Psychosocial conditions of orphans and vulnerable children in two Zimbabwean districts doc

Table 2.1: Targeted and actual sample sizes of guardians by district 11Table 2.2: Targeted and actual sample sizes of OVC by district 12Table 3.1: Distribution of OVC by Household standa

P SYCHOSOCIAL CONDITIONS OF

CHILDREN

Simba Rusakaniko, Alfred Chingono, Stanford Mahati, Pakuromunhu F Mupambireyi, & Brian Chandiwana Edited by Parkie S Mbozi, M Boy Sebit & Shungu Munyati

Published by HSRC PressPrivate Bag X9182, Cape Town, 8000, South Africawww.hsrcpress.ac.za

© 2006 HSRC, BRTI, NIHR & FACTFirst published 2006

All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission

in writing from the publishers

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About the contributors ivAcknowledgements viOperational definitions of concepts viiList of tables & figures viii

Acronyms and abbreviations xExecutive summary xi

Chapter฀1฀฀฀฀Introduction฀฀฀฀1

Chapter฀2฀฀฀฀Methodology฀฀฀฀7

2.6 Sampling procedures 102.7 Field monitoring activities 122.8 Data management 12

4.1 OVC aged 6–14 years 51

Mr Alfred Chingono: MSc, Clinical Psychologist, College of Health Sciences, University

of Zimbabwe, Team Leader for PSS (Zimbabwe)

Professor Simba Rusakaniko: PhD, Consultant Biostatistician, College of Health

Sciences, University of Zimbabwe (Zimbabwe)

Stanford T Mahati: MPhil, BSc (Hons) Sociology & Anthropology, Social Scientist,

National Institute of Health Research (NIHR) Ministry of Health & Child Welfare, Harare

(Zimbabwe)

Pakuromunhu Freddie Mupambireyi: MSc Demography, BSc (Hons) Econs Statistician,

University of Zimbabwe, Deputy Dean, Faculty of Commerce, Harare (Zimbabwe)

Brian Chandiwana: BSc Econs, MBA, Health Economist, Biomedical Research & Training

Institute, Harare, OVC Research Project Manager (Zimbabwe)

Editors

Shungu Munyati: MSc, PhD (Cand), OVC Research Project Director, Acting Director,

National Institute of Health Research (NIHR), Ministry of Health & Child Welfare (Zimbabwe)

Mr Parkie S Mbozi: Communications Consultant, World Agroforestry Centre CRAF

Dr M Boy Sebit, Senior Lecturer, Clinical Psychologist, College of Health Sciences,

University of Zimbabwe Other Contributors

Peter P Chibatamoto: MBA, MSc Infectious Diseases, Biological Sciences; HIV/AIDS

(Mainstreaming) Technical Advisor UNDP, Windhoek (Namibia)

Natsayi Chimbindi: BSc HEP, (Health Education), Biomedical Research & Training

Institute Harare (Zimbabwe)

Stephen Buzuzi: MSc, BSc (Hons) Sociology & Anthropology, Biomedical Research &

Training Institute, Harare (Zimbabwe)

Stella Gwini: BSc (Hons) Statistics, Biomedical Research & Training Institute, Harare

(Zimbabwe)

Wilson Mashange: Dip Med Lab Tech, Medical Laboratory Technologist, National Institute

of Health Research (NIHR), Ministry of Health & Child Welfare, Harare (Zimbabwe)

George Chitiyo: MSc, BSc Econs; Catholic Relief Services, Harare (Zimbabwe) Maxwell Chirehwa: BSc (Hons) Applied Maths (Cand), National University of Science

and Technology, Bulawayo (Zimbabwe)

Timothy Mutsvari: BSc (Hons) Applied Maths, Biomedical Research & Training Institute,

Harare (Zimbabwe)

Teramai A Moyana: BSc (Hons) Sociology & Anthropology; Biomedical Research &

Training Institute, Harare (Zimbabwe)

Chenjerai K Mutambanengwe: BSc (Hons) Applied Maths (Cand), National University of

Science & Technology, Bulawayo (Zimbabwe)

The authors would like to thank the Biomedical Research and Training Institute (BRTI) together with the National Institute of Health Research (NIHR) former Blair Research Institute, of the Ministry of Health and Child Welfare for all the support it received from staff, through contributions of their time, skills, expertise and resources during the survey Special thanks go to the Human Sciences Research Council (HSRC), in particular the new President and Chief Executive Officer, Consultant and Project Champion of OVC Project, Dr Olive Shisana, who together with the Principal Investigator of the Research Component of the project, Professor Leickness Simbayi and the Overall Project Manager,

Dr Donald Skinner, supported the OVC research project

The team would like to thank Mr Rogers Sango from the Zimbabwe Central Statistics Office and a former employee of the same organisation, Mr Tichaona Chirimanyemba for their valuable technical input during the development of the research instruments, mapping, training of fieldworkers and fieldwork

The District Administrator for Bulilimamangwe, Mr Mzingaye Sithole, the Rural District Council Chairman for Bulilima (Mr Christopher Ndlovu), Plumtree (Mr Patrick Mabuza) and Mangwe (Mr Grey Ncube), traditional Chiefs and Councillors, are saluted for their facilitatory role in ensuring the successful implementation of the field data collection exercise The research team appreciates the support they received from the Bulilima, Mangwe and Plumtree OVC Local Liaison Team: Mr Irvine Ncube, Mrs Melta Moyo, Mr Frank Ngwenya, Mr Lincolin Ncube, Mrs Sifiso Dube and Mr Alois Sibanda during the whole exercise of data collection Gratitude is also extended to Mr Andrew Nleya and Mr Khumbulani Tshuma for their assistance during the fieldwork

In Chimanimani, we are grateful to the then District Administrator of Chimanimani

Mr Edgar Nyagwaya, Chimanimani Rural District Council Chairman of Chimanimani

Mr Joseph Harahwa, Traditional Chiefs and Councillors who facilitated the exercise

We acknowledge the support received from the Chimanimani OVC local liaison team members Mr Jobes Jaibesi, Mr Brian Muchinapo, the then District Nursing Officer the late Sister Mistress Ndhlovu and the new District Nursing Officer Sister Sifovo during the whole exercise

Our thanks are extended to the headmasters, teachers and nurses in all districts who readily assisted the research team, including supervisors and interviewers, with free training venues, accommodation and logistical support We are also greatly indebted

to the communities of Bulilimamangwe and Chimanimani for their co-operation and hospitality throughout

The field supervisors are highly commended for their sterling work We also thank the interviewers who industriously collected the data We would like to further acknowledge the work undertaken by the data entry clerks under the supervision of Mr Tendai Madiro and Mr Lowence Gomo

Sincere gratitude is also extended to the implementing partners, the Grant Maker FACT Mutare for their support during the entire psychosocial survey, and the WK Kellogg Foundation who generously funded the project

In the context of the OVC project in Zimbabwe, the following definitions were used:

Care-giver: a person who regularly voluntarily assists a household, whose members

are related or not related to him/her, in doing household chores, offering advice, giving

spiritual, psycho-social and material support

Child: a person under the age of 18 years.

