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Findings from a National Situation Analysis of Orphans and Vulnerable Children in Zambia

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Led by Mathew Ngunga.

A Child Status Network webinar on the findings from a national situation analysis of orphans and vulnerable children in Zambia – a report from the baseline study of the STEPS OVC project.

Published in: Health & Medicine
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Findings from a National Situation Analysis of Orphans and Vulnerable Children in Zambia

  1. 1. STEPS OVC Baseline Findings: Orphans and Vulnerable Children Component Webinar June 12, 2012
  2. 2. Agenda Overview of webinar technical tips –Gretchen Bitar Welcome and introduction to the webinar series– Liz Snyder Presentation of STEPS OVC Baseline – Mathew Ngunga
  3. 3. Troubleshooting If you lose connectivity  Re-enter the meeting room by clicking on the webinar link provided If you have trouble with audio and connection  Try disconnecting from the webinar and re-entering the meeting room. Send an email to glbitar@unc.edu if you continue to have technical difficulties. The webinar recording will be available on the MEASURE Evaluation website.
  4. 4. Tips for Participating in theDiscussion To comment, raise your hand by clicking on the icon.  Speak into your microphone (be sure it is enabled by clicking on the icon at the top of the screen  Clicking on the arrow beside the “raise your hand” icon will bring up a list of emoticons. Use these to express yourself during the presentation and discussion. A recording of the webinar will be made available at http://www.cpc.unc.edu/measure/networks/childstatu snet
  5. 5. STEPS OVC BaselineFindings: OVC Component Mathew Ngunga
  6. 6. Outline• Introduction – Research Questions – Methods – Study Limitations• Findings – OVC – Adult beneficiaries – Community Caregivers• Conclusions & Recommendations
  7. 7. Introduction• Research Question – What are the characteristics of the individuals targeted by the STEPS OVC program in terms of (a) HIV/AIDS knowledge, attitudes and practices; (b) well-being; and (c) access to/previous uptake of HIV prevention, care and support services?• Study design: quasi-experimental pre-/post-test design with cohort• Sampling: Multi-stage cluster sampling• Sample size: – OVC beneficiaries aged 11-17: 1,869 – Adult beneficiaries: 358 – Community caregivers: 406 – Key informants: 21
  8. 8. Intro cont...• Data collection tools – validated questions (CDC QoL, FANTA, SDQ)• Survey was conducted in 9 districts: Chongwe, Kafue, Kaoma, Mongu, Mumbwa, Kabwe, Nchelenge, Kawambwa, and Solwezi.• Data collection, entry and analysis - INESOR• Data entered into CSPro and analyzed in SPSS.• The study was approved by – Health Media Labs, Inc., an institutional review board in the USA – Biomedical Research Ethics Committee in Zambia
  9. 9. Study limitations• Outdated sampling frames – 31% replacement rate• Timing of the survey – Delayed ethics approval – Dec 10 to Feb 11• Unlinked caregivers and OVC – Cross-data set analysis not possible• Sensitivity of the questions – Implied HIV positivity – Sexual activity• Length of the questionnaire – >1 hr to administer
  10. 10. Findings - Demographics• Sex – 1,869 OVC [52% f]• Mean Age – 13.8 OVC – 11-14 yrs – 29.6% – 13-15 yrs – 49% – 16-17 yrs – 21.4%• Education – 95.2% OVC currently in school, sex differences not statistically significant • younger children more likely to be in school [p=0.000] • children living with biological parent or aunt/uncle more likely to report current school attendance than those living siblings or grandparents [p=0.05]
  11. 11. Social Capital and Protection• Status – 62.8% OVC under care of biological father or mother – Children spend most of their free time with agemates; boys more likely [p=0.000] – 45.4% children go to their mothers for helpPossession of Basic Items – 88.5% have 2+ sets of clothes (N=1859), age n/s • Girls are more likely to have 2+ sets of clothes than boys: 90.7% of girls and 86.3% of boys (p=0.003) – 60.1% have bedding (N=1860), sex n/s; age n/s – 45.8% have 1+ pair of shoes (N=1860), sex n/s • Older children are more likely to have shoes (p=0.000)
  12. 12. Food Security• 32.6% went a whole day & night without eating because there was no food (N=1,865)• 58.0% went to sleep hungry because there was not enough food in the last 4 weeks (N=1,866)• 67.5% ate a smaller meal than they felt they needed because there was not enough food (N=1,865)• 72.8% ate fewer meals in a day because there was not enough food (N=1,862)• No differences between girls & boys, or age groups across all
  13. 13. Psychosocial Wellbeing Nearly one in five children surveyed showed abnormal emotional well- being (somatic complaints, worries, tearful feelings, nervousness, fear and insecurities), and a further 19% had “borderline” scores.
  14. 14. Protection• Work: 54.0% have worked for money (N=1865) – Boys more likely than girls to report previous work: 60.9% of boys compared to 47.9% of girls (p=0.000) – Older children more likely to report work (p=0.000)• Physical abuse – 74.6% reported ever being hit/beaten (N=1854, sex n/s, age n/s) – 49.3% reported being hit/beaten in last 6 months (N=1380, sex n/s, age n/s)• Sexual abuse – 3.5% reported ever forced sex (N=1801, sex n/s, age n/s) – 1.7% of boys reported forcing someone to have sex (N=812, age n/s)
