Time to Rethink 'Orphans and Vulnerable Children'? Findings from a Phenonenological Study in Uganda

The increasing number of 'orphans and vulnerable children' ('OVC') in sub-Saharan Africa has been the subject of much inquiry and intervention in research, policy and practice. Two major concerns have been highlighted: i) traditional mechanisms for their care and support are overstretched and ii) 'OVC' have poor socioeconomic outcomes. Dominant discourses emphasize adults' central role in '˜OVC' wellbeing while 'OVC' are cast as helpless, passive victims. Study Aim: This research sought to give representation to the voices of 'OVC' in constructing their own experiences. Methods: 'OVC' were engaged as producers of knowledge and agents of change using innovative child-centred approaches. A total of 129 participants took part in the study including children, caregivers, community members and key informants. Findings: This study found that the majority of existing '˜OVC' representations are adult constructs not necessarily subscribed to by 'OVC'. Acknowledging their difficult circumstances, most 'OVC' have devised solutions to their challenges and are optimistic despite being constrained by structural and cultural barriers. Traditional care mechanisms have evolved and require strengthening. The lens through which most interventions have been commissioned, implemented and evaluated is paternalistic and does not acknowledge 'OVC' competencies. Conclusions: '˜OVC' voices and lived experiences should inform interventions; also they should be constructed in a more balanced light - showing their challenges while acknowledging their agency in dealing with these challenges

Examining the agency and construction of ‘Orphans and Vulnerable Children’ in rural Uganda

The increasing number of “orphans and vulnerable children” (‘OVC’) in sub-Saharan Africa has been the subject of much inquiry and intervention in research, policy and practice. Two major concerns have been highlighted: i) traditional mechanisms for their care and support are overstretched and ii) ‘OVC’ have poor socioeconomic outcomes. Dominant discourses emphasise adults’ central role in ‘OVC’ wellbeing while ‘OVC’ are cast as helpless, passive victims and not active social agents who demonstrate resilience and ingenuity in dealing with difficult circumstances. Focussing on Sheema district in rural Uganda, this study sought to give voice to ‘OVC’ and use their lived experiences to develop a robust framework of care and support. ‘OVC’ were engaged as producers of knowledge and agents of change using innovative child-centred approaches to explore representations of their care and support through verbal and visual representation of their lived realities. This methodology enabled the development of narratives and critical dialogue about social issues with grassroots social activism. For example participatory methods such as draw-and-write, community mapping and daily-routine-diagrams located the conceptual tools and analytic skills in the hands of ‘OVC’. This study found that the majority of existing ‘OVC’ representations are adult constructs not necessarily subscribed to by ‘OVC’ themselves. Acknowledging their difficult circumstances, most ‘OVC’ have devised solutions to their challenges and are optimistic despite being constrained by structural and cultural barriers. Traditional care mechanisms have evolved and require strengthening, particularly at community level. The lens through which most interventions have been commissioned, implemented and evaluated is paternalistic and does not acknowledge ‘OVC’ competencies. ‘OVC’ voices and lived experiences should inform interventions; also they should be constructed in a more balanced light – showing their challenges while acknowledging their agency in dealing with these challenges. This study proposes a more nuanced label for ‘OVC’ and also develops a robust theoretical framework for their care and support

Perceived opportunities and challenges of family and community members in supporting teen mothers in rural Eastern Uganda

There is tremendous need for feasible and acceptable community-based interventions to address poor nutrition and health among teen mothers in rural Eastern Uganda. To inform such interventions, we identified facilitators/opportunities and challenges for maternal/child nutrition and health at community level, as perceived by those closest to the problem. In-depth interviews were conducted among 101 teens, family and community members in Budondo sub-county using questions based on social cognitive theory constructs related to nutrition/health. Data were analyzed thematically using Atlas-ti7.5.4. Facilitators included family support for positive teen decision-making regarding healthcare and practices and opportunities included income generation training and availability of healthcare services. Challenges included poor attitude of parents towards community workers, harsh treatment, inability to obtain income generation materials, insufficient land, food or medical supplies and medical understaffing. To exploit opportunities for improved maternal/child health and progress towards global sustainable development goals, this study points to needs for local action. Keywords: Teenage mother, nutrition, health, supports, challenges, social cognitive theory Il existe un énorme besoin d'interventions communautaires réalisables et acceptables pour lutter contre la mauvaise nutrition et la santé des mères adolescentes dans les régions rurales de l'Est de l'Ouganda. Pour éclairer ces interventions, nous avons identifié des facilitateurs / opportunités et défis pour la nutrition et la santé maternelle / infantile au niveau communautaire, tels que perçus par les personnes les plus proches du problème. Des entretiens approfondis ont été menés auprès de 101 adolescents, membres de la famille et de la communauté du sous-comté de Budondo à l'aide de questions basées sur des concepts de théorie sociale cognitive liés à la nutrition / santé. Les données ont été analysées par thème à l'aide d'Atlas-ti7.5.4. Les animateurs comprenaient le soutien de la famille pour la prise de décisions positives chez les adolescents concernant les soins de santé et les pratiques et les opportunités comprenaient une formation sur la génération de revenus et la disponibilité des services de santé. Les défis comprenaient l'attitude médiocre des parents envers les agents communautaires, les traitements sévères, l'incapacité d'obtenir des matériaux générateurs de revenus, l'insuffisance des terres, de la nourriture ou des fournitures médicales et le manque de personnel médical. Afin d'exploiter les opportunités d'amélioration de la santé maternelle / infantile et de progresser vers les objectifs mondiaux de développement durable, cette étude souligne les besoins d'action locale. Mots-clés: Mère adolescente, nutrition, santé, soutiens, défis, théorie cognitive sociale &nbsp

