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.

1. STEPS OVC Baseline Findings:
Orphans and Vulnerable
Children Component
Webinar
June 12, 2012

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

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MEASURE Evaluation website.

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5. STEPS OVC
Baseline
Findings: OVC
Component
Mathew Ngunga

6. Outline
• Introduction
– Research Questions
– Methods
– Study Limitations
• Findings
– OVC
– Adult beneficiaries
– Community Caregivers
• Conclusions & Recommendations

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. 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. 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• Outdated sampling frames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. 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. 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 help
Possession 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Alcohol & Drugs
• 98.2% have not consumed alcohol in past 4
weeks (N=1312)
• 99% have never tried drugs (N=1234)

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. Recommendations
1. Prioritize food security and ES to ensure that
households, either from their own production or
through purchases, have adequate food to meet
the dietary needs
2. Need for interventions that mitigate against school
drop-out
3. Child protection and PSS to be integrated in all
OVC programming
4. Strengthen Peer to Peer education e.g. through life
skills trainings to encourage delayed sexual debut
5. HIV prevention messaging to include focus on
misconceptions and myths and stigma reduction

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. MEASURE Evaluation is funded by the U.S. Agency for
International Development and is implemented by the
Carolina Population Center at the University of North
Carolina at Chapel Hill in partnership with Futures Group
International, ICF Macro, John Snow, Inc., Management
Sciences for Health, and Tulane University. The views
expressed in this presentation do not necessarily reflect
the views of USAID or the United States Government.