Child-headed household: a household in which a person aged 18 years and below is

responsible for making day-to-day decisions for a group of persons who stay or who usually reside together and share food from the same pot, whether or not they are related

Grant maker: organisation that sources resources and rolls out grants to

community-based organisations to implement OVC interventions Family AIDS Caring Trust (FACT) is the grant maker for the OVC project in Zimbabwe

Head of household: a person, regardless of age, who is responsible for making

day-to-day decisions for a group of persons who stay or who usually reside together and share food from the same pot, whether or not they are related by blood

Household: a group of persons who stay or who usually reside together and share food

from the same pot, whether or not they are related by blood.

Local liaison teams: key people selected from the districts where research is being

conducted who spearhead the OVC project activities

Orphan: a person under the age of 18 who has lost either one or both parents

Vulnerable Child: A child is considered vulnerable if he/she is living under difficult

circumstances These include children living in poor households, those receiving inadequate care, those with sick and terminally ill parents, those living in child-headed households, those dependent on old, frail or disabled care-givers, and children in households that assume additional dependency by taking in orphaned children There is

no direct relationship between orphanhood and vulnerability One can be an orphan and yet not vulnerable and another can be vulnerable and not necessarily be an orphan

Ward: a ward is a composition of 500 to 600 households.

Table 2.1: Targeted and actual sample sizes of guardians by district 11Table 2.2: Targeted and actual sample sizes of OVC by district 12Table 3.1: Distribution of OVC by Household standard of living 16Table 3.2: Inheritance-related issues as reported by orphans 17Table 3.3: Distribution of family items inherited by people other than orphans/siblings 18Table 3.4: Psychological issues (emotions) 19

Table 3.5: Psychological issues or experiences expressed by OVC 20Table 3.6: Reported sexual experiences and abuse of OVC 22Table 3.7: Distribution of reported indices of psychological well-being 26Table 3.8: Distribution of orphans by the things that made them happy 28Table 3.9: Distribution of OVC by their reported coping strategies 29Table 3.10: Agencies and forms of assistance received by OVC or orphans? 31Table 3.11: Reported sexual experiences of OVC 33

Table 3.12: Discussions held with OVC concerning parents’ illness 35Table 3.13:Distribution of guardians by employment status and source of income 40Table 3.14: Distribution of guardians according to what they perceived to be the main needs of OVC 41

Table 3.15: Guardians’ perceptions of the community’s concerns with regards to HIV/AIDS 42Table 3.16: Distribution of guardians by reported communication on HIV/AIDS with children 43Table 3.17: Perceptions about OVC situation in their neighbourhood 43

Table 3.18: Children’s reactions to the coming in of OVC into their households 44Table 3.19: Demographic characteristics of child heads of households 45

Table 3.20: Household situation and sources of income 46Table 3.21: Needs and problems within child-headed households 46Table 4.1: Distribution of OVC according to their kinship to current Guardian 52Table 4.2: Level of the OVC’s satisfaction with living in current households 52Table 4.3: Distribution of family Items inherited by people other than orphans/siblings 53Table 4.4: Psychological issues (emotions) as reported by OVC 55

Table 4.5: Psychological issues (experiences) 56Table 4.6: Distribution of OVC by reported household economic situation 60Table 4.7: Distribution of OVC by food consumption patterns 60

Table 4.8: Distribution of OVC by food consumed the day preceding the survey 61Table 4.9: Distribution of OVC according to their relatedness to and their relationships with guardian and other household members 62

Table 4.10: Distribution of OVC by district according to reported treatment by their guardian 63Table 4.11: Distribution of orphans’ expectations of their guardians 65

Table 4.12: Distribution of how orphans felt about their parent(s)’ death 66Table 4.13: Orphans’ feelings and wishes with respect to inherited items 67Table 4.14: Distribution of family items inherited by relatives other than orphans and their siblings 69

Table 4.15: Distribution of reported indices of psychological well being 70Table 4.16: Reported usual coping strategies following parent(s)’ death 72Table 4.17: OVC perceptions about how society members treated them 73Table 4.18: Reported life changes following parent(s) death 74

Table 4.19: Agencies assisting OVC 75Table 4.20: Forms of assistance received by OVC 75Table 4.21: Reported sexual experiences of OVC 77Table 4.22: Discussions held with OVC concerning parent(s)’ illness 78Table 4.23: OVC’s educational level they attained by age group 83Table 4.24: Distribution of perceptions of guardians on the impact of taking OVC into their household 84

Table 4.31: Needs, challenges, problems and concerns for child-headed households 89

HIV Human฀Immunodeficiency฀Virus

HSRC Human฀Science฀Research฀Council

IRDP Integrated฀Rural฀Development฀ProgrammeKABP

KAP฀ ฀ Knowledge,฀attitudes฀and฀practicesMRCZ฀ ฀ Medical฀Research฀Council฀of฀ZimbabweNGO฀ ฀ Non-governmental฀organisation

NIHR National฀Institute฀for฀Health฀Research

OVC Orphans฀and฀Vulnerable฀ChildrenPSS฀ ฀ Psychosocial฀Survey

RH฀฀ ฀ Reproductive฀Health

SAfAIDS Southern฀Africa฀HIV/AIDS฀Information฀Dissemination฀Service

SADC Southern฀Africa฀Development฀CommunitySTI฀ ฀ Sexually฀transmitted฀infection

UNAIDS Joint฀United฀Nations฀Programme฀on฀HIV/AIDSUNDP฀ ฀ United฀Nations฀Development฀ProgrammeWKKF฀ ฀ WK฀Kellog฀Foundation

The Human Sciences Research Council (HSRC) together with its partners within the Southern African Development Community (SADC) region have been commissioned by The WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention project on orphans and vulnerable children (OVC) as well as families and households coping with an increased burden of care for affected children in Botswana, South Africa and Zimbabwe.

As part of this broader research and intervention project on OVC across three countries in the SADC region, a baseline psychosocial survey (PSS) of orphans and vulnerable children and their guardians was conducted in selected sites aimed at determining baseline data

on the social, psychological, economical and physical conditions and experiences of OVC The information would be useful for strengthening existing OVC interventions and in evaluating the effectiveness of new interventions that would be implemented in the districts at the mid-point and at the end of the project The general objective of the project was to develop a comprehensive understanding of the challenges faced by the OVC in those sites, regarding their demographic characteristics, housing situation, food security, psychosocial experiences, inheritance issues, experience with stigmatisation and sexual involvement and abuse

The study was carried out in Chimanimani and Bulilimamangwe Districts in Manicaland and Matabeleland South Province of Zimbabwe respectively It was cross-sectional in design and conducted in 10 randomly selected wards out of the 23 in Chimanimani district and 32 out of the 35 in Bulilimamangwe district

The study assessed psychosocial issues (i.e household living situation and relationships, emotional well-being, experiences of stigma and discrimination) of OVC (6–14 & 15–18 years age group) and their guardians The sampling frame was derived from the 2003 BRTI/NIHR OVC Census data Using the census data, households with vulnerable children were identified using a vulnerability assessment/indicator score, which was a summary

of the household situation in terms of food and clothing availability, and care available for children in the households Households which were ranked as either moderately or highly vulnerable, with children under 19 years, comprised the target population (total 8

972 in Bulilimamangwe and 4 286 in Chimanimani) The target sample sizes for guardians

of OVC were 1 000 in both districts and for the 6–14 and 15–18 age groups it was 500 each

Data entry was done for a period of two weeks using a template designed in Epi-Info version 6.0 Data cleaning was first done in Epi Info version 6.0 and then in STATA Intercooler Version 7.0 The latter was then used for data analysis

