The extent of community and public support available to families caring for orphans in Malawi.

There are an estimated 15 million AIDS orphans worldwide. Families play an important role in safeguarding orphans, but they may be increasingly compromised by the HIV/AIDS epidemic. The international aid community has recognized the need to help families continue caring for orphaned children by strengthening their safety nets. Before we build new structures, however, we need to know the extent to which community and public safety nets already provide support to families with orphans. To address this gap, we analyzed nationally representative data from 27,495 children in the 2004-2005 Malawi Integrated Household Survey. We found that communities commonly assisted orphan households through private transfers; organized responses to the orphan crisis were far less frequent. Friends and relatives provided assistance to over 75% of orphan households through private gifts, but the value of such support was relatively low. Over 40% of orphans lived in a community with support groups for the chronically ill and approximately a third of these communities provided services specifically for orphans and other vulnerable children. Public programs, which form a final safety net for vulnerable households, were more widespread. Free/subsidized agricultural inputs and food were the most commonly used public safety nets by children's households in the past year (44 and 13%, respectively), and households with orphans were more likely to be beneficiaries. Malawi is poised to drastically expand safety nets to orphans and their families, and these findings provide an important foundation for this process

The Effects of Negative Economic Shocks at Birth on Adolescents’ Cognitive Health and Educational Attainment in Malawi

We provide new evidence of the association between moderate negative economic shocks in utero or shortly after birth and adolescents’ cognitive outcomes and educational attainment in Malawi. This is one of the first studies to analyze the effect of not one, but multiple moderate negative economic shocks in a sub-Saharan African (SSA) low-income country (LIC). This focus is important as multiple economic shocks in early life are more representative of the experiences of adolescents in LICs. Combining data on adolescents aged 10-16 from the Adverse Childhood Experiences (ACE) project with the Malawi Longitudinal Study on Families and Health (MLSFH) (N = 1; 559), we use linear and probit regression models to show that girls whose households experienced two or more economic shocks in their year of birth have lower cognitive skills as measured by working memory, reading and mathematical skills. Girls also have lower educational attainment, conditional on age. These effects are gendered, as we do not observe similar effects among boys. Overall, our results point to lasting effects of early-life adversity on adolescents, and they highlight that, even in a LIC context where early-life adversity is common, policymakers need to intervene early to alleviate the potential long-term educational impacts of in utero or early life shocks among girls

Integrative approaches required to support children affected by COVID-19

No abstract available.https://www.journals.elsevier.com/the-lancet-child-and-adolescent-healthhj2023Educational Psycholog

The Epidemiology of College Alcohol and Gambling Policies

Background: This article reports the first national assessment of patterns of drinking and gambling-related rulemaking on college campuses (e.g., punitive versus recovery oriented). Analyses relating school policies to known school rates of drinking or gambling identified potentially influential policies. These results can inform and encourage the development of guidelines, or "best practices," upon which schools can base future policy. Methods: The college policy information was collected from handbooks, Web sites and supplemental materials of 119 scientifically selected colleges included in the fourth (2001) Harvard School of Public Health College Alcohol Study (CAS). A coding instrument of 40 items measured the scope and focus of school alcohol and gambling policies. This instrument included items to measure the presence of specific policies and establish whether the policies were punitive or rehabilitative. A total of 11 coders followed a process of information extraction, coding and arbitration used successfully in other published studies to codify policy information. Results: Although all schools had a student alcohol use policy, only 26 schools (22%) had a gambling policy. Punitive and restrictive alcohol policies were most prevalent; recovery-oriented policies were present at fewer than 30% of schools. Certain alcohol and gambling policies had significant relationships with student binge drinking rates. Conclusions: The relative lack of college recovery-oriented policies suggests that schools might be overlooking the value of rehabilitative measures in reducing addictive behaviors among students. Since there are few college gambling-related policies, schools might be missing an opportunity to inform students about the dangers of excessive gambling

HIV/AIDS, declining family resources and the community safety net

Families play central roles in the HIV/AIDS pandemic, caring for both orphaned children and the ill. This extra caregiving depletes two family resources essential for supporting children: time and money. We use recent data from published studies in sub-Saharan Africa to illustrate deficits and document community responses. In Botswana, parents caring for the chronically ill had less time for their preschool children (74 versus 96 hours per month) and were almost twice as likely to leave children home alone (53% versus 27%); these children experienced greater health and academic problems. Caregiving often prevented adults from working full time or earning their previous level of income; 47% of orphan caregivers and 64% of HIV/AIDS caregivers reported financial difficulties due to caregiving. Communities can play an important role in helping families provide adequate childcare and financial support. Unfortunately, while communities commonly offer informal assistance, the value of such support is not adequate to match the magnitude of need: 75% of children's families in Malawi received assistance from their social network, but averaging only US$81 annually. We suggest communities can strengthen the capacity of families by implementing affordable quality childcare for 0–6 year olds, after-school programming for older children and youth, supportive care for ill children and parents, microlending to enhance earnings, training to increase access to quality jobs, decent working conditions, social insurance for the informal sector, and income and food transfers when families are unable to make ends meet