Addressing Poverty, Malnutrition and Poor Health for Adolescent Mothers in Rural Eastern Uganda: Recommendations of Local Level Stakeholders

Background: Adolescent mothers in Uganda were a large and highly vulnerable population with inadequate food, economic and social resources thus nutrition and health care unlike their adult counterparts. This could place young mothers at risk of poor wellbeing. Objective: To identify perceived individual and community-level recommendations and capacity building support young mothers for improved adolescent maternal/child nutrition and health. Methodology: This qualitative study was conducted in rural Budondo sub-county (Jinja district), Eastern Uganda which is one of the poorest regions. Interviews were conducted with 101 adolescent mothers aged 14-16 years, family members and service providers in the fields of health, education and community administration. The unique application of the social cognitive theory (SCT) took cause, while interview guides were translated into the Lusoga language, guidelines laid down in the Declaration of Helsinki and all procedures were approved by the Office of Research Ethics of the University of Waterloo (ORE # 20708). Pretesting was done in rural Butagaya sub-countywith a few members representatives of the target groups. community members whose perceptions were framed around constructs of the social cognitive theory and thematic analysis was conducted using Atlas-ti (version 7.5.4). Results: The study identified diverse needs and barriers facing young mothers such as Sensitizing community members to treat them kindly; monitoring health-related services; job creation; paying service providers for additional roles; provision of medical staff houses, operating theatres, medical equipment/materials; using tailored nutrition and health education videos; creating facilities to support food skills training; designating spaces within health facilities for young mothers; and supplying adequate and needs-based drugs. Conclusion: Capacity building, training of: health personnel to serve young mothers, community workers to counsel parents. instructors in handcraft and food nutrition skills. The social cognitive theory, point to changes in behaviors or practices on the part of individuals, families, community, society and government to better support these very vulnerable group and their babies. Recommendation:  Specialized community-based adolescent maternal / child friendly services built on available strength at individual and environmental level are required. Partnering organizations might help furnish the income generating projects, training support or capital/supplies as recommended by many participants as a capacity-building avenue. Keywords: Adolescent mother, nutrition, health, , capacity building, social cognitive theor

Needs and Barriers of Teen Mothers in Rural Eastern Uganda: stakeholders’ perceptions regarding maternal/child nutrition and health

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).For adolescent mothers in rural Eastern Uganda, nutrition and health may be compromised by many factors. Identifying individual and environmental needs and barriers at local levels is important to inform community-based interventions. This qualitative study used interviews based on constructs from social cognitive theory. 101 adolescent mothers, family members, health-related personnel and community workers in Budondo sub-county (Jinja district), eastern Uganda were interviewed. Young mothers had needs, related to going back to school, home-based small businesses; social needs, care support and belonging to their families, employment, shelter, clothing, personal land and animals, medical care and delivery materials. Barriers to meeting their needs included: lack of skills in income generation and food preparation, harsh treatment, pregnancy and childcare costs, lack of academic qualifications, lack of adequate shelter and land, lack of foods to make complementary feeds for infants, insufficient access to medicines, tailored health care and appropriate communications. Using the social cognitive framework, this study identified myriad needs of young mothers and barriers to improving maternal/child nutrition and health. Adolescent-mother-and-child-friendly environments are needed at local levels while continuing to reduce broader socio-cultural and economic barriers to health equity. Findings may help direct future interventions for improved adolescent maternal/child nutrition and health