This report describes research findings from the two selected sites in Zimbabwe In Chimanimani a total of 743 guardians of OVC aged 0–18years were interviewed The overall mean age of OVC was 9.2 years with slightly more males than females More than half of the OVC who were aged between 7 and 13 years had attained primary schooling

as their highest level of education, while almost a third of those aged between 14 and 18 years had attained secondary education Regarding the type of orphanhood, there were almost three times more paternal orphans than maternal orphans, whilst about a tenth of the OVC had lost both parents The mean age at which the OVC lost a mother was 6.6 years, whilst the mean age at which the OVC lost a father was 5.9 years and there was

no significant difference between the two mean ages The overall mean age of guardians

of OVC was 44.5 years and 2.8% of them were below 19 years of age (child-headed

households) All in all there were 21 child-headed households surveyed in Chimanimani district The majority of the child guardians were females and their mean age was 16.5 years The majority of guardians were in the economically active age group (19–64 years) More than three quarters of the children who were heading households in Chimanimani had attained secondary schooling as their highest level of education, while primary schooling was the highest attained by those guardians aged 19 years and above A greater proportion of the respondents were of the Apostolic sects Almost two thirds of the guardians of OVC were married while slightly over a quarter were widowed The sex distribution of those who responded in their capacity as guardians of OVC was skewed towards females with a ratio of almost three females to one male The HIV/AIDS pandemic has had negative effects on many aspects of people’s lives both in Chimanimani and Bulilimamangwe Despite all the efforts being put in place towards combating its spread, the majority of the guardians reported that the biggest concern facing their community with respect to HIV infection and AIDS was that the problem was getting worse Almost every guardian/parent had heard about AIDS While the majority of the respondents believed that children should know about sex, HIV/AIDS and reproductive health, the proportions that actually discussed these issues with the children were lower

In Bulilimamangwe, a total of 728 guardians of OVC were interviewed and it was found that the study population followed the national general population pattern, with slightly more female OVC than males With regard to the type of orphanhood, almost a quarter

of the OVC were reported to be paternal orphans whilst a tenth had lost their mother; less than a tenth had lost both parents Generally, the study found that children lost a father at an age significantly lower than that at which they lost a mother As reported by the guardians, around two thirds of the children of school-going age (7–13years) were in primary school while about a quarter of those aged 14–18years were in secondary school The sex distribution of guardians of OVC was over three females to one male The overall mean age of guardians of OVC was 48.5 years with guardians below the age of 18 years only constituting 1% More than half of the guardians of OVC were married and about

a quarter were widowed An overwhelming majority of the guardians were unemployed with only about 3% being in formal employment Of those guardians who had taken in OVC into their households, nearly half mentioned the death of the parents of the child

as the main reason for taking in these children The shortage of food and money and increased financial expenditure on food were mentioned by most of the guardians as the major impacts on the households since taking in OVC

In Chimanimani a total of 329 OVC of the age group 6 to 14 years were interviewed, with a mean age of 10.8 years, and almost all (93%) of them were attending school at the time of the survey The overall magnitude of orphanhood was 46% with paternal orphans being slightly more than half of the total This signifies the early disappearance of paternal role models in the lives of these children This deprivation of paternal roles at such a tender age may also exacerbate the vulnerability situation of the orphans with respect to household financial security Although, there were only five child heads of households, whose ages ranged from 10 to 14 years, grant makers need to keep an eye on the situation, as the problem may get worse as the pandemic grows further The households

in which the OVC were staying were generally poor, with more than three quarters (84%)

of the OVC mentioning that they did not have enough money for basics such as food and clothing This highlights that poverty is a major contributor to vulnerability in the households of these OVC Although the proportions of OVC who had engaged in sexual intercourse and those who had been inappropriately touched on their private parts by

guardians may seem rather low (less than 5% for both), it is nevertheless a cause for grave concern because of the ages of the children involved About 1% of the OVC had been inappropriately touched on their private parts by either community members or other children in the household This could be a manifestation of hidden sexual abuse, which should be of concern given the sexual precociousness of children in this age range and the risks of early pregnancies and infections with STIs and HIV

In Bulilimamangwe, 432 OVC aged 6–14 yearS were interviewed and their mean age was 10.7 years The magnitude of orphanhood was 43% There were more paternal orphans than maternal orphans by a ratio of two to one Like in Chimanimani, the households

in which the OVC in Bulilimamangwe were staying were generally poor, with more than three quarters (83%) of the OVC mentioning that they did not have enough money for basics such as food and clothes, which indicates that poverty plays a pivotal role in determining the level of vulnerability in the households of these OVC Nearly a fifth of OVC (10%) reported having scary dreams/nightmares while around 9% had trouble falling asleep

The next age-group was the 15–18 year old youth, where the survey was carried out with the general objectives of: characterising their demographic characteristics, housing and food security situation; KABP; socio-cultural and legal safety nets and support systems of OVC; OVC experiences of stigma and discrimination; their perceptions of the impact of HIV/AIDS on the community; the health services available to them and their health status

In Chimanimani, instead of the targeted 250 respondents, 185 OVC were interviewed and their mean age was 16.6 years The prevalence of orphanhood was 51% and 17% of them were double orphans At the time of the survey, 44% of the OVC were not attending school and of these, 30% had only attained primary education Over 60% of the orphans reported that they were still bothered by their parents’ death at the time of the survey

Concerning organisations assisting OVC, 42% of the respondents reported that they had received assistance from the NGO sector, mainly in the form of food parcels

In Bulilimamangwe, a total of 262 OVC aged 15–18 were interviewed and their mean age was 16.5 years The prevalence of orphanhood was 52.9% and there were three times more paternal orphans than maternal orphans This indicates that a significant portion

of the OVC in the study area have been deprived of parental care, support, love and protection At the time of the survey, 76% were not attending school and of these, 71%

had only attained primary education The majority (80%) of the OVC households did not have enough money for basics Most orphans expected that their guardians should provide (33%) or improve (47%) on the provision of material things such as food and clothes Around 50% of the orphans reported that they were still bothered by their parents’ death at the time of the survey

Regarding recommendations, grant makers need to take note of the OVC situation as the problem may get worse as the HIV/AIDS pandemic further expands Programmes that offer psychosocial support/services should be designed for OVC There is a need to put

in place intervention programmes to address the problems that are usually associated with early school drop out, since about three quarters of OVC aged between 15 and 18 years were not attending school, having attained primary education only Furthermore since most of the guardians were not employed, grant makers may also need to implement income-generating activities in order to help alleviate the poor living standards

Implementation of interventions should target identified areas of needs, concerns and

problems like food, educational and financial support Since the communities identified the increasing problem of HIV/AIDS in their communities, there is also a need for more awareness campaigns on HIV and AIDS in the communities

by AIDS in sub-Saharan Africa at the end of 2003 was 12 million According to SAfAIDS News (2000), 11 countries in sub-Saharan Africa will have 20–37% of children under

15 orphaned, including all nine countries in southern Africa, by 2010 The projections are worse for Botswana (37%), South Africa (31%), Swaziland (32%), Namibia (32%), Zimbabwe (34%) and Central African Republic (31%) UNAIDS predicts an ever greater catastrophe with numbers reaching 40 million in 2010 By far the largest estimated cause will be AIDS (UNAIDS, 2002) In addition a large number of children have been, and continue to be, made vulnerable due to the impact of the AIDS pandemic, although they are not orphans These vulnerable children include children living with sick parents, children who were primarily dependent on a breadwinner who has died; children who are in precarious care as a result of being dependent on old, frail or disabled care-givers and children in households that assume additional dependency by taking in orphaned children However, it is very difficult to obtain the exact figures on the numbers of vulnerable children