Child welfare in the context of HIV/AIDS epidemic: identifying vulnerable populations and shaping an effective response

Background: Over 15 million children have been orphaned by AIDS. While a growing literature suggests orphans are disadvantaged, other studies have failed to find health or educational disparities. This contradictory evidence has fueled debate over whether orphans should be targeted for assistance, or whether the response should be expanded to other vulnerable children.Objectives: This study sought to: 1) to estimate educational disparities for orphans relative to other AIDS-affected children; 2) to estimate health disparities for orphans relative to other AIDS-affected children; and 3) to describe the extent of community and public support available to households fostering orphans.Methods: Data are drawn from the 2004-5 Malawi Integrated Household Survey, a nationally-representative survey of 52,707 individuals in 11,280 households in 564 communities. Multilevel models examine the association between orphanhood and other AIDS-related impacts and 1) education for children 6-14 years; and 2) health status for children 6-17 years. Weighted descriptives and regression models are used to examine whether orphan households receive greater private, community and public support.Results: Double and maternal orphans are more likely to be out of school (OR=2.2, 2.5 respectively) and behind in attainment (grade difference = -0.3); these disparities are not explained by poverty. While there is no evidence that orphans suffer greater morbidity, children whose parents have an AIDS-related illness have higher burdens of both acute and chronic morbidity (ORs=1.5-1.9). Finally, friends and relatives provided assistance to 75% of households, and this support was more likely to be targeted to households with double orphans. Community-based organizations for the chronically ill were present in 40% of communities and many included orphan-specific programming.Conclusion: There is growing international commitment to mitigate the impact of AIDS on children, but debate remains around how to best target resources. Orphans and poor children both demonstrate educational disadvantage, suggesting a simultaneous need for orphan-specific programming and general poverty alleviation. Children living with sick parents demonstrated poor health; community home-based care programs are best situated to identify these children and mitigate their risk. Finally, while many households with vulnerable children are already receiving assistance, the value and coverage is inadequate to match the need and needs to be drastically scaled-up.Contexte: Plus de 15 millions d'enfants sont devenus orphelins dès suites du SIDA. D'un côté, un nombre grandissant d'études suggèrent que les orphelins sont désavantagés, tandis que de l'autre, plusieurs études n'ont pas été capables de démontrer des inégalités au niveau de la santé et de l'éducation. Cette contradiction dans la littérature suscite le débat à savoir si les orphelins devraient être ciblés de façon spécifique ou s'ils devraient être inclus dans des programmes d'aide englobant d'autres enfants vulnérables.Objectifs: Cette étude a pour objectif de: 1) estimer les inégalités au niveau de l'éducation des orphelins par rapport à celle des autres enfants affectés par le SIDA; 2) estimer les inégalités au niveau de la santé des orphelins par rapport à celle des autres enfants affectés par le SIDA; et 3) décrire l'étendue du support communautaire et public destinés aux ménages hébergeant des orphelins.Méthodologie: Les données proviennent du Malawi Integrated Household Survey de 2004-5, une base de données nationale et représentative de 52 707 individus répartis dans 11 280 ménages dans 564 communautés. Les modèles multiniveaux étudient l'association entre le statut d'orphelin et d'autres impacts liés au SIDA et 1) l'éducation des enfants de 6 à 14 ans; et 2) les conditions de santé des enfants de 6 à 17 ans. Des données descriptives pondérées et des modèles de régression sont utilisés pour étudier si les ménages ayant au moins un orphelin reçoivent plus de soutien des milieux privé, communautaire et public que les autres ménages.Résultats: Les orphelins dont la mère ou les deux parents sont décédés sont plus susceptibles d'avoir décroché de l'école (OR=2.2, 2.5 respectivement) ou d'accuser un retard au niveau scolaire (différence de niveau = -0.3); ces inégalités ne sont pas expliquées par la pauvreté. Même si d'un côté aucun résultat ne prouve que les orphelins ont un taux de morbidité plus élevé, les enfants qui ont des parents atteints du SIDA ou d'autres maladies connexes ont un niveau plus élevé de maladies chroniques ou graves (ORs= 1.5-1.9). Finalement, les amis et la famille procurent de l'aide dans 75% des ménages, et ce soutien est plus souvent présent dans les ménages avec des orphelins ayant perdus leurs deux parents. Les organismes communautaires venant en aide aux personnes atteintes de maladies chroniques sont présents dans 40% des communautés et plusieurs incluent des programmes s'adressant spécifiquement aux orphelins.Conclusion: Il y a un engagement international croissant afin de freiner l'impact du SIDA sur les enfants, mais le débat demeure à savoir comment allouer les ressources le plus efficacement. Les orphelins et les enfants pauvres dénotent tous les deux des retard en éducation ce qui suggère qu'une aide devrait être octroyée simultanément pour les programmes destinés aux orphelins et pour ceux visant l'élimination globale de la pauvreté. Il a été démontré que les enfants vivant avec des parents malades ont une mauvaise santé; les programmes communautaires de soins à domiciles sont les mieux placés pour identifier ces enfants et freiner les risques. Finalement, bien qu'il y ait plusieurs ménages qui reçoivent déjà de l'aide, la valeur et l'étendue de cette aide est inadéquate et ne répond pas au besoin; du soutien de l'extérieur devrait être ajouté