  15. 15. Health & CT• 78.9% rate their health good to excellent (N=1864) • No difference between girls & boys, or across age groups• 53.7% report illness in last 4 weeks (N=1866) – Girls more likely to report illness than boys: 58.5% vs. 48.6% of boys (p=0.000), age n/s – 36.8% with malaria; 26.5% with cough/cold; 16.5% diarrhea• 80.0% received treatment for last illness (N=1003) – No difference between girls & boys, or across age groups• 20.7% had had an HIV test (N=1300), sex n/s – Children aged 16-17 were twice as likely (32.0%) to have had an HIV test than younger children (p=0.000)
  16. 16. Malaria• 47.0% reported that HH had a net (N=1843) – 78.1% report someone in HH slept under net last night (N=887) – 59.6% reported sleeping under a net last night (N=879), sex n/s, age n/s• Malaria prevention knowledge (spontaneous, N=1844) – 64.0% report bednets/ITN as a prevention method – 9.3% report IRS as a prevention method – 5.2% report staying inside at dawn/dusk as prevention – 5.5% report wearing long sleeves / trousers as prevention
  17. 17. OVC Stigma• 25.9% believe families with HIV+ individuals are treated unkindly by other students (N=1555)• 15.4% believe families with HIV infected individuals are treated unkindly by teachers (N=1557)• 27.7% believe children who receive free services are treated unkindly by community (N=1558)
  18. 18. HIV/AIDS KAP (13-17yrs)• 83.8% have heard of HIV/AIDS (N=1,860), sex n/s – Older children are more likely to have heard of HIV than younger children (p=0.000)• Correct knowledge – 97.0% agree HIV can be transmitted by shared needles (N=1545), sex, age n/s – 67.0% agree mosquitoes cannot transmit HIV (N=1498); sex n/s; older children were most likely to respond correctly (p=0.004) – 86.4% agree HIV cannot be transmitted by sharing a meal w/ PLWHA (N=1527); sex n/s; older children were most likely to respond correctly (p=0.000) – 77.6% agree HIV cannot be transmitted via witchcraft (N=1556): 80.7% of boys and 74.9% of girls (p=0.005); older children were most likely to respond correctly (p=0.000) – 85.5% agree HIV cannot be cured by herbs (N=1556); sex, age n/s – 78.3% agree a healthy-looking person can be HIV+ (N=1499); sex n/s; older children were mostly likely to respond correctly (p=0.000)
  19. 19. HIV/AIDS KAP• Correct knowledge on prevention – 91.3% believe abstinence reduces HIV risk (N=1538, sex, age n/s) – 87.5% believe condom use reduces HIV risk (N=1486, sex, age n/s)• Attitudes – 78.4% believe if a pupil has HIV and is not sick, they should be allowed to continue attending school (N=1557, sex n/s) – 80.6% believe if a teacher is HIV+ but not sick, they should be allowed to continue teaching (N=1539, sex n/s) – Older children are more likely to hold accepting attitudes than younger children (p=0.000)
  20. 20. Sexual Debut• 21.9% ever had sex (N=1315) – Boys are twice as likely to report ever sex (30.2% vs. 14%, p=0.000) – Children aged 16-17 are more likely than those aged 13-15 to report ever sex (32.7% vs. 17.3%, p=0.000)• Age at sexual debut: range is 5 to 17 years (N=277) – Mean: 12.8 years for boys and 14 years for girls• Reason for first sex (N=286) – 44.8% report “love” – 3.5% report force – 5.2% reported “needed money”• 32.7% talked to partner about HIV before having sex (N=284), – No differences by sex or age group
  21. 21. Condoms• 87.3% have heard of condoms (N=1315) – Boys were more likely to report this (90.8 vs. 83.9%, p=0.000) – Older children were more likely to report this (p=0.000)• 51.0% are “confident” or “somewhat confident” that they could obtain a condom (N=1292) – Boys are more likely to report this (59.0% vs. 42.4%, p=0.000) – Older children are more likely to feel confident (p=0.000)• Condom use (N=310) – 40.3% report ever condom use (sex n/s); older children were more likely to report ever condom use (p=0.000) – 26.9% used a condom at first sex (age n/s); girls twice as likely to report this than boys (43.0% vs. 19.2%, p=0.000) – 35.9% used a condom at last sex (sex n/s); older children were more likely to report condom use at last sex (p=0.003)• Pregnancy: 11.8% of girls have ever been pregnant (N=110)
  22. 22. Alcohol & Drugs• 98.2% have not consumed alcohol in past 4 weeks (N=1312)• 99% have never tried drugs (N=1234)
  23. 23. Circumcision• 29.3% of boys reported being circumcised (N=884) – No differences by age group• 37.6% not circumcised want to become circumcised (N=529, age n/s) – 70.9% cite “HIV/STI prevention” as reason – 13.8% cite “hygiene” as reason
  24. 24. Recommendations1. Prioritize food security and ES to ensure that households, either from their own production or through purchases, have adequate food to meet the dietary needs2. Need for interventions that mitigate against school drop-out3. Child protection and PSS to be integrated in all OVC programming4. Strengthen Peer to Peer education e.g. through life skills trainings to encourage delayed sexual debut5. HIV prevention messaging to include focus on misconceptions and myths and stigma reduction
  25. 25. Acknowledgements• USAID/Zambia – PEPFAR – Dr. Mwaba Kasese Bota, AOTR• INESOR – Dr. Jolly Kamwanga – Joseph Simbaya – Richard Bwalya• Futures Group – Dr. Jenifer Chapman – Mari Hickman• 40 RAs, 4 supervisors, 1,962 OVC, 358 adult respondents, 406 caregivers• STEPS OVC staff – DDU workshop• Everyone else who supported this study in one way or the other• And you, my audience, for your attention
  26. 26. MEASURE Evaluation is funded by the U.S. Agency forInternational Development and is implemented by theCarolina Population Center at the University of NorthCarolina at Chapel Hill in partnership with Futures GroupInternational, ICF Macro, John Snow, Inc., ManagementSciences for Health, and Tulane University. The viewsexpressed in this presentation do not necessarily reflectthe views of USAID or the United States Government.

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