Hence as the pandemic unfolds and takes its toll on the young adults it is leaving one

or more generations of children to be raised by their grandparents, in households with high dependency ratios, or child-headed households Children who have lost their parents to AIDS face a more difficult future than other orphans Nationally representative household surveys from 40 countries in sub-Saharan Africa that assessed the impact of AIDS on the prevalence of orphanhood and care patterns (Kamali et al., 1996), showed that orphans more frequently lived in households that are female-headed, larger and have a less favourable dependency ratio The head of the household was considerably older Child-caring practices differed between countries, and between non-orphans and orphans Based on the country medians, almost nine out of ten non-orphans lived with their mother and eight out of ten non-orphans lived with their father Single orphans were less likely to live with their surviving parent: three out of four paternal orphans lived with their mother and just over half of maternal orphans lived with their father The (extended) family took care of over 90% of the double orphans but these double orphans were most likely to be disadvantaged In addition orphans were 13% less likely to attend school than non-orphans An assessment in a rural population in South-West Uganda with an HIV seroprevalence of 8% among adults (Monasch & Boerma, 2004) showed that HIV-1 seroprevalence rates were higher among orphans than among non-orphans and were up

to six times higher in the 0–4 year age group Seropositivity rates were also higher among surviving parents of orphans than among parents of non-orphans

Without the care of a parent or appointed care-giver, children are likely to face risks

of malnutrition, poor health, inadequate schooling, migration, homelessness and abuse (Shetty & Powell, 2003) According to UNAIDS (2000), help for orphans should be targeted at supporting families and improving their capacity to cope, rather than setting

up institutions for the children, as orphanages are not a sustainable long-term solution In addition, institutional care is known to have deleterious effects on children Children 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 community AIDS has both direct and indirect effects on children The direct effects result from infection and illness of either or both the child and his or her care-givers There are a large number of children who will suffer indirectly as a result of the HIV/AIDS pandemic These indirect cases of HIV/AIDS impact are mostly unreported (Foster & Williamson, 2000) Also, children whose families provide financially for relatives affected by AIDS, or whose mothers take on or go to care for sick relatives, may experience a reduced quality of life In addition, all children are affected when there are increased deaths in their community, and when their close and extended family, community and societal institutions and services are strained by the consequences of the AIDS epidemic The impact of the AIDS pandemic on children and families is incremental (Foster & Williamson, 2000) Worst hit are communities that are already poor, with inadequate infrastructure and limited access to basic services For example, not taking into account the effect of the AIDS pandemic on socio-economic conditions, it is estimated that 61% of children in South Africa live in poverty (Smart, 2000) It is these children whose family and household conditions will further deteriorate because of the impact of the AIDS epidemic One hundred and ninety three children aged 6–20 years in Rakai district of Uganda were interviewed in a study exploring the psychological effects of orphanhood All of the children were orphaned due to their parents’ death from AIDS Teachers and some orphans also participated in focus group discussions, and where possible, guardians were interviewed The children were able to distinguish between their quality of life when their parents were alive and well, when they became sick, and when they eventually died Most children lost hope when it became clear that their parents were sick They also felt sad and helpless Many were angry and depressed when they were adopted Children living with widowed fathers and those living on their own were significantly more depressed and externally oriented than those who lived with their widowed mothers The study suggests that teachers should be trained on how to diagnose psychosocial problems and given skills to manage them Short courses on problem identification and counselling should also be organised for guardians and community development workers (Foster et al., 1997) This special article explores a century of paediatric and child psychiatry research covering five areas

of potential biologic and social risk to infants and young children in orphanage care: (1) infectious morbidity, (2) nutrition and growth, (3) cognitive development, (4) socio-affective development, and (5) physical and sexual abuse These data demonstrate that infants and young children are uniquely vulnerable to the medical and psychosocial hazards of institutional care, negative effects that cannot be reduced to a tolerable level even with massive expenditure Scientific experience consistently shows that, in the short term, orphanage placement puts young children at increased risk of serious infectious illness and delayed language development In the long term, institutionalisation

in early childhood increases the likelihood that impoverished children will grow into psychiatrically impaired and economically unproductive adults (Foster et al., 1996).Most southern African orphans are cared for by extended families but the implications

of the spatial dispersal of such families are seldom recognised: orphans often have to migrate to new homes and communities A study conducted with children and guardians

in urban and rural Lesotho and Malawi examines orphans’ migration experiences in order to assess how successful migration might best be supported Most children found migration traumatic in the short term, but over time many settled into new environments Although many HIV/AIDS policies in southern Africa stress the role of communities, the

burden of care lay with extended family households Failed migrations, which resulted in renewed migration and trauma, were attributable to one of two household-level causes:

orphans feeling ill-treated in their new families, or changes in guardians’ circumstances

Policy interventions to reduce disruption and trauma for young AIDS migrants should aim at facilitating sustainable arrangements by enabling suitable households to provide care Reducing the economic costs of caring for children, particularly school-related costs, would: allow children to stay with those relatives (e.g grandparents) best able

to meet their non-material needs; reduce resentment of foster children in impoverished

It is quite clear therefore that orphans may grow up without basic material resources and may lack the love and support that emotionally-invested care-givers usually provide;

they may be discriminated against because of the presumed sero-status of their parents;

and they may be forced to discontinue their education because of lack of money or the need to take care of their siblings From a social perspective, the consequences of large numbers of children being raised without parents will prove costly for the region, both in direct costs for relief, indirect costs associated with an increased burden of ill health and/

or social pathology, as well as opportunity costs associated with lost years of education and work preparedness As a general response in the region, families and communities have taken in orphaned children and raised them as part of the extended family There are also a growing number of programmes in the region that attempt to provide relief and support for affected children, encourage fosterage, and provide institutional care for very vulnerable children

1.2 HIV/AIDS and orphanhood in Zimbabwe

Before AIDS, the number of orphans in most developing countries was decreasing due to improvements in life expectancy Orphans were likely to be older than age five years and have lost a father It was uncommon for a child to have lost both parents This scenario

no longer prevails As growing numbers of young adults die, sibling- and headed households are becoming increasingly common An estimated 25 million adults and children were living with HIV in sub-Saharan Africa at the end of 2003, with an adult prevalence of 24.6% in Zimbabwe alone, and an estimated 980 000 children have been orphaned by AIDS (UNAIDS, 2004) In Zimbabwe it is possible that 40% of children may have lost their parents within a decade (Foster et al., 1995)

grandmother-Regarding conditions existing for orphans in Zimbabwe, an orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe, in 1992 Orphan prevalence was highest in a peri-urban rural area (17%) and lowest in a middle-income medium density urban suburb (4%) Orphan household heads were likely to be older and less educated than non-orphan household heads The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances

Care-giving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms However, the emergence of orphan households headed by siblings is

an indication that the extended family is under stress (Nelson, 2000; Sengendo & Nambi, 1997) Interviews and focus group discussions involving 40 orphans, 25 caretakers and

