boys reported receiving talks on disease prevention,

possibly because people are more sympathetic to girls than boys The participation

of neighbours (15.5%) and friends (8.5%) in talking to OVC about disease prevention provides an opportunity for more community education and peer training for intervention programmes

OVC ages 15–18 in Palapye: Survey findings

Background information

Information was collected on children aged 15–18 years In the target population, the sample consisted of 139 respondents in Palapye Of these, 41.7% were male and 58.3% were females The children sampled in this age group were mainly Tswana speaking and only 2 (1.4%) were heads of households

Education

Most of the respondents (77.5%) indicated that they were attending school These

comprised 84.5% of males and 72.5% of females Twenty-two per cent of the

respondents reported that they were not in school The reasons given for not being in school included, having failed at school (46.7%), having completed school (26.7%) A further 16.7% were not in school because their families did not have enough money

to send them to school (see also Figure 3.1) The highest grade passed by most of the respondents (58.3%) was Form 3, which is the end of the ten years of basic education

Figure 3.1: OVC 15–18 in Palapye: Reasons for not attending school, by gender

Respondents were also asked questions about missing school Most (81.4%) reported

that they never missed school The overwhelming majority of those who missed school

(92.3%) did so when sick, while 7.7% said they missed school because they did not feel

safe going to school

Employment status

Children in the age group 15–19 years were also asked about their economic activity Of

the 114 who responded to this question, a small percentage (4.4%) reported that they

were working Those working were employed mostly as gardeners (3), herders (1), and

shop assistants (1) Twenty-nine per cent of those who are working reported earning only

five Pula per day

Faith and religion

Just over half of the respondents reported that they have attended some religious events

(51.5%) Three did not state whether they were affiliated to any religion When asked

how often they go to church or other religious activities, 50.6% of the respondents

said they go to church or attend religious activities at least once a week while a small

percentage (13.6%) said they never go to church or attend religious activities

Household situation

Many of the children (72.8%) who responded to the survey questionnaire indicated that

their families do not have enough money for basic things like food and clothing About

16.9% of the children mentioned that they had money for clothing and food, but were

short of many other things

Dislike ofschoolReasons for not attending school

MaleFemaleTotal

Failure Expulsion Completed

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The main source of income for the children who responded to the questionnaire was income from part-time or piece work (29%) and other sources (24.4%) Income from pensions/grants and contributions from adults and relatives was reported by 5.3%

Food intake

To document nutritional intake, children were asked about the number of meals they had each day and the type of food consumed Forty-six per cent of the respondents reported that they usually had one meal per day A third (33.3%) usually had two meals per day, 1.4% usually took three meals a day and 18.1% sometimes were without any meal in a day Most (97.8%) of the respondents reported that they had their meals at home, while 1.4% reported that they had their meals at school Even though some reported that there were days that they did not have anything to eat, 95.6% of these respondents indicated that they had a meal the day before the interview

Asked about access to water, 72.1% indicated that they got their water from a yard tap, 21.3% got water from a communal standpipe and 5.9% got water from an indoor tap This indicates that most of the respondents had access to safe drinking water

Psychosocial issues

Background information on father

In an attempt to understand the psychosocial issues affecting children, a set of questions were posed to children on the survival status of their parents Fifty-seven per cent of the respondents indicated that their father is not alive, while 27.6% said their fathers were still alive, and another 14.9% did not know their father’s survival status The death of the father for over 40% of those who had lost their fathers had occurred at least one year before the survey There were those who did not know when their fathers had died (17.9%) A high number of the respondents whose fathers were alive said they are not living with their father (85.4%) Forty-six per cent of the respondents whose fathers are still alive said they sometimes visited their father, while 43.6% of these said they never visited their father Those that visited their fathers (25%) made those visits on a monthly basis, while 8.3% said they visited their fathers every three months Those who did not visit their fathers (9.5%) mentioned reasons such as lack of transport money and their father not allowing visits