Prioritising action to accelerate gender equity and health for women and girls: Microdata analysis of 47 countries

The Sustainable Development Goals set ambitious targets for health. Meeting such will require drastic improvements in the social conditions for women and girls. Understanding which social conditions have the greatest impact on health can help prioritise action, yet there is little comparative data. We use microdata from 338,580 women in 47 low- and middle-income countries to estimate the relative contributions of improved social determinants in bringing about maternal and child health gains over the past 20 years. Regression analyses examine determinants related to education, work, health services, family, and violence; the potential health benefit that could be derived from improving conditions is calculated. Secondary education and child marriage emerge as the strongest and most consistent predictors of health. The largest impact is seen on adolescent births: we estimate that achieving universal completion of secondary schooling for young women could lower adolescent births by 18 percentage points; eliminating child marriages could lower adolescent births by 11 points. Intervening in these two areas could also bring about substantial reductions in the unmet need for family planning, past-year intimate partner violence, and child mortality. Thus, we suggest prioritising policies targeting secondary education and child marriage in order to accelerate gender equity and health

The extent of community and public support available to families caring for orphans in Malawi.

There are an estimated 15 million AIDS orphans worldwide. Families play an important role in safeguarding orphans, but they may be increasingly compromised by the HIV/AIDS epidemic. The international aid community has recognized the need to help families continue caring for orphaned children by strengthening their safety nets. Before we build new structures, however, we need to know the extent to which community and public safety nets already provide support to families with orphans. To address this gap, we analyzed nationally representative data from 27,495 children in the 2004-2005 Malawi Integrated Household Survey. We found that communities commonly assisted orphan households through private transfers; organized responses to the orphan crisis were far less frequent. Friends and relatives provided assistance to over 75% of orphan households through private gifts, but the value of such support was relatively low. Over 40% of orphans lived in a community with support groups for the chronically ill and approximately a third of these communities provided services specifically for orphans and other vulnerable children. Public programs, which form a final safety net for vulnerable households, were more widespread. Free/subsidized agricultural inputs and food were the most commonly used public safety nets by children's households in the past year (44 and 13%, respectively), and households with orphans were more likely to be beneficiaries. Malawi is poised to drastically expand safety nets to orphans and their families, and these findings provide an important foundation for this process

Emerging partner violence among young adolescents in a low-income country: Perpetration, victimization and adversity.

BackgroundIntimate partner violence (IPV) is prevalent in high- as well as low-income contexts. It results in a substantial public health burden and significant negative socioeconomic and health outcomes throughout the life-course. However, limited knowledge exists about IPV during early adolescence. This period is critical during the transition to adulthood for at least two reasons: it is when the majority of adolescents in low-income countries first encounter dating, sexuality and partnerships, often with older adolescents or adults, and it is also the period when lifelong patterns of violence and norms about acceptable IPV are formed. The current study is one of the first to measure IPV prevalence among young adolescents in a low-income setting, examine the potential etiology, and investigate relationships with gender ideology, poverty, mental health and childhood adversity.MethodsWe surveyed 2,089 adolescents aged 10-16 in Malawi using standardized instruments. We estimated the prevalence of IPV, and use multivariate logistic regression to test potential correlates.ResultsMore than a quarter (27%) of ever-partnered adolescents in Malawi report being victimized. A substantial proportion of both male and female adolescents (15%) report committing violence against their partner. Girls were more likely than boys to report being a victim of sexual IPV (24% versus 8%), and boys more likely to perpetrate such (9% versus 1%). Almost 10% of the sample had both committed and been a victim of IPV. Cumulative childhood adversity (e.g., physical abuse, witnessing domestic violence) was a consistent and strong correlate of IPV victimization (adjusted odds ratio (aOR) 1.30) and of perpetration (aOR 1.35). Depression and PTSD were likewise associated with IPV victimization in the overall sample. Notably, gender ideology was not predictive of either victimization or perpetration, even among boys.ConclusionsIPV is common for both male and female young Malawian adolescents, and includes both victimization and perpetration. IPV compounds other adversities experienced by adolescents in this low-income setting, and it is rarely alleviated through help from the health system or other formal support. These findings underscore the need to intervene early when interventions can still break destructive pathways and help foster healthier relationships. This focus on early adolescence is particularly critical in low-income countries given the early onset and rapid pace of the transition to adulthood, with sexual activity, dating and partnership thus being common already in young adolescence. Promising interventions would be those that reduce violence against or around children, as well as those that reduce the impacts of such trauma on mental health during adolescence