33 community workers from a rural area near Mutare, Zimbabwe, explored community responses to children orphaned as a result of the AIDS pandemic and other factors

The extended family remained the principle orphan-care unit, although some relatives exploited the children’s labour and failed to meet their educational and medical needs,

with some of the orphans reporting being forced to work rather than attend school, isolated from peers, neglected or maltreated by caretakers and stigmatised (Nelson, 2000) However, stigmatisation was more likely to be based on orphan status or poverty than

non-governmental organisations are designing programmes to help caretaker households and

A recent study has also supported the fact that the tradition of incorporating orphans into the extended family has broken down while, on the other hand, HIV-infection rates have increased Community-based orphan support programmes that use volunteers to visit the most needy children have the potential to complement existing coping mechanisms in a cost-effective manner (Nyamukapa & Gregson, 2005)

It is therefore quite clear from the above literature that the high prevalence of HIV/AIDS

in the region has resulted in an unprecedented number of OVC Understanding the impact of HIV and AIDS on households and children is important in the prioritisation, design and evaluation of programmes to support vulnerable children

1.3 Zimbabwe OVC project

The Human Sciences Research Council (HSRC), working with partners in the Southern African Development Community (SADC) region, was commissioned in 2002 by the WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention project on orphans and vulnerable children (OVC), as well as families and households coping with

an increased burden of care for affected children initially in Botswana, South Africa and Zimbabwe, and later including Lesotho, Mozambique and Swaziland In Zimbabwe, the Biomedical Research and Training Institute’s Centre for International Health and Policy (CIHP) and National Institute of Health Research (NIHR) of the Ministry of Health and Child Welfare form the monitoring and evaluation team of the OVC project The Family AIDS Caring Trust (FACT) is the grant maker

The primary aim of the OVC project is to develop a comprehensive understanding of the challenges faced by orphans and vulnerable children in Zimbabwe The overall philosophy behind the project is the empowerment of communities to help themselves and this puts a very strong emphasis on sustainability of the project after funding from a donor ceases

Thus the project aims to develop, implement and evaluate some existing and/or new OVC intervention programmes that address the following issues:

1.4 The baseline psychosocial survey (PSS) of OVC and their guardians

leaves orphans in countless affected households and communities Understanding the impact of HIV/AIDS on households and children is important in the prioritisation, design

and evaluation of programmes to support extremely vulnerable children The 2003 OVC Census conducted by the Biomedical Research Training Institute and the National Institute

of Health Research showed an orphanhood magnitude of 26.0% in Bulilimamangwe and

survey to inform interventions on the burden on households caring for OVC

The baseline psychosocial survey (PSS) sought to determine baseline data on needs and experiences of OVC aged 0–5, 6–14 and 15–18 years, as well as obtain information from their parents and guardians about their own needs and experiences This information would be useful for evaluating the effectiveness of the new OVC interventions that would

be implemented in the two districts at mid-point and at the end of the project

1.4.1 General objective

The general objective of the psychosocial survey was to establish and characterise the social, economic, psychological and physical conditions and experiences of OVC and guardians of OVC and the general community responses to the situation of OVC in Chimanimani and Bulilimamangwe districts of Zimbabwe

1.4.2 Specific objectives

The specific objectives were to:

1) Investigate and characterise the demographic characteristics of guardians of OVC in the study districts;

2) Investigate the social conditions under which the OVC and their guardians were living;

3) Investigate the psychological conditions of OVC and their guardians;

4) Examine the economic conditions of OVC, guardians of OVC and their households

in the two districts;

5) Investigate and characterise the knowledge, attitudes, beliefs and practices with respect to HIV/AIDS among the OVC and their guardians;

6) Establish guardians’ perceptions and experiences regarding the problem of OVC;

7) Characterise orphanhood and the general causes of orphanhood;

8) Establish and characterise the community and families’ responses to the situation of orphans;

9) Investigate the coping mechanisms adopted by OVC and families with OVC;

10) Investigate the sexual habits and abuse among OVC

2.2.1 Description of the study sites

Chimanimani district is located in Manicaland province in the Eastern Highlands of Zimbabwe (Figure 2.1) The district, which is predominantly rural, is 155 km south east

of the provincial capital Mutare and borders Mozambique to the east, Buhera district to the west, Chipinge district to the south and Mutare district to the north The district is divided into 23 wards that are further divided into enumeration areas The population is

predominantly of the Ndau ethnic group, which is a Shona sub-ethnic group The district

represents all five agro-ecological regions found in Zimbabwe The high and rugged terrain in the eastern side experiences high rainfall, while the low-lying flat lands in the western part are characterised by erratic rainfall pattern

Bulilimamangwe area is located in Matabeleland South Province In 2002 it was split into three districts, namely Bulilima, Mangwe and Plumtree, as it was considered to be too large for administration Bulilima and Mangwe districts are rural districts whilst Plumtree

is an urban district The districts are located in Region 5 of the agro-ecological zones;

this region experiences low rainfall All three districts are in South Western Zimbabwe

and they share a border with Botswana (Figure 2.1) The Ndebele and Kalanga are the

dominant ethnic groups in the districts Bulilima district in the north is divided into 19 wards and Mangwe in the south is divided into 12 wards, while Plumtree district, which is between Mangwe and Bulilima, has four wards The three districts share one government, one mission hospital, three rural hospitals, seven rural health centres and 11 clinics

Figure 2.1: Location of Bulilimamangwe and Chimanimani Districts

2.3 Questionnaire development

The questionnaires for all three categories of respondents (guardians, OVC aged from 6–14 years, and OVC aged 15–18 years) were adapted from the OVC generic protocol compiled by the Human Sciences Research Council (HSRC) These comprised three sets

of OVC PSS baseline questionnaires developed by two organisations, ‘Strengthening Community Participation for the Empowerment of Orphans and Vulnerable Children’

(SCOPE) and Family Health International (FHI) (see http://www.popcouncil.org/horizons/ AIDSQuest/summaries/ssSCOPE.html) for a similar project in Zambia 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 These tools were further adapted to suit the Zimbabwean situation and necessary changes were effected This included addition and/or modification of questions, dropping irrelevant questions and changing the sequencing of some questions The questionnaires comprised a combination of closed questions and open-ended questions Translations and back translations were done into the main vernacular languages of Shona and Ndebele by the BRTI research team and the OVC local liaison teams from the districts The following thematic issues were covered in the questionnaires:

A For guardians of OVC the following questions were considered:

B For OVC aged 6–14 years, the following questions were considered:

C For OVC aged 15–18 years, the following questions were considered:

consumption);

Ethical approval for the entire OVC project, which included this psychosocial component, was granted by the HSRC Research Ethics Committee and subsequently, for the

Zimbabwean component, from the Medical Research Council of Zimbabwe (MRCZ)

2.4 Pre-testing of the instruments

A pre-test exercise was carried out in both research sites, Chimanimani and Bulilimamangwe, a month before the actual field data collection exercise The pre-test teams comprised four researchers and two local liaison committee members The local liaison committee members assisted with the administration and validation of the questionnaires They advised on how to gain entry into the field areas, especially regarding the normative, cultural and ethical etiquette that had to be observed in each site A total of 15 and 22 respondents were interviewed, in Chimanimani and in Bulilimamangwe, respectively The pre-test helped the research team to:

field-related logistical problems that were likely to be encountered;

The pre-test also helped in modification of questions and dropping of irrelevant questions