The majority of the respondents who lost their fathers said they missed the care from their fathers the most as compared to that of their mothers and 5.6% said they missed the fact that their father used to help with money at home A few respondents (15%) said they missed nothing about their late fathers

When the respondents were asked what they did to feel better when their fathers

were ill, 24.2% said they did nothing while 11.3% indicated that they cried in order to feel better A few (8.1%) said they helped their fathers, while a small number of the respondents said they talked with their mothers about the condition of their father

Background information on mother

Regarding the survivorship of their mother, 40.5% indicated that their mothers were not alive For those respondents whose mothers died, 26.8% indicated having lost their mothers over six years ago, and 16% said they had lost them in the 7–12 months before the survey When asked what they missed most about their dead mother, 31% of the respondents said they missed their mothers’ care, and 29.3%, their love (see Table 3.1)

Most (66.5%) of the respondents whose mothers were alive were living with their

mothers Of those not with their mothers, 20.8% said they visited their mothers on a

weekly basis, 16.7% visited their mothers on a monthly basis and 12.5% visited every

three months Those who indicated not visiting their mothers said they did not visit

because they did not have transport money A few (8.3%) of the respondents said that

they did not visit because their mothers did not allow them

Table 3.1: What OVC 15–18 in Palapye miss about their late mothers – percentage distribution by

When asked what they did to make themselves feel better when their mothers were ill,

32.1% of the respondents said they did nothing, 16% said they helped their mother, 10%

said they cried, while almost 9% said they talked to their relatives Asked to state what

they did to make themselves feel better after their mother had died, 39% said they did

nothing, 21% cried and 4.7% talked to their friends

Child/guardian relationship

When asked how they got along with their guardian, 80.4% indicated that they got along

well while 18.5% indicated a poor relationship with their guardians (see Table 3.2 below)

Table 3.2: Quality of relationships between OVC 15–18 and their guardians, in Palapye

How well children got along

with their guardians

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When asked how they felt living in their present homes, 69.5% said they were happy while 22.4% said they were unhappy More than half (54%) however indicated that they spent their free time with their guardian Only a small percentage of the respondents (5.4%) mentioned that when they had a problem or were worried they would talk to their guardian about the problem, even though more than half had indicated spending a considerable amount of time with their guardians Among the most likely persons they would talk to if they had a problem were their siblings (17.9%)

Of those displaced or taken in by new guardians, an overwhelming majority (88%) knew their guardians very well before they entered their care, and only 8.6% stated that they knew guardians only a little bit

When the respondents were asked how they were treated in the household, 68.3% said they were fairly treated while 10.8% felt they were treated roughly As to whether their guardian treated them better, compared to their own children, 75% said they were treated the same, while 11% said they were treated better

Displacement of OVC

Some orphans had had to move from their original home (28%) while the rest stayed in the home they stayed in with their parent(s) A small percentage of those who did not move had to accommodate a new caretaker into their homes (13%)

Household relationships

For the respondents who did not move from their initial homes, 88% of them said that there is no one who assists them in the maintenance of the house, while only 7% said they had someone who assisted them Almost two thirds of these respondents (64.1%) said that their brothers and sisters had ownership of the house Only 33% said their brothers and sisters did not have ownership of the house

Emotional well-being issues

The majority (93%) of the respondents who were orphans or whose parents were sick indicated that it was important for their parents to discuss their health status with them before they died Fifty-one per cent of the respondents said their parents discussed their health status with them before they died while 41% did not discuss When asked for one

of the reasons for wanting to know about the health condition of their parents/guardians, 76.2% of the respondents mentioned that it would be helpful to know the true cause of death of their parents/guardians Five per cent rejected the idea of wanting to know the true cause of death

Fifty-four per cent of the respondents mentioned that they sometimes felt worried When worried, a large majority (65.8%) of the respondents indicated that they talked to unnamed ‘others’ (see Table 3.3), while 13.9% and 10.1% of them talked to their friends and siblings respectively