2.5 Field Work Activities

2.5.1 Community sensitisation

The local leadership participated in the OVC sensitisation workshops held in each of the study sites before the 2003 OVC Census The distribution of OVC T-shirts and bags to supervisors, interviewers and drivers of project vehicles during the PSS and census also contributed to the successful publicity of the project’s activities The communities were well informed regarding the objectives of the PSS and they linked its objectives to that of the 2003 OVC Census As a result of this sensitisation, the study was well received by the communities

2.5.2 Recruitment and selection of supervisors and interviewers

The majority of the interviewers and supervisors selected in the two districts had participated in the 2003 OVC Census Teachers, nurses and environmental health technicians and other local technocrats were recruited mostly from the communities to work as supervisors and interviewers For purposes of empowering community members and for effective monitoring of the research work, the project saw it prudent to blend the local people with experienced researchers from BRTI and NIHR

2.5.3 Training of supervisors and interviewers

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:

During training, participants engaged in role-plays in groups and during plenary sessions Training and data collection started on 26 January 2004 and ended on 12 February 2004 Fieldwork ended on 15 February 2004 Supervisors and interviewers were instructed to obtain signed informed consent from the guardians Guardians aged 16 years and above were required to sign a consent form For guardians aged 15 years and below, verbal consent was sought, as well as obtaining the consent of their guardians

2.5.4 Field logistics and deployment

A total of 45 interviewers and 15 supervisors were proportionally distributed throughout the 10 selected wards in Chimanimani district, and 44 interviewers and 15 supervisors in the 32 selected wards in Bulilimamangwe district These were then divided into teams of

four members including the supervisor Each supervisor was provided with a field kit that contained T-shirts, questionnaires, pens, letters of introduction, consent forms, notebooks and bags adequate for the team Each interviewer and supervisor was given a unique identification code for administrative and quality control purposes

2.6 Sampling procedures

Prior to the survey, a population census of OVC was conducted in November 2003

in which households with vulnerable children were identified using a vulnerability

assessment/indicator score The score was a measure/proxy of the extent of vulnerability

The population sampling frame for the PSS was then developed from the census data using this score (see Appendix 1) The target population comprised households that were either moderately or highly vulnerable A total of 13 258 vulnerable households, with children under six years of age or aged between six to eighteen years, comprised the target population from which the guardians to be surveyed were drawn If there was no orphan in the household, the household still qualified regarding vulnerability Ten wards were randomly selected from the 23 wards in Chimanimani, and in Bulilimamangwe 32 wards were selected from the 35 wards The selection of wards using EPI Info Version 6.0 was done according to land-use patterns namely: communal, resettlement, large-scale commercial, small-scale commercial and urban Using the OVC Census data, all those children aged 18 years and below in the sampled households were listed Their first and second names, sex, age and other additional information, which assisted in the identification of the household and respondents, were recorded

The sampling frame for the households was obtained from the selected wards Using the 2003 OVC Census data and the TVIS, selected households were listed The required sample size for each ward, calculated proportional to size, was randomly selected from the wards A total of 1 000 households were sampled Using the census data, all those children aged 18 years and below in the sampled households were listed Their first and second names, sex, age and other additional information, which assisted in the identification of the household, were recorded These lists then constituted the sampling frames for the targeted respondents

2.6.1 Sample size

A total of 4 283 and 8 972 households satisfied the Total Vulnerability Indicator Score (TVIS) cut-off point of 50% in Chimanimani and Bulilimamangwe, respectively The targeted and actual sample sizes by district and the three respondent categories were distributed as follows:

Table 2.1: Targeted and actual sample sizes of guardians by district

1 The Total Vulnerability Indicator Score (TVIS) was defined from all the nine contributing indicators, (BRTI 2003

OVC Census) Each indicator was coded 1 if the household was commensurate with vulnerable status and coded 0 if otherwise The nine vulnerability indicator scores were then added to come up with a TVIS, which was then expressed

as a percentage The maximum possible score was nine indicating a state of being highly vulnerable

Table 2.2: Targeted and actual sample sizes of OVC by district

to represent, one child was randomly selected Where both age groups (0–5 and 6–18) were represented in a household, the guardian responded on behalf of the 0–5years In

a household, the sex of children, that is, whether it should be boy or girl, and whether orphan or non-orphan was determined by random selection

2.7 Field monitoring activities

The BRTI/NIHR monitoring teams were centrally based in Chimanimani and Bulilimamangwe central districts and were assisted by OVC local liaison officers Monitors visited each research team at least once in two days to check on progress, quality

of work, clarify some questions in the questionnaires, supply them with additional questionnaires and stationery, collect completed questionnaires, refuel their vehicles and advise them on how to solve logistical problems

2.7.1 Field quality control of questionnaires

During fieldwork, the completed questionnaires were periodically collected by the monitoring team, once the supervisors were satisfied with their quality On submission of the completed questionnaires, the supervisors also had to account for every consent form, letter of introduction, map and spoilt questionnaire The completed questionnaires were stored at the central point from where they were then dispatched to Harare once a week Each supervisor was required to write a detailed report on the activities, problems faced

in the field, and how they managed to overcome problems they had encountered in their team

2.8 Data management

2.8.1 Data entry

Ten data entry clerks were recruited and trained for one week The selection of data-entry clerks was based on their performance during the 2003 OVC Census data entry process The training of the data-entry clerks involved the following:

user-friendly for data entry;

2.8.2 Data cleaning

The core research team members did primary and secondary data cleaning A workshop

on data cleaning was held and the objectives of data cleaning were explained as follows:

Data cleaning was first done in Epi Info 6.0 and then in STATA Intercooled Version 7.0

2.8.3 Data analysis

Data entered were transferred using STAT Transfer Version 5.0 from Epi Info Version 6.0

to STATA Intercooled Version 7.0 for analysis Quantitative data analysis was done through descriptive summary statistics, such as means and proportions

Results: Chimanimani

In Chimanimani district, a total of 1 257 respondents were interviewed, comprising 329 children aged between 6 and 14 years, 185 children aged 15–18 years and 743 guardians

The three sections below present the results from these categories of respondents

3.1 OVC aged 6–14 years

at the time of the survey Almost half (46%) of the OVC were orphans and among the orphans, those who had lost fathers (26%) outnumbered those who had lost mothers (6%)

by a ratio of almost four to one

OVC฀heading฀households฀

Of the 329 OVC, five (1.5%) were heads of households Their mean age was 12.6 years and ranged from 10 to 14 years Three were male and two female All five were attending school with two of them having reached secondary level

Employment฀and฀sources฀of฀income

Out of the 329 OVC, only a handful (7%) had paid jobs, with a median monthly earning

of as low as Z$5000 (US$1 is equal to Z$3775.63,) More than a third (37%) of the orphans were doing community chores in order to bring money into the household and the commonly cited chore was assisting in farming (cited by 75% of the respondents)

Household฀economic฀situation฀

Table 3.1 below shows that the majority of the OVC (84%) reported that their households

did not have enough money for basics Only 2.7% had enough for a few luxury things

Table 3.1 Distribution of OVC by household standard of living

%Not enough money for basic things like food and clothes

Have money for food & clothes, but short on many other thingsHave most of the important things, but few luxury thingsSome money for extra things such as going on holidays & luxury things Don’t know

Not stated

8103021

Household฀stability/displacement฀

About a quarter (27%) of the OVC indicated that they had moved into another household

Of the 248 OVC who had not moved, 15% indicated that someone else had moved into their household Half of the orphans (50%) were still living in the same household as they did with their parents, and among these, 13% reported that someone else had moved in

to assist in the maintenance of the household Slightly more boys (53%) than girls (47%) experienced movement into another household

OVC-guardian฀kinships/฀relationships

Just under half (43%) of the OVC were under the guardianship of their mothers, while 18% were being looked after by their grandmothers, and 14% being looked after by their

fathers Almost half (47%) of the OVC had known their current guardians very well before

they started taking care of them

Ninety percent (90%) of the OVC were either happy or very happy in the households in which they were living, while about a third (37%) of the orphans were either happy or very happy in their current situation, as compared to when they stayed with their parents Close to 40% of the orphans stated that they were still bothered by their parent’s death

Inheritance฀issues

Of the group of 329 orphans and vulnerable children, only 150 were actual orphans

Questions on inheritance issues were therefore only addressed to these orphans About

a fifth (19.7%) of them reported that they had been consulted on the distribution of family items after the death of their parents More than a third (38%) of the orphans had inherited their parents’ house About 39% of the orphans reported that most of the family goods had been distributed to people looking after them The issues surrounding inheritance of late parents/guardians’ possessions by orphans are summarised in Table 3.2

Table 3.2: Inheritance-related issues as reported by orphans

%

Family items possessed by orphans:

Photos Letters Traditional/cultural accessories Bible

Clothes Jewellery Other

Moments when orphans look at inherited items:

Happy Sad/lonely Want to be closer to late parent(s)/guardian(s) Other

No response

Feelings orphans have when looking at inherited items:

Content Happy Warm Sad Angry Rejuvenated/inspired Other

No response

1706538315

N=85

942151320

31535251712

The orphans were asked a question on family items they were in possession of and multiple responses were possible Among the items the orphans inherited were clothes (38%), photos (17%), traditional/cultural accessories (6%), Bible (5%), jewellery (3%%) and other items (15%) A total of 85 (57%) of the 150 orphans reported to be in possession

of family items They were further asked when they looked at the items and most (42%) stated that they usually looked at the items when they were feeling sad On how they felt after looking at the items, slightly more than half (52%) felt sad, with 5% feeling angry About 20% felt content, happy, warm or rejuvenated

A summary of the distribution of family items inherited by people other than the

orphans or their siblings is shown in Table 3.3 Over 60% of the orphans reported that

their relatives had not received such things as livestock, furniture or money during the distribution of the family assets

Table 3.3: Distribution of family items inherited by people other than orphans/siblings

%

Livestock:

None Less than half More than half All

Don’t know N/A Not stated

Furniture:

None Less than half More than half All

Don’t know N/A Not stated

Money:

None Less than half More than half All

Don’t know

6991450013

6113590011

6313650

N/A Not stated

Other valuables:

None Less than half More than half All

Don’t know N/A Not stated

013

5319770013

Emotional฀well-being

A number of psychological and emotional issues were assessed among the OVC and the results are shown in Table 3.4 below The table shows the range and frequency

of negative emotions experienced by OVC Sadly the most cited feeling is that of

hopelessness – never having feelings of hope for the future, as expressed by 33% of respondents – followed by often feeling unhappy and often being frustrated, as cited by

Feeling happy Often

Sometimes Never

Feelings of loneliness or prefer to be alone Often

Sometimes Never

Feelings of worry Often

Sometimes Never

Frequency฀of฀the฀following฀psychological฀aspects N฀=฀329

n฀(%)

Frustrations Often

Sometimes Never

Anger Often

Sometimes Never

Feeling of hope for the future Often

Sometimes Never

Fear of novel/new situations Often

Sometimes Never

Feelings of running away from home Often

Sometimes Never

Table 3.5 highlights other psychological experiences of OVC, and of note from the table

is that nearly a fifth (18.2%) of them reported often having scary dreams/nightmares

while around 14% had trouble falling asleep

Table 3.5: Psychological issues or experiences expressed by OVC

Frequency฀of฀the฀following฀psychological฀aspects N฀=฀329

n฀(%)

Scary dreams/nightmares

Often Sometimes Never

Fights with other children Often

Sometimes Never

Refusal to eat at meal times

Often Sometimes Never

Trouble falling asleep

Often Sometimes Never

Difficulty in making friends

Often Sometimes Never

Slightly more than a tenth (11%) of the orphans reported that the children in their households were treated badly, while more than 10% of the guardians of orphans were reported to have been treating them badly The reason that ‘community members do not

like orphans’ was cited by almost a fifth of the orphans as the reason why adults in the

community did not talk to orphans

Counselling฀and฀care฀experiences

OVC were asked questions to examine if there was some level of counselling and caring

in their families or communities Almost all OVC reported that they felt free to talk to their guardians when feeling sick, bad or down An overwhelming majority (94%) of the respondents indicated that their guardians offered some comfort when OVC were talking

to them and 68% said they spoke some kind words to OVC and explained things they did

not know More than three quarters (77%) of the OVC said that they were encouraged by their guardians to live without fear Ninety-three of the OVC reported that their guardians attended community meetings on health issues, and of the guardians who attend

community meetings, 69% of them discussed the proceedings of the meetings with the OVC Less than half of the OVC stated that their community supported people affected by HIV/AIDS and actively protected them from stigma and discrimination

Table 3.6 shows that almost 4% of the OVC had engaged in sexual intercourse while ten out of the 329 (4%) reported that someone (guardian/other household children/community members) had inappropriately touched their private parts

Table 3.6: Reported sexual experiences and abuse of OVC

n฀(%)

Ever had sex

Touched private parts by guardians

Touched private parts by other household children

Touched private parts by community members

9 (3.7)

6 (2)

2 (1)

2 (1)

3.1.2 Discussion: OVC aged 6–14 years

The sex distribution of OVC in the 6 to 14 year age range in Chimanimani mirrors the national picture of the general population with slightly more females than males Our finding that more fathers than mothers were dying is in line with the 2003 BRTI/NIHR OVC Census results, which showed that there were more paternal orphans than maternal ones The disproportionately high death rate among fathers may exacerbate the vulnerability situation of the orphans with respect to household financial insecurity, early demise of male role models and the loss of other paternal protective factors

Although there were only five child-headed households in Chimanimani, grants makers need to keep an eye on the situation, as the problem may get worse as the pandemic grows Children who are heads of households have a double burden of looking after other children after losing their own parents The fact that these young children have had

to assume a parental role over their siblings may be a pointer to the growing erosion

of the traditional safety nets normally provided by the extended family Although these children were attending school, the burden of looking after other children may result in them prematurely dropping out of school and/or lowered grades

Of the 23 OVC who had a paid job, 19 were also attending school This situation may

be a reflection of the need on their part to source funds for their school fees, but should also alert stakeholders to the possible negative impacts this may have on their school performance Most of the OVC who were doing community chores in order to bring money to the household were assisting in farming, which is in line with the main agricultural activity in Chimanimani

The fact that over 80% of the OVC mentioned that their household did not have enough money for basics is evidence of the overall poor economic situation in which they find

themselves These findings are in line with the findings of BRTI/NIHR OVC Census 2003 and the situational analysis, which became the basis for generating a vulnerability index that was used in selecting OVC for this survey

The food consumption patterns of the 6 to 14 age group were not different from that which obtains throughout the country generally, where most children have breakfast before going to school and then supper at night What could be of note is that only a minority mentioned feeding centres, but this may be explained by the fact that food aid may not be a priority need that grant makers have to respond to, since farming is a major activity in the district

Our survey revealed that about one in every four OVC had been displaced and that among those that had not been displaced, almost one in every eight reported someone else moving into their household Such displacements and moving in of others into one’s household may have psychosocial ramifications for adjusting to new situations and relationships On the other hand, having someone coming in to help in the maintenance

of an otherwise vulnerable household may be one way that communities can provide support to OVC while minimising their displacement from family environments

In those situations where the OVC had moved into another household, they were separated from their sibling/s Separation of siblings may be traumatising and could possibly cause psychosocial instability, leading to loosening of familial ties and possibly, identity crises The extent of the burden of care in terms of OVC household composition may result in reduced standard of living and increased burden of care Traditional safety nets and family ties are still playing a pivotal role in the district as evidenced by the large proportions of OVC living with parents, grandparents and close relatives like aunts The higher proportion of OVC being looked after by female relatives (mothers, grandmothers and aunts) might be explained by the larger proportion of paternal deaths among orphans, as well as the fact that male relatives are more likely to be away from home than their female counterparts OVC were on the whole happy living in their households, probably because most of them were living with their parents, grandparents or other relatives

For this age group, the relatively small proportion of orphans who were consulted on the distribution of family items may be related to the fact that they were still young and may

be regarded by the family as too young or incompetent to participate in discussions of this nature In rural areas, children usually remain in their household after the death of their parents and this is reflected in our findings where more than a third of the orphans inherited the house (or to put it more correctly, their parents’ homesteads)

Feelings of unhappiness, frustration and hopelessness were prevalent among the OVC,

although only around a fifth of the OVC reported often feeling unhappy, frustrated and

hopeless It is the frequency of experiencing such feelings that grant makers should note

By and large, OVC reported that children in the household or community were willing

to play with them, implying that stigma is not a major problem among children in these communities To note, however, is the 13% that reported that their guardians treated them badly, as this may indicate/reflect the extent of possible child abuse in the community requiring interventions on the part of grant makers Nearly all OVC felt free to talk to their guardians, who in turn offered comfort

Although for children in this age group, the proportions of OVC who had engaged

in sexual intercourse and those who had been sexually molested seem low, it is nevertheless a cause for concern because sexual precociousness is usually a manifestation

of unreported sexual abuse

3.2 OVC Aged 15–18 Years

to the Apostolic sect The prevalence of orphanhood was 51% and there were twice as many paternal orphans than maternal Of note, however, is the 17% of orphans who had lost both parents

Educational฀status฀of฀OVC

The highest educational levels attained by most OVC were secondary (cited by 59%) and primary (cited by 21%) More than two fifths of the OVC were not attending school at the time of the survey and the major reason cited by 55% of them was that their families did not have enough money Of significance are the OVC who had dropped out of school after attaining primary education (30%)

Employment฀status฀and฀economic฀situation฀

Out of the 185 OVC interviewed, seventeen (9%) had a paid job and just over half of them were employed as herd boys, while more than a tenth was employed as domestic workers On average, the OVC were earning Z$20,000 (US$1=Z$3775.63) a month The

majority (85%) of the OVC reported not having enough money for basic things like food and clothes, with only 4% reporting that they had most of the important things, but few luxury goods

Food฀consumption฀patterns

Generally, the average number of meals taken by OVC per day was two Breakfast and supper were the usual meal combinations (cited by 48%) followed by breakfast, lunch and supper (cited by 28%) Almost all the OVC (99%) interviewed reported that they had eaten something the day before the survey The average number of meals that had been consumed was two Over 90% reported having all their meals at home Only one person

in each case reported having breakfast and lunch at feeding centres

their current guardian asked for them and 11% cited school reasons (OVC can not attend school at mother’s home)

Relationships฀with฀guardians฀and฀other฀children฀in฀their฀households฀

On the question regarding their relationships with their guardians and other children in the household, 43% of the OVC were under the guardianship of their mother, 18% were under the care of their father and 11% were being taken care of by their grandmother

The majority of the OVC (78%) reported that they had always lived in the same household as their guardians Of those who had not always lived with their current guardian in the same household, about two thirds reported that they had known their

guardians very well prior to staying with them Of note is the fact that 19% of the OVC did not know their guardians at all, while 12% either rarely or never saw their guardians

prior to staying with them

On how guardians and the other children treated them in the household, close to half

(47%) of the OVC reported that their guardians treated them caringly, while 9% reported that they were being treated roughly More than a third (37%) reported that they were treated the same, and less than a quarter (24%) said they were treated worse compared to

the biological children

Living฀conditions฀in฀households

On the question of level of satisfaction with their living conditions, 34% of the orphans

felt happy and 27% very happy about living in their current household Eighteen per cent reported feeling either sad or very unhappy Almost half of the orphans (49%) reported that nothing had changed in their life since moving into the new household while nearly

a quarter (24%) reported that they had less food/clothes as an individual and school attendance had declined or stopped.

The expectations of the orphans were that the guardians should provide (41%) or improve (71%) on the provision of material things such as food, clothes and school fees With respect to the guardians’ behaviour, the majority of orphans did not want their guardians to change (do anything differently), with around 29% reporting that the guardians should not abuse them (i.e scolding or beating)

Recreational฀activities

The most common recreational activities for the majority of OVC during their free time were playing with friends (cited by 45%), reading (40%) and playing football or other sports (33%) By and large, the orphans usually played with their friends

clothes, fees and food (34%) The majority of the orphans missed love and care (40% and 32% respectively) following their mothers’ death, while 39% missed materials things such

as food, clothes, fees and livestock as a result of their fathers’ death

Inheritance

Orphans only (95 children) were asked about the items they had inherited or had been dispossessed of and how they felt about these items Over half of the orphans (65%) had not inherited any special items that had belonged to their late parents and of those who reported having kept something that had belonged to their parents, 67% reported having clothes and 30% kept some photos Most of the orphans (48%) looked at the items they had inherited from their late parents when they were feeling sad or lonely, while 27.3% did so when they wanted to be closer to their deceased parent(s) For more than half (54%) of these orphans, looking at these items made them feel sad More than half (58%)

of the orphans did not wish to have any of the items that had belonged to their late parents

They were also asked if their parent(s) had made plans or wills for them Eight (8%) out

of the 95 orphans reported that their late parents had made plans for them and four of them reported that the plans had been adhered to Four out of the 95 orphans (4%) said their parents had left a will and of these, three reported that the terms of the wills were being adhered to Between 23% and 46% of the orphans reported that family possessions such as livestock, furniture, money, houses, valuables and clothes had not been inherited

by relatives

Psychosocial฀well-being฀

This section on psychosocial well-being was asked to orphans only (i.e 95 children) The

questions were aimed at establishing how they as orphans coped with the loss of their parent(s) and assessed the frequency of various indices of psychosocial well-being Table 3.7 shows the reported frequencies on some of these psychosocial indices

Table 3.7: Distribution of reported indices of psychological well-being

n฀(%)

Scary dreams/nightmares

OftenSometimesNever

Fights with other children

OftenSometimesNever

Prefer being alone

OftenSometimes

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